Pretomanid for Tuberculosis: Dosage, Side Effects, and Uses

Summary of Key Points

Pretomanid is an antibiotic used to treat specific types of tuberculosis (TB), particularly drug-resistant forms. It is typically prescribed in combination with other medications to effectively combat the infection. Pretomanid works by inhibiting the growth of the bacteria that cause TB. This medication is available only under the supervision of a healthcare provider. Always consult your doctor or one of our telemedicine providers before starting or adjusting your dose.

Names of Medication

US Brand Name: Pretomanid

The generic name refers to the active ingredient in the medication, which in this case is also Pretomanid. Therefore, Pretomanid serves as both the brand and generic name.

Pharmacologic Category

Antitubercular Agents

Pretomanid belongs to a class of medications known as antitubercular agents, which are specifically used to treat tuberculosis infections. Other medications in this category include isoniazid, rifampin, and pyrazinamide.

Pretomanid Dosing Guidelines

Pretomanid is used to treat various forms of tuberculosis, especially drug-resistant strains. The dosing schedule depends on the type of TB being treated. Always follow your healthcare provider’s instructions and never adjust your dose without consulting them. If you need a consultation, you can speak with one of our telemedicine providers at any time.

Multidrug-Resistant Tuberculosis (MDR-TB)

Dose: 200 mg once daily

Frequency: Once daily for 26 weeks

Pretomanid is used in combination with bedaquiline and linezolid to treat MDR-TB. This combination is known as the BPaL regimen.

Extensively Drug-Resistant Tuberculosis (XDR-TB)

Dose: 200 mg once daily

Frequency: Once daily for 26 weeks

Similar to MDR-TB, Pretomanid is part of the BPaL regimen to treat XDR-TB, a more severe form of drug-resistant TB.

Pulmonary Tuberculosis

Dose: 200 mg once daily

Frequency: Once daily for 26 weeks

Pretomanid is used in combination with other medications to treat pulmonary tuberculosis, which primarily affects the lungs.

Latent Tuberculosis Infection

Pretomanid is not typically used for latent TB infections, which are usually treated with medications like isoniazid or rifampin. Consult your healthcare provider for the appropriate treatment for latent TB.

Drug-Resistant Tuberculosis

Dose: 200 mg once daily

Frequency: Once daily for 26 weeks

Pretomanid is used in combination with other medications to treat drug-resistant TB, which does not respond to standard TB treatments.

Chronic Tuberculosis

Dose: 200 mg once daily

Frequency: Once daily for 26 weeks

Chronic TB may require prolonged treatment, and Pretomanid is used in combination with other medications to manage the infection.

Mycobacterial Infections

Pretomanid is not typically used for non-tuberculous mycobacterial infections. Consult your healthcare provider for appropriate treatment options.

Tuberculous Meningitis

Pretomanid is not commonly used for tuberculous meningitis, which affects the brain and spinal cord. Other medications are typically preferred for this condition.

Disseminated Tuberculosis

Dose: 200 mg once daily

Frequency: Once daily for 26 weeks

Disseminated TB occurs when the infection spreads beyond the lungs. Pretomanid is used in combination with other medications to treat this severe form of TB.

Dosage Forms and Strengths

Tablet: 200 mg

Administration Instructions for Pretomanid

Pretomanid should be taken exactly as prescribed by your healthcare provider. It is usually taken once a day with food to improve absorption. Swallow the tablet whole with water; do not crush or chew it. If you miss a dose, take it as soon as you remember. However, if it’s close to your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not double up to make up for a missed dose. Always consult your healthcare provider if you have any questions or concerns about how to take your medication.

Pretomanid Side Effects and Adverse Reactions

Like all medications, Pretomanid can cause side effects. It’s important to be aware of potential reactions and contact your healthcare provider if you experience any concerning symptoms. Below are some common and serious side effects:

1. Nausea: Feeling nauseous is a common side effect. It can often be managed by taking Pretomanid with food.
2. Vomiting: Some patients may experience vomiting. If this occurs frequently, consult your healthcare provider.
3. Headache: Headaches are common but usually mild and temporary.
4. Peripheral Neuropathy: A rare but serious side effect that causes tingling or numbness in the hands and feet. Contact your healthcare provider if you experience these symptoms.
5. Liver Toxicity: Pretomanid can affect liver function, so your doctor may monitor your liver enzymes during treatment. Symptoms of liver problems include yellowing of the skin or eyes (jaundice), dark urine, and severe fatigue.
6. Low Blood Sugar (Hypoglycemia): Some patients may experience low blood sugar, especially if they are also taking medications for diabetes.

Contraindications for Pretomanid

A contraindication is a specific condition in which a medication should not be used because it may cause harm. It’s important to know if you have any contraindications before starting Pretomanid.

Contraindications for Pretomanid

1. Severe liver disease: Pretomanid is processed by the liver. If you have severe liver disease, your body may not break down the medication properly, leading to toxic levels.
2. Allergy to Pretomanid or its components: If you have a known allergy to Pretomanid or its ingredients, taking it could cause a severe allergic reaction, including life-threatening anaphylaxis.
3. Severe kidney disease: Although Pretomanid is primarily processed by the liver, some of it is excreted through the kidneys. If your kidneys are not functioning properly, the medication may accumulate, increasing the risk of side effects.
4. Pregnancy: Pretomanid has not been proven safe during pregnancy. It may harm the developing fetus, so it is contraindicated unless the potential benefits outweigh the risks.

Drug to Drug Interactions

Drug interactions occur when one medication affects how another works, potentially leading to harmful effects or reduced effectiveness. Below are some medications that may interact with Pretomanid:

Rifampin (Rifadin): Rifampin can reduce Pretomanid’s effectiveness by accelerating its breakdown in the liver.

Efavirenz (Sustiva): This HIV medication may also lower Pretomanid’s effectiveness by increasing its metabolism in the liver.

Carbamazepine (Tegretol): Used to treat seizures, carbamazepine can decrease Pretomanid levels, making it less effective.

Phenytoin (Dilantin): Similar to carbamazepine, phenytoin can reduce Pretomanid levels, diminishing its effectiveness.

Pretomanid in Pregnancy

Is it Safe to Take Pretomanid During Pregnancy?

Pretomanid is generally not recommended during pregnancy unless the potential benefits outweigh the risks. There is limited data on its safety in pregnant women, and animal studies suggest it may pose risks to the fetus. If you are pregnant or planning to become pregnant, it is important to consult your healthcare provider to carefully weigh the risks and benefits. Our telemedicine providers are available to help you make an informed decision.

Pretomanid While Breastfeeding

Is it Safe to Take Pretomanid While Breastfeeding?

It is currently unknown whether Pretomanid passes into breast milk. Due to the potential for serious side effects in a nursing infant, breastfeeding is not recommended while taking Pretomanid. If you are breastfeeding or planning to breastfeed, consult your healthcare provider to discuss alternative treatments or feeding options. Our telemedicine providers can guide you through this decision.

Estimated Cost of Pretomanid

The estimated cost of a 30-day supply of Pretomanid without insurance ranges from $1,000 to $1,200 with a GoodRx coupon. Prices may vary depending on the pharmacy and location. Be sure to check with your pharmacy for the most accurate pricing.

Possible Alternatives to Pretomanid

If Pretomanid is not suitable for you, other treatment options for tuberculosis and related conditions are available. Always consult your healthcare provider before making any changes to your treatment plan. Our telemedicine providers can help you explore these alternatives.

1. Multidrug-resistant tuberculosis (MDR-TB): Alternatives include bedaquiline (Sirturo) or linezolid (Zyvox), often used in combination with other antibiotics. Lifestyle changes, such as improving nutrition and avoiding tobacco, can also support recovery.
2. Extensively drug-resistant tuberculosis (XDR-TB): Bedaquiline (Sirturo), delamanid, and linezolid (Zyvox) are commonly used in combination with other medications. Consult your healthcare provider for the most appropriate treatment plan.
3. Tuberculosis (TB): Standard treatment typically involves a combination of antibiotics such as isoniazid, rifampin (Rifadin), pyrazinamide, and ethambutol. Lifestyle changes, such as avoiding alcohol and maintaining a healthy diet, can also aid in recovery.
4. Pulmonary tuberculosis: The same combination of antibiotics used for TB is generally effective. Quitting smoking and improving air quality can further support lung health.
5. Latent tuberculosis infection: Isoniazid or rifampin (Rifadin) are commonly used to treat latent TB. Regular monitoring and a healthy lifestyle can help prevent the infection from becoming active.
6. Drug-resistant tuberculosis: Bedaquiline (Sirturo) and linezolid (Zyvox) are often used in combination with other antibiotics. Consult your healthcare provider for the best treatment plan.
7. Chronic tuberculosis: Long-term antibiotic therapy is usually required. Lifestyle changes, such as improving nutrition and avoiding alcohol, can support recovery.
8. Mycobacterial infections: Treatment depends on the specific type of mycobacteria involved. Common treatments include antibiotics like clarithromycin (Biaxin) or azithromycin (Zithromax). Discuss your options with your healthcare provider.
9. Tuberculous meningitis: Treatment typically involves a combination of antibiotics such as isoniazid, rifampin (Rifadin), and pyrazinamide. Corticosteroids may also be used to reduce inflammation. Consult your provider for the best treatment plan.
10. Disseminated tuberculosis: This form of TB requires aggressive treatment with a combination of antibiotics, such as isoniazid, rifampin (Rifadin), and ethambutol. Early diagnosis and treatment are crucial for recovery.

Recent Updates on Pretomanid Research

Recent studies have focused on Pretomanid’s effectiveness as part of combination therapy for drug-resistant tuberculosis. One promising development is the BPaL regimen, which combines Pretomanid with bedaquiline (Sirturo) and linezolid (Zyvox). This regimen has shown high success rates in treating multidrug-resistant and extensively drug-resistant tuberculosis. Ongoing research is also exploring Pretomanid’s use with other medications to shorten TB treatment duration and improve outcomes for patients with drug-resistant strains.

As new studies emerge, staying informed about the latest treatment options is essential. Our telemedicine providers are available to discuss the most up-to-date research and help you make informed decisions about your care.

James Kingsley

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