Toxicity of pyrazinamide, administered once weekly in high dosage, in tuberculous patients.

The success of a twice-weekly regimen of streptomycin plus isoniazid, reported earlier from the Tuberculosis Chemotherapy Centre, Madras, prompted an investigation at the Centre of various once-weekly regimens of chemotherapy. In this context, a pilot study was undertaken in 19 patients to assess the toxicity of high-dosage pyrazinamide (70 mg/kg of body-weight), when administered once weekly, together with isoniazid (14 mg/kg of body-weight) and streptomycin (1 g), for at least 6 months. Serial estimations of SGOT and SGPT activity, urine tests for urobilin and bilirubin and haematological investigations were undertaken at frequent intervals. None of the patients showed any clinical evidence of hepatotoxicity; however, there was a slight and transient elevation in aminotransferase activity, probably of a non-specific nature, at 2 weeks. These findings are encouraging for the use of high-dosage pyrazinamide in once-weekly regimens of chemotherapy.

Concentrations of pyrazinamide attained in serum with different doses of the drug.

Serial concentrations of pyrazinamide in 3 volunteers showed that increasing the dose from 22 mg/kg of body-weight to 66 mg/kg resulted in substantially higher serum concentrations of the drug and a longer period of coverage (at a concentration of 25 mug/ml). Similarly, in a study based on 6 tuberculous patients, increasing the dose of pyrazinamide from 66 mg/kg to 88 mg/kg led to appreciably higher concentrations in the serum. In neither series of tests was any acute hepatic toxicity observed. The findings suggest that it would be interesting to study the effect of doses of about 90 mg/kg of pyrazinamide in once-weekly regimens of chemotherapy for the treatment of tuberculosis.

Effect of pyridoxine on vitamin B6 concentrations and glutamic-oxaloacetic transaminase activity in whole blood of tuberculous patients receiving high-dosage isoniazid.

An earlier report from the Tuberculosis Chemotherapy Centre, Madras, showed that, in tuberculous patients receiving high-dosage isoniazid (12.5-15.6 mg/kg body-weight), the concomitant administration of 6 mg of pyridoxine prevented peripheral neuropathy. In that study, biochemical determinations of B(6) concentrations and GOT activity in whole blood had been routinely undertaken on all patients on admission to treatment, and at 6, 12, 24 and 52 weeks thereafter; in addition, extra determinations were undertaken for patients who developed peripheral neuropathy. The present paper reports the findings of these investigations, which are: (a) peripheral neuropathy developed predominantly among slow inactivators of isoniazid, and was associated with a substantial reduction in GOT activity but no apparent change in B(6) concentration; (b) the reduction in GOT activity appeared to be due to deficiency of both the coenzyme (pyridoxal phosphate) and the apoenzyme; (c) the concomitant administration of pyridoxine (6 mg or 48 mg) with high-dosage isoniazid to 3 patients with peripheral neuropathy, 1 of whom had convulsions also, resulted in increased B(6) concentrations and GOT activity, and no further convulsions; and (d) the concomitant administration of pyridoxine 6 mg daily, as a prophylactic, resulted in a significant increase in B(6) concentrations and GOT activity and prevention of the neuropathy.These findings establish the existence of a definite association between the occurrence of isoniazid-induced toxicity and diminished pyridoxine function.