'Zinamide' should only be used when close daily observation of the patient is possible, and when laboratory facilities are available for performing frequent liver-function tests and blood uric acid determinations.
Pre-treatment examinations should include in-vitro sensitivity tests of recent cultures of M. tuberculosis from the patient as measured against the usual antituberculous drugs. Side effects for 'Zinamide' primarily involve the liver and vary from asymptomatic elevations of liver function tests to serious clinical manifestations of hepatic disease; therefore, liver-function tests, especially aspartate transferase (AST) and alanine transferase (ALT) determinations, should be carried out prior to therapy, and then every two to four weeks during therapy. Therapy with 'Zinamide' should be withdrawn and not reinstated if signs of hepatocellular damage occur.
Patients or their carers should be told how to recognize signs of liver disease, and advised to discontinue treatment and seek immediate medical attention if symptoms such as persistent nausea, vomiting, malaise or jaundice develop.
Reduction in the size and/or frequency of dose is recommended for patients with renal insufficiency.
Pre-treatment examinations should include renal function, hepatic function and particularly base-line uric acid determinations. Pyrazinamide inhibits excretion of urates, frequently resulting in hyperuricaemia which is usually asymptomatic. If hyperuricaemia accompanied by an acute gouty arthritis occurs, therapy should be discontinued and not reinstated. Close monitoring is advised to detect any increasing difficulty in the management of patients with a history of gout or diabetes mellitus.
Zinamide should be used with caution in pregnant women.
Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicine.