Pretomanid
Pretomanid is a medication used in adults with tuberculosis (TB) infection of the lungs that's very difficult to treat. It's taken in combination with two other medications to treat TB, Sirturo (bedaquiline) and linezolid (Zyvox). You might be asked to go to a healthcare facility every day as part of a directly observed therapy (DOT) program to make sure you take all of your medication as directed. Your provider will give you each dose of pretomanid and watch as you take the medication.
What is Pretomanid?
What is Pretomanid used for?
Tuberculosis (TB) lung infection that's difficult to treat in adults
How Pretomanid works
Pretomanid is an antitubercular agent. This medication kills the bacteria that cause tuberculosis (TB) by stopping the bacteria from making their own protective covering.
Drug Facts
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What are the side effects of Pretomanid?
Common Side Effects
- Weakness, tingling, or numbness of hands and feet (81%)
- Acne (39%)
- Low red blood cell count (anemia; 37%)
- Nausea (37%)
- Vomiting (34%)
- Muscle, joint, or back pain (29%)
- Headache (28%)
- Higher liver enzymes (28%)
- Heartburn (24%)
- Low appetite (22%)
- Rash (21%)
- Itchiness (20%)
- Stomach pain (19%)
- Sharp chest pain (19%)
- Respiratory tract infection (e.g., bronchitis, pneumonia; 15%)
- Coughing up blood (13%)
- Cough (12%)
- Vision problems (12%)
Other Side Effects
- Low blood sugar
- Abnormal weight loss
- Diarrhea
- Constipation
- Dry skin
- Trouble sleeping
Serious Side Effects
- Liver damage: dark urine, right-side stomach pain, yellowing of the eyes or skin, tiredness, loss of appetite, nausea, vomiting
- Bleeding or bruising that doesn't stop or go away
- Low white blood cell count: repeated fevers or infections
- Abnormal heart rhythm: abnormally fast heart rate, fainting
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Cough
- Headache
- Nausea
- Stomach pain
- Upset stomach
- Vomiting
Pros and cons of Pretomanid
Pros
Used for TB that's difficult to treat, which is a serious health problem with few new antibiotic options
Can prevent the spread of TB when taken as directed
Taken by mouth compared to some other TB medications
Taken in combination with fewer medications compared to other regimens for resistant TB (usually 4 or more medications)
Cons
Might require daily trips to a healthcare facility to receive each dose
Long course of treatment (about 6 to 7 months)
Can be expensive
Not for latent (inactive) TB or TB that has spread outside the lungs
Pharmacist tips for Pretomanid
Pretomanid should be taken in combination with two other anti-TB medications, Sirturo (bedaquiline) and linezolid (Zyvox). It should not be taken by itself as this can cause your TB infection to become resistant to the medication.
Take pretomanid with food for best absorption. Swallow the tablet whole with water.
Keep taking pretomanid for the full treatment time, even if you feel better after the first few doses. It's very important not to miss any doses of pretomanid or other anti-TB medications. Skipping doses can make pretomanid not work as well, allow the bacteria to become resistant to the medication, and make your infection harder to treat. To make sure you follow your treatment regimen correctly, you might need to be monitored by a healthcare provider when you take each dose.
Since the combination regimen of pretomanid, Sirturo (bedaquiline), and linezolid (Zyvox) can cause liver damage, it's best to avoid alcohol and herbal supplements (e.g., green tea extract, black cohosh, ginseng) that can add harm to your liver while you're taking pretomanid.
Certain medications can interact with pretomanid, which can change the levels of pretomanid in your body. This can affect how well pretomanid works against your TB infection or raise your risk of side effects. Tell your provider and pharmacist about all the medications you take, including supplements and over-the-counter medications. Before starting any new medications, make sure your provider knows you're taking pretomanid.
If you have to go to the hospital for any reason, make sure you bring your pretomanid and other TB medications with you so that your treatment isn't interrupted. It's an expensive medication that the hospital might not have in their pharmacy.
Frequently asked questions about Pretomanid
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What are the risks and warnings for Pretomanid?
Pretomanid can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Liver damage
Risk factors: History of liver damage
The combination of pretomanid, Sirturo (bedaquiline), and linezolid (Zyvox) can cause damage to your liver. This is more likely to happen if you have a history of liver problems, but can happen to anyone. Your provider will order regular blood tests to monitor the health of your liver. To be safe, avoid alcohol while you're taking pretomanid, and make sure to tell your provider and pharmacist about all the other medications or supplements you’re taking or plan to take, in case they also raise your risk of liver injury. Let your provider know right away if you experience tiredness, loss of appetite, nausea or vomiting, dark urine, right-side stomach pain, or yellowing of the eyes or skin, as these can be signs of liver problems.
Low blood counts
Pretomanid is typically used together with Sirturo (bedaquiline) and linezolid (Zyvox), and it's known that linezolid (Zyvox) can lower your blood counts. This can raise your risk of serious bleeding. It can also weaken your immune system, making you more likely to develop other infections, which can be life-threatening. Your provider will regularly check your blood counts and can adjust the doses of your other TB medications if you develop or have worsening low blood counts. Seek medical help if you experience any serious bleeding that doesn't stop or infections or fevers that don't go away.
Heart rhythm problems
Risk factors: History of abnormal EKG or heart rhythm problems | Heart failure | Low thyroid levels | Low calcium, magnesium, or potassium levels
Pretomanid is typically used together with Sirturo (bedaquiline) and linezolid (Zyvox). It's known that Sirturo (bedaquiline) can affect the way your heart beats and cause a condition called QT prolongation. This heart rhythm condition can be serious and potentially life-threatening. Having low blood levels of calcium, magnesium, or potassium can also lead to QT prolongation. To monitor your risk for this side effect, your provider will regularly check your heart rhythm through a heart scan (electrocardiogram, EKG) and your electrolytes through blood work. It's important to tell your provider and pharmacist about your full medical history. Certain conditions can put you at a higher risk for QT prolongation and heart rhythm problems. Seek medical help right away if you experience an abnormally fast heart rate or fainting.
Nerve and eye problems (peripheral and optic neuropathy)
Pretomanid, when used together with Sirturo (bedaquiline) and linezolid (Zyvox), can cause nerve problems. This is a common side effect of linezolid (Zyvox), and can affect your arms, hands, legs, and feet (peripheral neuropathy) and sometimes your eyes (optic neuropathy). Nerve problems are generally reversible or improved after adjusting the dose of linezolid (Zyvox). Let your provider know if you experience numbness, burning, a feeling of "pins and needles", tremors, problems with balance, weakness in your arms or legs, or any changes in vision. If you notice changes in vision, you'll likely need to follow up with an eye specialist to make sure your eyes are okay.
Pretomanid dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 200mg | 26 tablets | $638.23 | $24.55 |
Typical dosing for Pretomanid
The typical dose is 200 mg by mouth once a day for about 6 to 7 months (26 weeks).
Pretomanid must be taken with Sirturo (bedaquiline) and linezolid (Zyvox). Ask your provider about dosing for these two other medications.
How much does Pretomanid cost?
What are alternatives to Pretomanid?
Tuberculosis (TB) lung infection that's difficult to treat in adults
Tuberculosis (TB) that is resistant (doesn't respond to) to first-choice anti-TB antibiotics (e.g., isoniazid or rifampin (Rifadin))
TB infection in people who can't take other anti-TB antibiotics
Tuberculosis (TB) that's hard to treat with first-choice antibiotics
Urinary tract infections (UTIs), after first-choice options haven't worked
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