Pyrazinamide is associated with which major adverse effects?

• A. Hyperuricemia and hepatotoxicity
• B. Ototoxicity
• C. Optic neuritis
• D. Neurotoxicity

Answer: (A)

Pyrazinamide’s major adverse effects are hyperuricemia and hepatotoxicity. It often raises uric acid levels by reducing renal urate clearance and can trigger gout flares, especially in patients with preexisting hyperuricemia. It also carries a notable risk of liver injury, so liver enzymes are routinely monitored during treatment. These two effects are the most characteristic and clinically important for this drug.

Ototoxicity is more typical of aminoglycosides; optic neuritis is a hallmark of ethambutol; and neurotoxicity is more associated with isoniazid. Pyrazinamide is not primarily linked to those adverse effects, which is why hyperuricemia and hepatotoxicity are the best-supported choices.