Strong Or Moderate Cyp3a Inducers
Severe
Textbook
Reduced pretomanid exposures.
Avoid coadministration with strong or moderate CYP3A inducers.
Source: G&G 14e · p1277
Drug reference
pretomanid
Bicyclic nitroimidazole · Antituberculosis
Bicyclic nitroimidazoleAntituberculosis
CDSCO approved
EXCRETION
—
not curated
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
—
not curated
Top interactionssee all 12 →
- Strong Or Moderate Cyp3a InducersSevereTextbookG&G 14e · p1277
- ApalutamideSevereDatabaseDDInter
- BosentanSevereDatabaseDDInter
- CarbamazepineSevereDatabaseDDInter
Mechanism
Pretomanid inhibits M. tuberculosis mycolic acid and protein synthesis under aerobic conditions. It is a prodrug requiring bacterial activation via a nitroreduction step involving FGD1 (NADP-dependent G6PD) and cofactor F420. In nonreplicating persistent bacilli, it generates reactive nitrogen species such as nitric oxide via its des-nitro metabolite, augmenting the kill of intracellular NRPB, and causes ATP depletion by poisoning the respiratory complex.
Indications
extensively drug-resistant tuberculosis (in combination with bedaquiline and linezolid)
Dosing
- Adult
- 200 mg/day
Pharmacokinetics
Metabolism
Approximately 20% by CYP3A
Side effects
Serious
- hepatotoxicity (under investigation)
- effects on human male fertility (under investigation)
Drug interactions
Apalutamide
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Bosentan
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Carbamazepine
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Cenobamate
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Dabrafenib
Severe
Database
Clinical effect not specified
Source: DDInter
Dexamethasone
Severe
Database
Clinical effect not specified
Source: DDInter
Efavirenz
Severe
Database
Clinical effect not specified
Source: DDInter
Enzalutamide
Severe
Database
Clinical effect not specified
Source: DDInter
Eslicarbazepine
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Etravirine
Severe
Database
Clinical effect not specified
Source: DDInter
Fosphenytoin
Severe
Database
Clinical effect not specified
Source: DDInter
Related guidelines
Ask House about pretomanid
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: Goodman & Gilman 14e, Harrison 22e·Verified: 2026-05-10 · House clinical team