delamanid

Delamanid is an anti-tuberculosis medication used to treat multidrug-resistant tuberculosis (MDR-TB). It is a nitroimidazole derivative developed by Otsuka Pharmaceutical and is approved for use in several countries as part of a multidrug regimen for adults with MDR-TB. In the European Union, it received marketing authorization from the European Medicines Agency in 2014 for use with other TB drugs in adults with MDR-TB. The World Health Organization has included delamanid on its Model List of Essential Medicines for MDR-TB.

Mechanism of action does not rely on direct inhibition of a single bacterial target; instead, delamanid is a prodrug activated by mycobacterial enzymes, leading to the formation of reactive nitrogen species. These species disrupt energy production and inhibit the synthesis of mycolic acids, contributing to the drug’s bactericidal activity against Mycobacterium tuberculosis, including some dormant bacilli.

Administration and dosing are in the context of an optimized background regimen. The usual adult dosing is 100 mg taken twice daily for up to 24 weeks, as part of combination therapy. Delamanid tablets are available in 50 mg and 100 mg strengths to achieve the required dose. Patients require monitoring for drug interactions and adverse effects.

Safety and interactions are important considerations. A key safety concern is QT interval prolongation, which can be worsened by other QT-prolonging drugs; baseline and follow-up ECGs are often recommended. Rifampicin and other strong enzyme inducers can reduce delamanid exposure, potentially lowering efficacy. Potential liver-related adverse effects warrant regular liver function monitoring. Delamanid is generally not recommended during pregnancy due to limited safety data, and pediatric data are limited.

See also: treatment guidelines for MDR-TB and nitroimidazole anti-TB drugs.