Pharmacology · Antituberculosis drugs
Delamanid !
A nitroimidazole prodrug for drug-resistant TB, activated inside the bacillus. It is part of the 6-month BDLLfxC regimen; it modestly prolongs QT.
Updated 2026-11-01
Also called: Dlm
Mechanism of action
Delamanid is a bicyclic nitroimidazole prodrug. Inside the bacillus the nitroreductase Ddn, using the cofactor F420, activates it into a reactive intermediate that blocks mycolic acid production. Resistance comes from mutations in the genes of this activation pathway.
- Ddn and F420 activate delamanid inside the bacillus
- A reactive intermediate forms
- Mycolic acid production is blocked
Pharmacokinetics
- Absorption
- Low bioavailability; food increases exposure
- Metabolism
- Largely through albumin rather than cytochrome P450
Indications
- Multidrug- or rifampicin-resistant tuberculosis (6-month BDLLfxC regimen and longer regimens) Tuberculosis →
- Drug-resistant pulmonary tuberculosis Pulmonary tuberculosis →
Adverse effects
Common
- Headache
- Insomnia
Contraindications
- Hypersensitivity to delamanid
Key interactions
- Food
- Increase absorption: it is taken with food and, if possible, apart from other medicines
- Bedaquiline, clofazimine and other QT-prolonging drugs
- QT effects can add up: ECG monitoring
What is monitored
- ECG before and during treatment
- Electrolytes
- Sleep and headache
Administration and safety
- By mouth with food
- Always within a combination regimen
Nursing care
- Teach to report palpitations or fainting
- Ask about sleep problems
- Check ECG and electrolyte schedule, especially with bedaquiline and clofazimine
Test yourself
Think of the answer, then tap the question to see it.
Which bacterial enzyme activates delamanid?
The deazaflavin (F420)-dependent nitroreductase Ddn.
What does BDLLfxC contain?
Bedaquiline, delamanid, linezolid, levofloxacin and clofazimine (6 months).
Why is delamanid taken with food?
Its bioavailability is low and food increases exposure.
Related drugs
Related conditions
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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: WHO consolidated guidelines on tuberculosis: module 4: treatment and care (World Health Organization (WHO), 2025); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 65 (McGraw Hill, 2023).
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Representative model, for educational purposes only.