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[Pharmacology](https://durgical.com/en/pharmacology/) · [Antituberculosis drugs](https://durgical.com/en/pharmacology/classes/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

- Class: [Antituberculosis drugs](https://durgical.com/en/pharmacology/classes/antituberculosis-drugs/)
- Enzyme: Deazaflavin-dependent nitroreductase Ddn (activating enzyme)
- ATC code: J04AK06
- WHO Model List of Essential Medicines

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 →](https://durgical.com/en/conditions/tuberculosis/)
- Drug-resistant pulmonary tuberculosis [Pulmonary tuberculosis →](https://durgical.com/en/conditions/pulmonary-tuberculosis/)

## Adverse effects

### Common

- Headache
- Insomnia

### Serious (rare, important)

- QT prolongation (modest)

## 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

## Memory aid

Delamanid and pretomanid: nitro-twins woken up by Ddn.

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/delamanid/)

## Related drugs

- [Pretomanid](https://durgical.com/en/pharmacology/pretomanid/)
- [Bedaquiline](https://durgical.com/en/pharmacology/bedaquiline/)
- [Clofazimine](https://durgical.com/en/pharmacology/clofazimine/)
- [Levofloxacin](https://durgical.com/en/pharmacology/levofloxacin/)

## Related conditions

- [Tuberculosis](https://durgical.com/en/conditions/tuberculosis/)
- [Pulmonary tuberculosis](https://durgical.com/en/conditions/pulmonary-tuberculosis/)

[← Back to the class: Antituberculosis drugs](https://durgical.com/en/pharmacology/classes/antituberculosis-drugs/)

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](https://www.who.int/publications/i/item/9789240107243) (World Health Organization (WHO), 2025); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=J04AK06) (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.

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Source: https://durgical.com/en/pharmacology/delamanid/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/delamanid/