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Paul A. Pham, Pharm.D. and John G. Bartlett, M.D.
06-26-2009
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Available formulation in Zambia: Tablet: 50 mg; 100 mg (dihydrogen citrate).
- First line agent for treatment of patients with lymphatic filariasis and loiasis.
- Use with close monitoring in the treatment of onchocerciasis because diethyl-carbamazine inflammatory reaction may cause encephalopathy or permanent ocular complications. Consider corticosteroid pre-treatment.
Zambia Information Author: Paul A. Pham, Pharm. D.
- Not FDA approved, but available from the CDC (404-639-3670)
- Lymphatic filaria
- Loa loa
- Visceral larva migrans
brand
name
| generic
| Mfg
| brand
forms
| cost*
|
| Hetrazan | Diethyl-carbamazine | Available from the CDC 404-639-3670) | oral
tab
50 mg | n/c |
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
- Lymphatic filaria: 6 mg/kg/day PO in 3 divided doses x 14d. Diethylcarbamazine dose escalation recommended to reduce inflammatory reactions: day 1 - 50 mg, day 2 - 50 mg q8h, day 3 - 100 mg q8h, day 4 through 14 - 6 mg/kg in 3 divided doses.
- Retreatment for microfilaremia often necessary q 6-12 mos as demonstrated by repeat blood smear or antigen testing.
- Loiasis: 5-10 mg/kg/day PO divided into 3 doses x 2-4 wks. May require repeated treatment. If high parasitemia, consider consultation with tropical medicine expert (encephalitis risks).
- With heavy microfilaremia, start with lower doses of diethyl-carbamazine along with corticosteroid pretreatment.
Usual regimen.
Consider dose reduction.
Consider dose reduction.
No data.
No data.
No data.
- Severe allergic or febrile reactions to dying worms in patients with microfilaria in blood or skin
- Local reactions include lymphadenitis and transient lymphedema
- GI intolerance (dose related)
- Malaise
- Encephalopathy (with high microfilaremia)
- Angioedema
- Acute psychosis
Urinary alkalinizers (sodium lactate, sodium bicarbonate): toxicity of diethyl-carbamazine may be increased due to decreased renal clearance in alkaline urine.
Wuchereria bancrofti, Brugia malayi, Brugia timori
Must contact CDC (404-639-3670) to obtain DEC in US. Ivermectin is drug of choice for onchocerciasis because DEC inflammatory reaction may cause encephalopathy or permanent ocular complications. DEC continues to be a mainstay for Rx of pts with lymphatic filariasis and loiasis.
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