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Pham P and Bartlett JG
08-29-2008
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Available formulation in Zambia: Melarsoprol injection: 3.6% solution, 5ml ampoule (180 mg of active compound).
- Used in the treatment of African sleeping sickness (Gambian and Rhodesian trypanosomiasis) with neurologic involvement.
- Second line treatment of early African sleeping sickness resistant to treatment with suramin.
- Pre-treatment with suramin for 24-48 hours recommended in debilitated pts w/ high levels of parasitemia in order to reduce Jarisch-Herxheimer-like reaction.
Zambia Information Author: Paul A. Pham, Pharm. D.
- Late stage African sleeping sickness (Gambian and Rhodesian trypanosomiasis) with neurologic involvement.
- Early stage African (Gambian and Rhodesian trypanosomiasis) sleeping sickness, resistant to treatment with suramin or pentamidine.
brand
name
| generic
| Mfg
| brand
forms
| cost*
|
| Arsobal, Mel B and Melarson Oxide-BAL | Available from the CDC ( 404-639-3670 ) | - | -
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- | - |
*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.
- Late stage T. brucei gambiense: melarsoprol 3.6 mg/kg/day (up to 180 mg) on days 1, 2, 3, 11, 12, 13 and if CSF WBC>20, days 21, 22, 23. Pre-treatment with 1-2 doses of 4 mg/kg pentamidine 24-72h before 1st injection of melarsoprol to prevent Jarisch-Herxheimer-like reaction .
- Late stage T. brucei rhodesiense: melarsoprol in mg/kd (day): 0.36mg/kg (day1), 0.72mg/kg (day2), 1.1 mg/kg (day3), 1.8mg/kg (day10,11,and 12), 2.2mg/kg (day19), 2.9mg/kg (day20), 3.6mg/kg (up to 180 mg)(day21,28,29,and 30). Pre-treatment with 2-3 doses of suramin (5,10,20 mg/kg) IV over 3-5 days before 1st injection of melarsoprol to prevent Jarisch-Herxheimer-like reaction .
- Prevention of melarsoprol-induced encephalopathy: prednisolone 1 mg/kg up to 40 mg/day started 1-2 days before first dose of melarsoprol, continued to last dose, tapered over 3 days (30, 20, 10 mg).
- Eflornithine is a more effective and better-tolerated for T. b. gambiense infections.
Usual dose.
No data. Consider dose reduction.
No data. Consider dose reduction.
No data. Consider dose reduction.
No data.
- Encephalopathy (10-12% of patients, usually after day 3, and the start of the second course)
- Phlebitis
- Peripheral neuropathy
- Jarisch-Herxheimer-like reaction (pre-treatment with suramin or pentamidine for 24-48 hours recommended in debilitated pts w/ high levels of parasitemia in order to reduce Jarisch-Herxheimer-like reaction)
- Rash
- Hepatic dysfunction
- Hypertension
- Arthralgia
- Hemolytic anemia
None known
Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense
Melarsoprol (Mel B, Arsobal), an investigational drug, is an arsenical compound with trypanosomicidal effects. It is indicated for the treatment of African sleeping sickness (Gambian and Rhodesian trypanosomiasis) with neurologic involvement and for the treatment of early African sleeping sickness that is resistant to treatment with suramin or pentamine.
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