CLINIC PHARMACOLOGIC APPROACHES TO DRUG SELECTING IN HELMINTHIASISDzhakubekova A.

General approaches to drug selecting in helminthiasisThe goal of anthelmintic therapy is to eradicate the parasite completely or to decrease the magnitude of infestation (worm burden).Anthelmintics should be used along with personal and public health control measures to prevent spread of parasitic infestations.

General approaches to drug selecting in helminthiasisSpecific measures vary according to type of organism, the environment and the host.Anthelmintics should be used only when clearly indicated (laboratory documentation of parasitic infestation).Monitoring of safety and efficacy is required.

Classification of HelminthiasisNematodiasis

AscariasisFillariasisAncylostomiasisTrichocephaliasisEnterobiasis TrichinosisStrongyliasisToxocariasisTrichuriasis

Classification of HelminthiasisTrematodiasis

OpisthorchiasisClonorchiasisParagonomiasisFascioliasisSchistosomiasis

Classification of HelminthiasisCestodiasis

TaeniasisTaeniarhynchiasis DiphillobotriasisHymenolepiasisEchinococcosis

Drug Therapy of Nematodiasis

AscariasisFillariasisAncylostomiasisTrichocephaliasisEnterobiasis TrichinosisStrongyliasisToxocariasisTrichuriasisPyrantelMebendazoleThiabendazoleAlbendazoleFlubendazoleIvermectineDiethylcarbamazine

Drug Therapy of Trematodiasis

OpisthorchiasisClonorchiasisParagonomiasisFascioliasisSchistosomiasisPraziquantelTriclabendazoleBithionolOxamniquine

Drug Therapy of Cestodiasis

TaeniasisTaeniarhynchiasis DiphillobotriasisHymenolepiasisEchinococcosisPraziquantelNiclosamideAlbendazole

Drug selecting in AscariasisFirst choice drug - pyrantel pamoate

Second choice drugs - levamisol, mebendazol, albendazol

Drug selecting in AncylostomidiasisFirst choice drug - pyrantel pamoate

Second choice drugs - levamisol, mebendazol, albendazol

Drug selecting in EnterobiasisFirst choice drug - pyrantel pamoate

Second choice drugs - mebendazol, albendazol

Drug selecting in TrichocephaliasisFirst choice drug - mebendazol

Second choice drugs - albendazol

Drug selecting in StrongyloidiasisFirst choice drug - albendazol

Second choice drugs - ivermectine

PYRANTEL PAMOATEPyrimidine derivativeActive against only nematodesDepolarizing skeletal muscle relaxantPoorly absorbed in GIT, excreted predominantly in fecesAdverse effects: abdominal pain, anorexia, nausea, vomiting, headache, vertigo, drowsiness, rash

PYRANTEL PAMOATE: WARNINGSPregnancy: NO adequate clinical trials, not recommended to use in pregnantsBreastfeeding: NO adequate clinical trials, not recommended to use in lactationHepatic insufficiency: use with cautionDrug interaction: dont combine with piperazine due to pharmacodynamic antagonism

PYRANTEL PAMOATE: information for patientsUse orally before/during/after meal with fruit juice or milk;Dont change dosage regimen. Dont use laxative drugs;The following side effects may occur: abdominal pain, diarrhea, nausea, drowsiness, dizziness, insomnia (avoid driving or performing hazardous tasks) ;Report skin rash, joint pain, severe headache, dizzinessIn enterobiasis: its required to treat all family members for complete eradication

MEBENDAZOLEBenzimidazole derivativeBroad spectrum of antihelmintic actionInhibits tubuline synthesis, glucose utilizing and ATP formation in intestinal parietal cellsPoorly absorbed in GIT , bioavailability is increased by fat food, excreted predominantly in fecesAdverse effects: abdominal pain, diarrhea, nausea, vomiting, headache, vertigo, neatropenia, rash

MEBENDAZOLE: WARNINGSPregnancy: in animals teratogenic effect was observed, NO adequate clinical trials, not recommended to use in pregnantsBreastfeeding: NO adequate clinical trials, not recommended to use in lactationChildren: not recommended to use in children under 2 years

MEBENDAZOLE: WARNINGSHypersensitivity: cross-hypersensitivity to other benzimidazole derivativesHepatic insufficiency: cumulative effect, use with caution GIT inflammatory diseases: bioavailability is increased, use with caution, dont use in ulcerative colitis and Crones diseaseDrug interaction: carbamazepine induces the metabolism and decreases antihelmintic activity of mebendazole

MEBENDAZOLE: information for patientsChew or swallow whole or crushed and mixed with food;Pinworms are easily transmitted; all family members should be treated for complete eradication;Use strict handwashing and hygiene measures;The following side effects may occur: abdominal pain, diarrhea, nausea;Report fever, severe diarrhea

ALBENDAZOLE: Adverse effectsCNS: headache, vertigo, dizziness; GI: abdominal pain, nausea, vomiting, abnormal liver function tests;Hematologic: neutropenia, leucopenia, bone marrow depression;Renal: acute renal failure;Other: fever, rash, reversible alopecia

ALBENDAZOLE: information for patientsTake this drug with food;Follow the cycle days carefully if taking drug for hydatid disease;Mark calendar with drug and drug-free days;The following side effects may occur: abdominal pain, diarrhea, nausea, vomiting, headache (use analgesics), dizziness (avoid driving or operating dangerous machinery);Report fever, bruising, infections, pregnancy

ALBENDAZOLE: drug interactionIncreased antihelmintic activity with: Dexamethasone PraziquantelCimetidine

MONITORING OF SAFETY OF BENZIMIDAZOLESHepatic and renal functionsWhite blood cells numberAdverse reactionsDont use in pregnants, recommend to use contraceptives during and for 1 month after therapy

PRAZIQUANTEL: WARNINGSIsoquinoline derivativeBroad spectrum of antihelmintic actionProduces skeletal muscle contraction and paralysisWell-absorbed in GIT, 80% binding to plasma proteins, penetrates through blood-brain barrier, in breast milk, excreted predominantly in urineAdverse effects: abdominal pain, diarrhea, nausea, vomiting, headache, vertigo, neutropenia, dizziness, convulsions, rash, angioedema, fever

PRAZIQUANTEL: WARNINGSPregnancy: in animals teratogenic effect was observed, NO adequate clinical trials, not recommended to use in pregnantsBreastfeeding: NO adequate clinical trials, not recommended to use in lactationChildren: not recommended to use in children under 4 years

PRAZIQUANTEL: WARNINGSHepatic insufficiency: cumulative effect, use with caution CNS diseases: the risk of neurotoxicity is increasedDrug interaction: phenitoin, carbamazepine, dexamethasone decrease praziquantel plasma concentration, cimetidine increases praziquantel plasma concentration, chloroquine decreases praziquantel bioavailability

PRAZIQUANTEL: information for patientsTablets should be swallowed unchewed during meal, with a small amount of liquid;Dont hold the tablet in your mouth; it has a bitter taste that causes gagging and vomiting;The following side effects may occur: abdominal pain, nausea, vomiting, drowsiness, dizziness (avoid driving or operating dangerous machinery);Report rash, severe abdominal pain, marked weakness, dizziness

IVERMECTIN: WARNINGSSemisynthetic broad spectrum antihelmintic agentStimulates GABA-receptors in skeletal muscle and produces paralysisWell-absorbed in GIT, 93% binding to plasma proteins, doesnt penetrate through blood-brain barrier, penetrates in body tissues and fluids, in breast milk, excreted predominantly in fecesAdverse effects: abdominal pain, nausea, weakness, vertigo, tremor, conunctivitis, rash, angioedema, fever

IVERMECTIN: WARNINGSPregnancy: in animals teratogenicity was observed, NO adequate clinical trials, not recommended to use in pregnantsBreastfeeding: NO adequate clinical trials, not recommended to use in lactationChildren: not recommended to use in children under 5 yearsGeriatrics: use with caution in elderly patients due to hepatic disorders

IVERMECTIN: WARNINGSHepatic insufficiency: cumulative effect, use with caution CNS diseases: the risk of neurotoxicity is increasedDrug interaction: No reports

IVERMECTIN: information for patientsTake this drug with water. Follow-up stool examinations will be needed to ensure that the parasite has been eradicated;Dont use in pregnants, recommend to use contraceptives during and for 1 month after therapy;The following side effects may occur: nausea, vomiting, dizziness (avoid driving or operating dangerous machinery);Report fever, pregnancy, rash, severe swelling, visual changes, difficulty breathing

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