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Azanidazole/Diaveridine 831 American Trypanosomiasis Azanidazole/Diaveridine 831 American trypanosomiasis. Available treatment for Ameri- ble in water; practically insoluble in alcohol; very slightly solu- can trypanosomiasis (p.827) is generally unsatisfactory, but ben- ble in chloroform and in ether. znidazole is of value especially in the acute phase. WHO1 recom- Cl USP 31 (Decoquinate). Store in airtight containers. mends that benznidazole should be given for 60 days but some in the USA2 suggest courses of 30 to 90 days. Although treat- Profile Decoquinate is an antiprotozoal used in veterinary practice for ment is usually confined to the acute phase of the disease, thera- 3 the control of coccidiosis in calves, sheep, and chickens. It is also py during the early chronic phase was reported to be beneficial, N used for toxoplasmosis in sheep. and long-term follow-up in patients who had received benznida- zole has shown a reduction in cardiac complications and parasi- O N 4 taemia. HN 1. WHO. Control of Chagas disease: second report of the WHO OClN Dehydroemetine Hydrochloride (BANM, rINNM) expert committee. WHO Tech Rep Ser 905 2002. Available at: http://libdoc.who.int/trs/WHO_TRS_905.pdf (accessed BT-436; Déhydroémétine, Chlorhydrate de; 2,3-Dehydroemet- 17/07/08) Pharmacopoeias. In Eur. (see p.vii) for veterinary use only. ine Hydrochloride; Dehydroemetini Hydrochloridum; DHE; 2. Abramowicz M, ed. Drugs for parasitic infections. 1st ed. New Ph. Eur. 6.2 (Clazuril for Veterinary Use; Clazuril BP(Vet) 2008). Hidrocloruro de dehidroemetina; Ro-1-9334. 2,3-Didehydro- Rochelle NY: The Medical Letter, 2007. A white or light yellow powder. Practically insoluble in water; 6′,7′,10,11-tetramethoxyemetan dihydrochloride; 3-Ethyl- 3. de Andrade ALSS, et al. Randomised trial of efficacy of benzni- slightly soluble in alcohol and in dichloromethane; freely soluble 1,6,7,11b-tetrahydro-9,10-dimethoxy-2-(1,2,3,4-tetrahydro-6,7- dazole in treatment of early Trypanosoma cruzi infection. Lancet in dimethylformamide. Protect from light. dimethoxy-1-isoquinolylmethyl)-4H-benzo[a]quinolizine dihydro- 1996; 348: 1407–13. chloride. 4. Viotti R, et al. Treatment of chronic Chagas’ disease with benz- Profile nidazole: clinical and serologic evolution of patients with long- Clazuril is an antiprotozoal used in veterinary practice for the Дегидроэметина Гидрохлорид term follow-up. Am Heart J 1994; 127: 151–62. control of coccidiosis in pigeons. C29H38N2O4,2HCl = 551.5. Preparations CAS — 4914-30-1 (dehydroemetine); 2228-39-9 (dehydro- emetine hydrochloride). Proprietary Preparations (details are given in Part 3) Clefamide (BAN, rINN) Arg.: Radanil; Braz.: Rochagan; Ecuad.: Ragonil. Chlorphenoxamide; Clefamida; Cléfamide; Clefamidum. 2,2- H3CO Dichloro-N-(2-hydroxyethyl)-N-[4-(4-nitrophenoxy)benzyl]- acetamide. N Buparvaquone (BAN, rINN) Клефамид H3CO H Buparvacuona; Buparvaquonum; BW-720C. trans-2-(4-tert- C H Cl N O = 399.2. 17 16 2 2 5 CH3 Butylcyclohexylmethyl)-3-hydroxy-1,4-naphthoquinone. CAS — 3576-64-5. Бупарвахон ATC — P01AC02. C21H26O3 = 326.4. OCH3 HN CAS — 88426-33-9. Cl ATC Vet — QP51AX22. O O OCH Cl 3 O N (dehydroemetine) O2N OH NOTE. The name DHE has been used to denote a preparation of Profile dihydroergotamine mesilate. CH3 Clefamide is an antiprotozoal that has been used as a luminal Pharmacopoeias. In Int. OH amoebicide in the treatment of Entamoeba histolytica infections. CH H C 3 Profile O 3 Dehydroemetine, a synthetic derivative of emetine (p.833), is a tissue amoebicide with similar actions and uses, although proba- Profile Clopidol (BAN, USAN, rINN) bly of a lower toxicity. Buparvaquone is an antiprotozoal used in veterinary practice for Clopidolum; Clopindol; Meticlorpindol. 3,5-Dichloro-2,6- Dehydroemetine should be avoided in patients with cardiac, the treatment of theileriosis in cattle. dimethylpyridin-4-ol. renal, or neuromuscular disease and patients should be moni- tored for cardiac toxicity during treatment. Клопидол When used in the treatment of amoebiasis (p.822), dehydroeme- C7H7Cl2NO = 192.0. tine hydrochloride is given by intramuscular injection in a dose Carnidazole (BAN, USAN, pINN) CAS — 2971-90-6. of 1 mg/kg daily (maximum daily dose of 60 mg), generally for Carnidazol; Carnidazolum; R-25831; R-28096 (carnidazole hy- up to 4 to 6 days, but for no more than 5 days in children. A dose drochloride). O-Methyl [2-(2-methyl-5-nitroimidazol-1-yl)ethyl]- of 0.5 mg/kg has been suggested for elderly or severely ill pa- H3C N CH3 tients. At least 6 weeks should elapse before treatment is repeat- thiocarbamate. ed. Following treatment with dehydroemetine, all patients Карнидазол should receive a luminal amoebicide to eliminate organisms C H N O S = 244.3. Cl Cl from the colon. Patients with hepatic amoebiasis may be given 8 12 4 3 supplementary treatment with chloroquine. CAS — 42116-76-7. OH ATC Vet — QP51AA09. Liver fluke infections. Dehydroemetine has been given1 in the treatment of the liver fluke infection fascioliasis (see p.137). Profile Clopidol is an antiprotozoal used in veterinary practice for the 1. Farid Z, et al. Treatment of acute toxaemic fascioliasis. Trans R Soc Trop Med Hyg 1988; 82: 299. H3C prevention of coccidiosis in poultry and rabbits either alone or with methyl benzoquate (p.837). N N Diaveridine (BAN, USAN, rINN) HN Decoquinate (BAN, USAN, rINN) BW-49-210; Diaveridina; Diavéridine; Diaveridinum; NSC- + S O N 408735. 5-Veratrylpyrimidine-2,4-diyldiamine. - Décoquinate; Decoquinato; Decoquinatum; HC-1528; M&B- O CH3 O 15497. Ethyl 6-decyloxy-7-ethoxy-4-hydroxyquinoline-3-carbox- Диаверидин ylate. C13H16N4O2 = 260.3. Profile Декохинат CAS — 5355-16-8. ATC Vet — QP51AX18. Carnidazole is a 5-nitroimidazole derivative similar to metroni- C24H35NO5 = 417.5. dazole. It is used in veterinary practice for the control of tricho- CAS — 18507-89-6. moniasis in pigeons. ATC Vet — QP51AX14. H3CO N NH2 H3C O N N Clazuril (BAN, USAN, rINN) H3CO (CH ) Clazurilo; Clazurilum; Klatsuriili; Klazuril; R-62690. (±)-[2-Chloro- 2 9 O CH3 NH H C 2 4-(4,5-dihydro-3,5-dioxo-as-triazin-2(3H)-yl)phenyl]-(p-chloro- 3 O phenyl)acetonitrile. OH O Pharmacopoeias. In Fr. for veterinary use. Клазурил Profile Pharmacopoeias. In US for veterinary use only. Also in C H Cl N O = 373.2. Diaveridine is an antiprotozoal used in veterinary practice for the 17 10 2 4 2 BP(Vet). control of coccidiosis in poultry. CAS — 101831-36-1. BP(Vet) 2008 (Decoquinate). A cream to buff-coloured, ATC Vet — QP51AJ02. odourless or almost odourless, microcrystalline powder. Insolu- The symbol † denotes a preparation no longer actively marketed The symbol ⊗ denotes a substance whose use may be restricted in certain sports (see p.vii) 832 Antiprotozoals Diclazuril (BAN, USAN, rINN) ing broxyquinoline and diiodohydroxyquinoline, have been re- ported elsewhere. Diclazurilo; Diclazurilum; Diklatsuriili; Diklazuril; R-64433. (±)-4- 3 ClCH Chlorophenyl[2,6-dichloro-4-(2,3,4,5-tetrahydro-3,5-dioxo- Diiodohydroxyquinoline has also been associated with gastroin- 1,2,4-triazin-2-yl)phenyl]acetonitrile. testinal effects such as abdominal cramps, nausea, and diarrhoea. N Adverse effects which may be attributable to the iodine content Cl Диклазурил of diiodohydroxyquinoline include pruritus ani, skin eruptions, C H Cl N O = 407.6. and enlargement of the thyroid gland. Fever, chills, headache, O 17 9 3 4 2 HO CAS — 101831-37-2. and vertigo have also occurred. ATC Vet — QP51AJ03. Precautions (diloxanide) Diiodohydroxyquinoline is contra-indicated in patients known to be hypersensitive to iodine or halogenated hydroxyquinolines N and in those with hepatic or renal impairment. It should be used Pharmacopoeias. In Br., Int., and US. with caution in thyroid disease and may interfere with determi- BP 2008 (Diloxanide Furoate). A white or almost white, odour- Cl nations of protein-bound iodine in tests for thyroid function for less or almost odourless, crystalline powder. Very slightly solu- up to 6 months after therapy. Its use is best avoided in patients ble in water; slightly soluble in alcohol and in ether; freely solu- O with neurological disorders. Long-term use should be avoided. ble in chloroform. Protect from light. Children. The Committee on Drugs of the American Academy USP 31 (Diloxanide Furoate). A white or almost white, crystal- line powder. Very slightly soluble in water; slightly soluble in al- Cl Cl NNH of Pediatrics1 considered that there was a potential risk of toxic- ity to infants and children from clioquinol and diiodohydroxy- cohol and in ether; freely soluble in chloroform. Store in airtight N quinoline applied topically. Since alternative effective prepara- containers. Protect from light. O tions are available for dermatitis, the Committee recommended that products containing either of these compounds should not be Adverse Effects Pharmacopoeias. In Eur. (see p.vii) for veterinary use only. used. Flatulence is the most common adverse effect during Ph. Eur. 6.2 (Diclazuril for Veterinary Use; Diclazuril BP(Vet) WHO considers that the use of halogenated hydroxyquinolines treatment with diloxanide furoate. Vomiting, pruritus, 2008). A white or light yellow powder. Practically insoluble in for the treatment of acute diarrhoea or amoebiasis in children water, in alcohol, and in dichloromethane; sparingly soluble in cannot be justified.2 There is no evidence of their efficacy in and urticaria may occasionally occur. dimethylformamide. Protect from light. acute diarrhoea and they have been associated with severe neu- Profile rological effects. On the rare occasions when a luminal amoebi- Pharmacokinetics Diclazuril is an antiprotozoal that has been tried in AIDS patients cide is required, other less toxic and more effective agents are Diloxanide furoate is hydrolysed before absorption for the management of diarrhoea associated with protozoal infec- available. from the gastrointestinal tract. The resulting diloxanide tion. It is used in veterinary practice for the control of coccidiosis 1. Kauffman RE, et al. American Academy of Pediatrics Commit- in lambs and poultry.
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