Betanaphthoi/Diethylcarbamazine Citrate 153 ATC Vet - QP52AGO I. monthly intervals. In areas where lymphatic filariasis is include fever, dizziness, drowsiness, headache, malaise, UN/I - T1JOJOU640. endemic. mass treatment campaigns can reduce the intensity microscopic haematuria, myalgia, nausea, and vomiting. of transmission and incidence of disease. Diethylcarbam­ Hypersensitivity reactions arise from the death of the Pharmacopoeias. In Br. and Fr. azine may also be used in the form of medicated salt to microfilariae. These can be serious, especially in onchocer­ BP 2014: (Dichlorophen). A white or slightly cream­ control lymphatic filariasis. For further details, see p. 154.3. ciasis where there may also be sight-threatening ocular coloured powder with a not more than slightly phenolic In the treatment of loiasis diethylcarbamazine citrate 6 toxicity; fatalities have been reported. Encephalitis may be odour. Practically insoluble in water; freely soluble in to 9 mg/kg daily in 3 divided doses for 21 days has been exacerbated in patients with loiasis and fatalities have alcohol; very soluble in ether. given. In heavy infections rapid killing of microfilariae can occurred; those with very high microfilaria counts are at cause severe adverse effects including encephalitis and increased risk. Profile treatment should start with very small doses, increasing Reactions occurring during diethylcarbamazine treat­ gradually over 3 days. A corticosteroid has been given ment of lymphatic filariasis are basically of 2 types: Dichlorophen is an anthelmintic that was used in the concurrently. In the prophylaxis of loiasis, a dose of 300 mg pharmacological dose-dependent responses and a response treatment of infection by tapeworms but has been weekly is recommended by WHO. of the infected host to the destruction and death of superseded by praziquantel or niclosamide. In the treatment of toxocariasis diethylcarbamazine parasites. 1 Dichlorophen also has antifungal and antibacterial citrate 6 mg/kg daily in 2 divided doses for 21 days may be • Reactions of the first type include weakness, dizziness, activity and has been used topically in the treatment of given. Diethylcarbamazine is considered by some to be the lethargy, anorexia, and nausea. They begin within I to 2 fungal infections and as a germicide in soaps and cosmetics. treatment of choice while others do not recommend its use hours of taking diethylcarbamazine, and persist for a few due to high rates of allergic reactions induced by dying hours. Hypersensitivity. Dichlorophen is used for its antibacterial larvae. To reduce the intensity of these reactions WHO • Reactions of the second type are less likely to occur and and antifungal properties in various manufactured pro­ suggests starting treatment at a dose of mg/kg twice daily I are less severe in bancroftian than in brugian filariasis. ducts and there is a report1 of a patient whose eczema of and increasing gradually to 3 mg/kg twice daily. They may be systemic or local. both with or without the hands and face and vesicular-bullous lesions of the For details of doses in children, see p. 154.3. fever. feet were associated with the presence of dichlorophen in Sy stemic reactions may occur a few hours after the first oral the leather of her shoes. It was of note that the appear­ Administration, Diethylcarbamazine was first used as the dose of diethylcarbamazine and generally do not last for ance of the reaction to dichlorophen in patch testing was chloride, but was subsequently produced as the dihydro­ more than 3 days. They include headache, aches in other delayed for 10 days. gen citrate which contains only half its weight as base. In parts of the body, joint pain, dizziness, anorexia, malaise, l. Barbuzza 0, et a/. Late patch test reaction to dichlorophene. J Investig reporting doses it was therefore important to indicate Allergol C/in lmmuno/ transient haematuria, allergic reactions, vomiting, and 2008; 18: 317-8. whether they referred to a specific salt or to the base; sometimes attacks of bronchial asthma in asthmatic unless otherwise stated, it could generally be assumed that patients. Fever and systemic reactions are positively Preparations the dose referred to the citrate.1 associated with microfilaraemia. Systemic reactions are l. WHO. Lymphatic filariasis: fourth report of the WHO expert committee Proprietary Preporo6ons (details are given in Volume B) reduced if diethylcarbamazine is given in spaced doses or on filariasis. WHO Tech Rep Ser 702 1984. Available at: http:l/libdoc.who. Mul6-ingredient Preporo6ons. UK: Mycota. intltrs!WHO_TRS_702.pdf (accessed 16/07/08) in repeated small doses. They eventually cease spontaneously and interruption of treatment is rarely Pharmacopoeial Prepora6ons Administration in children. Diethylcarbamazine citrate necessary; symptomatic treatment with antipyretics or BP 2014: Dichlorophen Tablets. may be given orally to children for the treatment of lym­ analgesics may be helpful. phatic filariasis, loiasis and toxocariasis (visceral larva Local reactions tend to occur latef in the course of migrans). treatment and last longer; they also disappear Diethylcarbamazine Citrate For the treatment of lymphatic filariasis US experts' spontaneously and interruption of treatment is not {BANM, r/NNM) consider that children may be given the same dose as for necessary. Local reactions include lymphadenitis, adults (see above), while WHO recommends that children abscess, ulc:;:eration, and transient lymphoedema; funi­ Citrato de dietilcarbamazina; Diethylcarbam. Cit.; Diethylcar­ under 10 years of age be given hall the usual adult dose 2 culitis and epididymitis may also occur in bancroltian bamazindihydrogencitrat; Diethylcarbamazine Acid Citrate; For the treatment of loiasis US experts consider that filariasis. Diethylcarbamazine, citrate de; Diethylcarbamazini Citras; children may be given a dose of 9 mg/kg daily in 3 divided It has been suggested that the release of interleukin-6 may Diethylkarbamazin-citrat; Dietilcarbamazin,a, citrato de; doses for 21 days; treatment should start with very small be implicated in diethylcarbamazine's adverse effects in Dietilkarbamazin-citr<lt; Dietilkarbamazino citratas; Dietylk­ doses, increasing gradually over 3 days.' No dose patients with lymphatic filariasis -' arbamazincitrat; Dietyylikarbamatsiinisitraatti; Ditrazini Citras:' recommendation is given by WH0 2 In most patients with onchocerciasis, the microfilar­ RP-3799; A•nr�nKap6aMa3�Ha Umpar. For the treatment of toxocariasis WHO considers that icidal activity of diethylcarbamazine leads to a series of NN-Diethyl-4-methylpiperazi ne-1 -carboxamide dihydrogen children may be given the same dose as for adults (see events with dermal, ocular, and systemic components, citrate. above) 2 known as the Mazzotti reaction, within minutes to hours after C10H21N30,(,;H807=391.4 l. Abramowicz M, ed. Drugs for parasitic infections. 3rd ed. New Rochelle its use.3 NY: The Medical Letter,20 I3. CAS - 90-89- 1 {diethylcarbamazine); 1642-54-2 (diethyl­ • Clinical manifestations can be severe, dangerous, and 2. WHO. WHO model form ulary. Geneva: WHO, 2008. Available at: http:// carbamazine citrate). www.who.int/selection_medicines/list/WMF2008.pdf (accessed debilitating. Systemic reactions include increased itch­ ATC - P02C802. 19/11109) ing, rash. headache, aching muscles, joint pain, painful UNII - OS I Z389KBS. swollen and tender lymph nodes, fever, tachycardia and Loiasis. Diethylcarbamazine is the main drug used in the hypotension, and vertigo. Most patients have eye Pharmacopoeias. In Chin., Bur. (seep. vii), Int., Jp n, and US. management of loiasis (p. 146.2). discomfort in the. first few hours after diethylcarbam­ Ph. Eur. (Diethylcarbamazine Citrate). A white or almost 8: References. azine treatment. Punctate keratitis can develop as can white, crystalline, slightly hygroscopic powder. Very soluble l. Nutman TB, et a!. Loa loa infection in temporary residents of endemic optic neuritis and visual field loss. in water; soluble in alcohol; practically insoluble in acetone. regions: recognition of a hyperresponsive syndrome with characteristic WHO no longer recommends the use of diethylcarbamazine J Infect Dis Store in airtight containers. clinical manifestations. 1986; 154: 10-18. in onchocerciasis as safer alternatives exist. 2. Nutman TB, et al. Diethylcarbamazine prophylaxis for human loiasis: USP 36: (Diethylcarbamazine Citrate). A white, crystalline, results of a double-blind study. N Eng! J Med 1988; 319: 752-6. I. WHO. Lymphatic filariasis: the disease and its control: fifth report of the slightly hygroscopic powder, odourless or has a slight odour. 3. Nutman TB, Ottesen EA. Diethylcarbamazine and human loiasis. N Eng! WHO expert committee on filariasis. WHO Tech Rep Ser 82I 1992. Also available at: http://libdoc.who.int/trs/WHO_TRS_821.pdf (accessed Very soluble in water; sparingly soluble in alcohol; J Med 1989; 320: 320. 4. Klion AD, et al. Effectiveness of diethylcarbamazine in treating loiasis 19/11109) practically insoluble in acetone, in chloroform, and in acquired by expatriate visitors to endemic regions: long-term follow-up. 2. Yazdanbakhsh M, eta!. Serum imerleukin-6 levels and adverse reactions ether. Store in airtight containers. J Infect Dis 1994; 169: 604-10. to diethylcarbamazine in lymphatic filariasis. J Infect Dis 1992; 166: 453- 4. 3. WHO. WHO expert committee on onchocerciasis: third report. WHO Tech Uses and Administration Lymphatic filariasis, Diethylcarbamazine is used in the