(1995; 152 pages) [French] [Spanish]
Group: antifilarial agent
Tablet 50 mg, 100 mg of diethylcarbamazine dihydrogen citrate
A filaricidal piperazine derivative that kills both the microfilariae and some adult worms of Wuchereria bancrofti, Brugia malayi and B. timori.
It is almost completely absorbed after oral administration and is widely distributed in non-fatty tissues. It is rapidly and extensively metabolized and the residuum is recovered unchanged in the urine within 48 hours. The plasma half-life is usually within the range of 6-12 hours.
Individual and community treatment of systemic lymphatic filariasis and occult filariasis (tropical pulmonary eosinophilia).
Dosage and administration
It is widely accepted that total cumulative dosages of 72 mg/kg are necessary to eliminate W. bancrofti infections. Lower dosages are recommended by some authorities for treating B. malayi and B. timori infections. Controlled studies are now ongoing to evaluate these recommendations. Children under 10 years of age should receive half the total adult dose.
The following dosage schedules are intended only as a guide since many countries have developed their own specific treatment regimens. The doses given are suitable for both adults and children aged over 10 years.
In all cases treatment is best initiated with smaller doses for 2-3 days in order to avoid the danger of immunological reactions.
W. bancrofti infection
Individual treatment: 6 mg/kg daily for 12 days administered orally, preferably in divided doses after meals.
Mass administration: 6 mg/kg in 24 hours administered, as above, 12 times at weekly or monthly intervals, or as a single annual dose.
B. malayi and B. timori infections
Individual treatment: 3-6 mg/kg daily for 6-12 days administered orally, preferably in divided doses after meals.
Mass treatment: 3-6 mg/kg in 24 hours administered, as above, 6 times at weekly or monthly intervals.
In both China and India several trials have shown that, used consistently over a period of at least 6 months, table salt medicated with diethylcarbamazine at a concentration of 0.1% can eliminate W. bancrofti lymphatic filariasis. A concentration of 0.3% for 3-4 months may be necessary where B. malayi is endemic.
A dose of 8 mg/kg daily for 14 days repeated, as necessary, if symptoms return.
Contraindications and precautions
Dosage should be reduced in patients with renal impairment.
Patients who are severely ill with other acute diseases should not receive diethylcarbamazine until after their recovery.
Pregnant women should not be treated until after delivery.
Immunological disturbances similar to the Mazzotti reaction-in onchocerciasis are induced by disintegrating microfilariae and dead adult worms. The incidence and severity of these reactions are correlated both with the degree of microfilaraemia and with the dose of diethylcarbamazine. Fever, headache, dizziness, anorexia, malaise, urticaria, vomiting and asthmatic attacks may occur within a few hours of the first dose and usually subside by the fifth day of treatment. Reversible proteinuria may also occur.
Recently killed adult worms often form nodules which are palpable subcutaneously and along the spermatic cord. Their death may result in transient lymphangitis and an exacerbation of lymphoedema.
Nausea, vomiting, headache, dizziness and drowsiness are characteristic. In severe cases convulsions may occur, requiring treatment with parenteral diazepam. Treatment is otherwise supportive and symptomatic.
Tablets should be stored in tightly closed containers.