Enlist the anti- parasitic drug. Describe the adverse effect of parasitic drug?
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Antiparasitic Drugs: Classification and Adverse Effects
Antiparasitic drugs are divided into three main groups based on the type of parasite they target: antimalarials, antiprotozoals (non-malarial), and anthelmintics (drugs against worms - nematodes, trematodes, and cestodes).
PART 1: Classification of Antiparasitic Drugs
A. Antimalarial Drugs
| Drug | Class | Use |
|---|---|---|
| Chloroquine | 4-aminoquinoline | Malaria prophylaxis/treatment (P. vivax, P. malariae) |
| Quinine / Quinidine | Cinchona alkaloid | Severe/complicated malaria |
| Mefloquine | 4-quinolinemethanol | Prophylaxis and treatment (chloroquine-resistant P. falciparum) |
| Primaquine | 8-aminoquinoline | Radical cure of P. vivax / P. ovale (kills liver hypnozoites) |
| Artemether-Lumefantrine (Coartem) | Artemisinin combination | First-line uncomplicated P. falciparum |
| Atovaquone-Proguanil (Malarone) | Antifolate combination | Prophylaxis and treatment |
| Doxycycline | Tetracycline antibiotic | Prophylaxis; adjunct in P. falciparum |
B. Antiprotozoal Drugs (Non-malarial)
(Source: Goodman & Gilman's Pharmacological Basis of Therapeutics)
| Drug | Target Organism |
|---|---|
| Metronidazole / Tinidazole | Entamoeba histolytica, Giardia, Trichomonas |
| Nitazoxanide | Giardia, Cryptosporidium, E. histolytica |
| Paromomycin | Intestinal amebiasis; Leishmaniasis |
| Miltefosine | Visceral leishmaniasis |
| Sodium stibogluconate | Leishmaniasis (first-line in many regions) |
| Pentamidine | African trypanosomiasis; Pneumocystis |
| Suramin | African trypanosomiasis (early stage) |
| Melarsoprol | African trypanosomiasis (late stage, CNS) |
| Eflornithine | African sleeping sickness (T. b. gambiense) |
| Nifurtimox | Chagas disease (T. cruzi) |
| Benznidazole | Chagas disease (drug of choice in endemic countries) |
| Fexinidazole | African trypanosomiasis |
| Amphotericin B (liposomal) | Visceral leishmaniasis (antimonial-resistant) |
| Pyrimethamine | Toxoplasmosis (+ sulfadiazine) |
| Trimethoprim-Sulfamethoxazole | Pneumocystis jirovecii pneumonia (PCP) |
C. Anthelmintic Drugs
For Nematodes (Roundworms)
| Drug | Use |
|---|---|
| Mebendazole | Trichuris, Enterobius, hookworms, Ascaris |
| Albendazole | Broad-spectrum; STHs, larva migrans, cysticercosis |
| Ivermectin | Onchocerciasis, strongyloidiasis, scabies, lice |
| Pyrantel pamoate | Pinworms, hookworms |
| Diethylcarbamazine (DEC) | Lymphatic filariasis, tropical eosinophilia |
| Moxidectin | Onchocerciasis |
For Trematodes (Flukes)
| Drug | Use |
|---|---|
| Praziquantel | Schistosomiasis, liver flukes, most trematodes |
| Triclabendazole | Fasciola hepatica/gigantica (liver flukes) |
For Cestodes (Tapeworms)
| Drug | Use |
|---|---|
| Praziquantel | Taeniasis, neurocysticercosis |
| Albendazole | Neurocysticercosis, echinococcosis |
| Niclosamide | Taeniasis, diphyllobothriasis (not available in US) |
PART 2: Adverse Effects of Antiparasitic Drugs
1. Antimalarial Drugs - Adverse Effects
(Source: Tintinalli's Emergency Medicine, Goldman-Cecil Medicine)
| Drug | Minor Toxicity | Major Toxicity | Special Notes |
|---|---|---|---|
| Chloroquine | Nausea, vomiting, diarrhea, pruritus, postural hypotension, headache, dizziness | Retinopathy (prolonged use); hypotension/shock (parenteral) | Avoid in psoriasis, porphyria |
| Quinine / Quinidine | Cinchonism: tinnitus, headache, nausea, dizziness, visual disturbance | Cardiac dysrhythmias, hypotension, hypoglycemia, Coombs-positive hemolysis, neuromuscular paralysis | Contraindicated in cardiac disease |
| Mefloquine | Nausea, cramps, diarrhea, nightmares, bradycardia | Acute toxic confusional states, seizures, cardiac dysrhythmias | Avoid in neuropsychiatric disorders, seizure history |
| Primaquine | Nausea, vomiting, diarrhea, methemoglobinemia | Massive hemolytic anemia in G6PD deficiency; SLE/RA exacerbation | Contraindicated in G6PD deficiency and pregnancy |
| Doxycycline | GI disturbances, photosensitivity, vaginal candidiasis | Esophageal ulceration | Avoid in pregnancy and children <8 years |
| Artemether-Lumefantrine | Headache, dizziness, anorexia, asthenia | QT prolongation, severe skin rash | Avoid with other QT-prolonging drugs |
| Atovaquone-Proguanil | Nausea, vomiting, oral ulcers, headaches | Serious allergic reactions, alopecia | Contraindicated in pregnancy, CrCl <30 mL/min |
2. Antiprotozoal Drugs (Non-malarial) - Adverse Effects
Metronidazole / Tinidazole:
- Nausea, metallic taste, headache
- Peripheral neuropathy (prolonged use)
- Disulfiram-like reaction with alcohol
- Rare: seizures
Nifurtimox (Chagas disease):
- Frequent: anorexia, nausea, vomiting, weight loss, abdominal pain
- Neurologic: insomnia, restlessness, paresthesias, twitching, polyneuritis, seizures
- Long course (90-120 days) limits tolerability (Goldman-Cecil Medicine)
Benznidazole (Chagas disease):
- Generally better tolerated than nifurtimox
- Rash, peripheral neuropathy, granulocytopenia (Goldman-Cecil Medicine)
Miltefosine (Leishmaniasis):
- GI: nausea, vomiting, diarrhea (very common)
- Hepatotoxicity, nephrotoxicity
- Teratogenic - absolutely contraindicated in pregnancy
Pentamidine:
- Severe hypoglycemia (may be followed by hyperglycemia/diabetes)
- Nephrotoxicity, hepatotoxicity
- Hypotension (especially IV infusion)
- QT prolongation, torsades de pointes
Melarsoprol (Trypanosomiasis):
- Post-treatment reactive encephalopathy (5-10% mortality)
- Peripheral neuropathy, fever, thrombophlebitis
- Highly toxic - arsenical compound
Suramin:
- Urticaria, fever, nausea
- Nephrotoxicity (monitor urine)
- Peripheral neuropathy
- Adrenal insufficiency with prolonged use
Eflornithine:
- Bone marrow suppression (anemia, thrombocytopenia, leukopenia)
- GI symptoms, diarrhea
- Seizures
Sodium Stibogluconate (Leishmaniasis):
- QT prolongation, cardiac dysrhythmias (potentially fatal)
- Pancreatitis, hepatotoxicity
- Myalgia, arthralgia, chemical pancreatitis
3. Anthelmintic Drugs - Adverse Effects
(Source: Lippincott Illustrated Reviews: Pharmacology; Goodman & Gilman)
Mebendazole:
- Common: abdominal pain, diarrhea
- Rare but serious: convulsions in infants <1 year
- Severe: Stevens-Johnson syndrome / toxic epidermal necrolysis (when combined with metronidazole)
- Contraindicated in pregnancy (first trimester especially)
Albendazole:
- Generally well tolerated for short courses
- GI upset, headache, dizziness
- Prolonged use: hepatotoxicity (elevated liver enzymes), bone marrow suppression (leukopenia)
- Teratogenic - avoid in pregnancy
Ivermectin:
- Mazzotti reaction (in onchocerciasis): fever, headache, dizziness, somnolence, hypotension - caused by killing of microfilaria; severity correlates with parasite load; managed with antihistamines or steroids
- Generally well tolerated for other indications
Pyrantel pamoate:
- Mild: nausea, vomiting, diarrhea
- Well tolerated overall
Diethylcarbamazine (DEC):
- Mazzotti-like systemic reaction: fever, urticaria, lymphadenopathy
- In loiasis: risk of encephalopathy if microfilaremia is high
- Headache, malaise
Praziquantel:
- Common: dizziness, malaise, headache, GI upset
- Drug interactions: CYP3A4 inducers (phenytoin, rifampin, carbamazepine) markedly reduce plasma levels - concurrent use is contraindicated
- Contraindicated in ocular cysticercosis (destruction of parasite in eye causes irreversible damage)
Triclabendazole:
- Abdominal pain, hyperhidrosis, nausea
- Use with caution in pregnancy (insufficient safety data)
Niclosamide:
- Generally well tolerated
- Mild GI upset
- Avoid alcohol within 24 hours of use
Summary Quick Reference
| Drug Category | Key Adverse Effect to Remember |
|---|---|
| Chloroquine | Retinopathy (chronic), pruritus |
| Quinine | Cinchonism, hypoglycemia, cardiac arrhythmia |
| Primaquine | Hemolysis in G6PD deficiency |
| Mefloquine | Neuropsychiatric effects, nightmares |
| Metronidazole | Metallic taste, disulfiram-alcohol reaction |
| Nifurtimox | Polyneuritis, GI toxicity |
| Melarsoprol | Post-treatment reactive encephalopathy (fatal) |
| Pentamidine | Hypoglycemia, nephrotoxicity, QT prolongation |
| Ivermectin | Mazzotti reaction |
| Mebendazole | Stevens-Johnson with metronidazole |
| Praziquantel | Drug interactions via CYP3A4 |
| Albendazole | Hepatotoxicity (prolonged use), teratogen |
Sources:
- Goodman & Gilman's Pharmacological Basis of Therapeutics (Chapters 67-68)
- Lippincott Illustrated Reviews: Pharmacology (Chapter 36)
- Goldman-Cecil Medicine (Antiparasitic drugs section)
- Tintinalli's Emergency Medicine (Table 159-4: Adverse Effects of Antimalarial Drugs)
- Harrison's Principles of Internal Medicine, 22nd Ed.
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