CLINIC PHARMACOLOGIC

APPROACHES TO DRUG
SELECTING IN
HELMINTHIASIS
Dzhakubekova A.
General approaches to drug
selecting in helminthiasis
The 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 helminthiasis
Specific 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 Helminthiasis
Nematodiasis



Ascariasis Fillariasis
Ancylostomiasis Trichocephaliasis
Enterobiasis Trichinosis
Strongyliasis Toxocariasis
Trichuriasis
Classification of Helminthiasis
Trematodiasis



Opisthorchiasis
Clonorchiasis
Paragonomiasis
Fascioliasis
Schistosomiasis
Classification of Helminthiasis
Cestodiasis



Taeniasis
Taeniarhynchiasis
Diphillobotriasis
Hymenolepiasis
Echinococcosis
Drug Therapy of Nematodiasis




Ascariasis
Fillariasis
Ancylostomiasis
Trichocephaliasis
Enterobiasis
Trichinosis
Strongyliasis
Toxocariasis
Trichuriasis
Pyrantel
Mebendazole
Thiabendazole
Albendazole
Flubendazole
Ivermectine
Diethylcarbamazine
Drug Therapy of Trematodiasis




Opisthorchiasis
Clonorchiasis
Paragonomiasis
Fascioliasis
Schistosomiasis
Praziquantel
Triclabendazole
Bithionol
Oxamniquine
Drug Therapy of Cestodiasis




Taeniasis
Taeniarhynchiasis
Diphillobotriasis
Hymenolepiasis
Echinococcosis
Praziquantel
Niclosamide
Albendazole
Drug selecting in Ascariasis
First choice drug - pyrantel pamoate

Second choice drugs - levamisol,
mebendazol, albendazol

Drug selecting in
Ancylostomidiasis
First choice drug - pyrantel pamoate

Second choice drugs - levamisol,
mebendazol, albendazol

Drug selecting in Enterobiasis
First choice drug - pyrantel pamoate

Second choice drugs - mebendazol,
albendazol

Drug selecting in
Trichocephaliasis
First choice drug - mebendazol

Second choice drugs - albendazol

Drug selecting in
Strongyloidiasis
First choice drug - albendazol

Second choice drugs - ivermectine

PYRANTEL PAMOATE
Pyrimidine derivative
Active against only nematodes
Depolarizing skeletal muscle relaxant
Poorly absorbed in GIT, excreted
predominantly in feces
Adverse effects: abdominal pain, anorexia,
nausea, vomiting, headache, vertigo,
drowsiness, rash
PYRANTEL PAMOATE:
WARNINGS
Pregnancy: NO adequate clinical trials, not
recommended to use in pregnants
Breastfeeding: NO adequate clinical trials,
not recommended to use in lactation
Hepatic insufficiency: use with caution
Drug interaction: dont combine with
piperazine due to pharmacodynamic
antagonism

PYRANTEL PAMOATE:
information for patients
Use 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, dizziness
In enterobiasis: its required to treat all family members
for complete eradication
MEBENDAZOLE
Benzimidazole derivative
Broad spectrum of antihelmintic action
Inhibits tubuline synthesis, glucose utilizing and
ATP formation in intestinal parietal cells
Poorly absorbed in GIT , bioavailability is
increased by fat food, excreted predominantly in
feces
Adverse effects: abdominal pain, diarrhea, nausea,
vomiting, headache, vertigo, neatropenia, rash
MEBENDAZOLE: WARNINGS
Pregnancy: in animals teratogenic effect was
observed, NO adequate clinical trials, not
recommended to use in pregnants
Breastfeeding: NO adequate clinical trials, not
recommended to use in lactation
Children: not recommended to use in children
under 2 years

MEBENDAZOLE: WARNINGS
Hypersensitivity: cross-hypersensitivity to other
benzimidazole derivatives
Hepatic insufficiency: cumulative effect, use with
caution
GIT inflammatory diseases: bioavailability is
increased, use with caution, dont use in ulcerative
colitis and Crones disease
Drug interaction: carbamazepine induces the
metabolism and decreases antihelmintic activity of
mebendazole
MEBENDAZOLE: information for patients
Chew 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 effects
CNS: 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 patients
Take 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 interaction
Increased antihelmintic activity with:
Dexamethasone
Praziquantel
Cimetidine

MONITORING OF SAFETY OF
BENZIMIDAZOLES
Hepatic and renal functions
White blood cells number
Adverse reactions
Dont use in pregnants, recommend to use
contraceptives during and for 1 month after
therapy
PRAZIQUANTEL: WARNINGS
Isoquinoline derivative
Broad spectrum of antihelmintic action
Produces skeletal muscle contraction and paralysis
Well-absorbed in GIT, 80% binding to plasma
proteins, penetrates through blood-brain barrier, in
breast milk, excreted predominantly in urine
Adverse effects: abdominal pain, diarrhea, nausea,
vomiting, headache, vertigo, neutropenia,
dizziness, convulsions, rash, angioedema, fever
PRAZIQUANTEL: WARNINGS
Pregnancy: in animals teratogenic effect was
observed, NO adequate clinical trials, not
recommended to use in pregnants
Breastfeeding: NO adequate clinical trials, not
recommended to use in lactation
Children: not recommended to use in children
under 4 years

PRAZIQUANTEL: WARNINGS
Hepatic insufficiency: cumulative effect, use with
caution
CNS diseases: the risk of neurotoxicity is increased
Drug interaction: phenitoin, carbamazepine,
dexamethasone decrease praziquantel plasma
concentration, cimetidine increases praziquantel
plasma concentration, chloroquine decreases
praziquantel bioavailability
PRAZIQUANTEL: information for patients
Tablets 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: WARNINGS
Semisynthetic broad spectrum antihelmintic agent
Stimulates GABA-receptors in skeletal muscle and
produces paralysis
Well-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 feces
Adverse effects: abdominal pain, nausea,
weakness, vertigo, tremor, conunctivitis, rash,
angioedema, fever
IVERMECTIN: WARNINGS
Pregnancy: in animals teratogenicity was
observed, NO adequate clinical trials, not
recommended to use in pregnants
Breastfeeding: NO adequate clinical trials, not
recommended to use in lactation
Children: not recommended to use in children
under 5 years
Geriatrics: use with caution in elderly patients
due to hepatic disorders

IVERMECTIN: WARNINGS
Hepatic insufficiency: cumulative effect, use
with caution
CNS diseases: the risk of neurotoxicity is
increased
Drug interaction: No reports
IVERMECTIN: information for patients
Take 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