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# Diloxanide furoate
## Overview
Diloxanide furoate is a luminal amebicide that acts by destroying *Entamoeba histolytica* trophozoites in the intestinal lumen. It is poorly absorbed systemically and is not effective against extraintestinal amebiasis (e.g., liver abscess).
## Primary Indications
* Asymptomatic intestinal colonization (cyst passers) with *Entamoeba histolytica*.
* Follow-up treatment after therapy for invasive amebiasis (to eliminate remaining luminal cysts).
## Adult Dosing
* **Standard dose:** 500 mg orally three times daily for 10 days.
## Pediatric Dosing
* **Standard dose:** 20 mg/kg/day divided into three doses for 10 days.
* **Note:** Total daily dose should not exceed 1500 mg.
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific manufacturer guidelines exist. Use with caution in patients with severe hepatic impairment, though systemic absorption is minimal.
## Contraindications
* Known hypersensitivity to diloxanide or any component of the formulation.
## Adverse Effects
* **Common:** Flatulence (highly frequent), nausea, vomiting, abdominal cramps, and pruritus.
* **Rare:** Urticaria, diarrhea, and dizziness.
## Key Drug Interactions
* Minimal clinical interaction data due to limited systemic absorption.
* Theoretical: Potential for interaction with intestinal flora, though not clinically established.
## Monitoring
* Monitor for resolution of gastrointestinal symptoms.
* Repeat stool microscopy for ova and parasites 2–4 weeks after completion of therapy to confirm clearance.
## Clinical Pearls
* **Combined Therapy:** It is mandatory to treat invasive amebiasis (e.g., dysentery or liver abscess) with a systemic tissue amebicide (e.g., metronidazole or tinidazole) *followed by* diloxanide furoate to eradicate luminal cysts.
* **Availability:** Frequently difficult to source in the United States; obtainment may require coordination with the CDC’s Drug Service.
* **Administration:** Take with or without food. If gastrointestinal upset occurs, administration with food may improve tolerability.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice guidelines and drug availability may vary by region. Always verify specific dosing, safety, and drug availability through current institutional protocols, official package inserts, or resources such as the CDC Drug Service or UpToDate before prescribing or administering medication.
