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# Diloxanide furoate
## Overview
Diloxanide furoate is a luminal amebicide used primarily to eradicate *Entamoeba histolytica* cysts from the intestinal tract. It is poorly absorbed from the GI tract, which confines its action to the intestinal lumen. It is often used in combination with a tissue amebicide (e.g., metronidazole or tinidazole) for the treatment of invasive amebiasis.
## Primary Indications
Treatment of asymptomatic *E. histolytica* colonization (cyst passers) and as a follow-up treatment after therapy for invasive amebiasis (to eliminate remaining luminal cysts).
## Adult Dosing
500 mg orally three times daily for 10 days.
## Pediatric Dosing
20 mg/kg/day orally, divided into three doses, for 10 days. Maximum dose should not exceed the adult dosage of 500 mg three times daily.
## Dose Adjustments
There are no established guidelines for hepatic or renal impairment; however, since the drug is minimally absorbed and primarily excreted in feces, dosage adjustments are generally not required. Use with caution in patients with severe hepatic disease due to the potential for systemic absorption of metabolic products.
## Contraindications
Hypersensitivity to diloxanide furoate or its components. Use caution in patients with significant hepatic impairment.
## Adverse Effects
* **Common:** Flatulence, nausea, vomiting, abdominal cramps, and diarrhea.
* **Less Common:** Pruritus, urticaria, and dizziness.
* **Rare:** Reversible increase in serum aminotransferases.
## Key Drug Interactions
There are no major clinically significant drug-drug interactions documented for diloxanide furoate. However, because it is an investigational or niche-market drug in some regions, comprehensive interaction studies are limited.
## Monitoring
* Monitor stool samples for the clearance of *E. histolytica* cysts after the completion of the 10-day course.
* Monitor for resolution of gastrointestinal symptoms.
## Clinical Pearls
* **Not for Invasive Disease:** Diloxanide furoate is ineffective against extra-intestinal amebiasis (e.g., hepatic abscesses). If symptomatic invasive disease is present, it must be used only after or in conjunction with a systemic amebicide (e.g., metronidazole).
* **Compliance:** Adherence to the full 10-day course is critical to prevent recurrence of luminal carriage.
* **Availability:** Diloxanide furoate is often difficult to source in many countries and may require procurement through specialized tropical disease centers or import programs (e.g., CDC Drug Service in the United States).
* **Local Protocol:** Always verify availability and specific treatment guidelines with your local infectious disease department or institutional formulary, as dosing and procurement pathways may vary by region.
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**Educational Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Consult current prescribing information, institutional protocols, and official guidelines (such as the CDC or WHO) before prescribing or administering medication.
