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# Diloxanide furoate
## Overview
Diloxanide furoate is a luminal amebicide that acts directly on *Entamoeba histolytica* in the intestinal lumen. It is poorly absorbed systemically and is primarily indicated for the treatment of asymptomatic intestinal carriage of *E. histolytica* (cyst passers). It is not effective for invasive amebic disease (e.g., amebic liver abscess or tissue-invasive colitis).
## Primary Indications
Treatment of asymptomatic intestinal infection with *Entamoeba histolytica* (cyst passers). Often used in combination with a tissue amebicide (e.g., metronidazole) to treat symptomatic amebiasis and eradicate 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.
## Dose Adjustments
* **Renal/Hepatic Impairment:** No formal dosage adjustments are established. Use caution in patients with severe hepatic impairment as systemic absorption, though limited, may occur.
## Contraindications
* Known hypersensitivity to diloxanide furoate.
* *Note:* Use with extreme caution (or avoid) in pregnancy unless benefit outweighs risk; safety data is limited.
## Adverse Effects
* **Common:** Flatulence (frequent), nausea, vomiting, abdominal cramps/pain, diarrhea.
* **Rare:** Urticaria, pruritus, transient elevation of liver enzymes.
## Key Drug Interactions
There are no major, well-documented clinically significant drug-drug interactions. However, as with any intestinal agent, consider potential impacts on oral contraceptive efficacy if significant diarrhea occurs.
## Monitoring
* Monitor for resolution of gastrointestinal symptoms.
* Follow-up stool examinations (ova and parasite testing) should be performed to confirm clearance of the organism after completion of therapy.
## Clinical Pearls
* **Luminal Agent Only:** Diloxanide furoate does not treat extra-intestinal amebiasis. In patients with invasive *E. histolytica* disease, it must be paired with tissue-active agents (e.g., metronidazole, tinidazole).
* **Administration:** Should be taken with meals to improve gastrointestinal tolerance.
* **Availability:** Availability varies significantly by region; it is often unavailable in the United States and may require procurement through specialized tropical medicine pharmacies or the CDC Drug Service.
* **Therapy Assessment:** Ensure the diagnosis is *E. histolytica* rather than *E. dispar* (which is non-pathogenic), as the latter does not require treatment.
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*Disclaimer: This information is for educational purposes only. Always verify current prescribing information, institutional protocols, and availability with clinical guidelines or a pharmacist before prescribing or administering medication.*
