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# Diloxanide furoate
## Overview
Diloxanide furoate is a luminal amebicide used primarily to eradicate *Entamoeba histolytica* cysts from the intestinal lumen. It is poorly absorbed from the GI tract, making it ineffective for invasive (extra-intestinal) amebiasis.
## Primary Indications
* Treatment of asymptomatic intestinal *Entamoeba histolytica* carriage (cyst passers).
* Follow-up treatment after therapy with a systemic tissue amebicide (e.g., metronidazole or tinidazole) for symptomatic invasive amebiasis.
## Adult Dosing
* 500 mg orally three times daily for 10 days.
## Pediatric Dosing
* 20 mg/kg/day orally in three divided doses for 10 days.
## Dose Adjustments
* **Renal/Hepatic Impairment:** No formal dosage adjustments are established; however, use caution in severe hepatic impairment, as the drug is metabolized in the liver. Clinically, systemic absorption is minimal, limiting the risk of toxicity.
## Contraindications
* Hypersensitivity to the drug or its components.
## Adverse Effects
* **Common:** Flatulence.
* **Less Common:** Nausea, vomiting, abdominal cramps, pruritus, and urticaria.
## Key Drug Interactions
* Diloxanide furoate has a limited potential for systemic drug-drug interactions due to its low bioavailability.
* Always check specific electronic clinical decision support tools (e.g., Lexicomp or Micromedex) if patient is on complex regimens, though none are typically considered clinically significant in standard practice.
## Monitoring
* Monitor for symptom resolution and eradication of cysts in stool samples (typically 2–4 weeks after treatment).
* Assess for GI tolerance during the 10-day course.
## Clinical Pearls
* **Not for invasive disease:** It does not treat liver abscesses or tissue invasion. If symptoms of invasive amebiasis are present, it must be paired with tissue-acting agents like metronidazole.
* **Compliance:** The 10-day duration is essential to ensure complete eradication of luminal cysts and prevent recurrence.
* **Availability:** In many regions (including the US), diloxanide furoate is considered an orphan drug or must be obtained via special request (e.g., CDC Drug Service); paromomycin is often used as a more readily available alternative for luminal amebiasis.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice guidelines vary by institution and region. Always verify specific dosing, safety, and contraindications by consulting current FDA-approved labeling, local institutional protocols, or authoritative resources like the CDC's Yellow Book or the Sanford Guide before prescribing.
