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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 used to eradicate asymptomatic carriage (cysts) rather than invasive disease.
## Primary Indications
* Treatment of asymptomatic intestinal amoebiasis (cyst passers).
* Follow-up treatment after therapy with a tissue amebicide (e.g., metronidazole, tinidazole) for invasive amebic dysentery or liver abscess 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:* 1500 mg/day (three 500 mg doses).
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific guidelines exist due to limited systemic absorption. Use with caution in patients with severe hepatic impairment, as the drug is metabolized in the liver.
## Contraindications
* Hypersensitivity to diloxanide furoate.
## Adverse Effects
* **Common:** Flatulence, abdominal cramps, nausea, vomiting, and diarrhea.
* **Rare:** Pruritus, urticaria, and elevated serum transaminases.
## Key Drug Interactions
* Minimal systemic absorption limits significant drug-drug interactions. Always cross-reference via a clinical platform (e.g., Lexicomp or Micromedex) if the patient is on multiple medications.
## Monitoring
* Monitor for resolution of gastrointestinal symptoms.
* Stool microscopy should be repeated at completion of therapy to confirm clearance of *E. histolytica* cysts (usually 2–4 weeks post-treatment).
## Clinical Pearls
* **Not for Invasive Disease:** Diloxanide furoate has no activity against extra-intestinal amoebiasis (e.g., liver abscess). It must be used in conjunction with a systemic tissue amebicide if invasive disease was present.
* **Formulation:** It is an insoluble ester that is hydrolyzed in the gut to release active diloxanide.
* **Availability:** In many regions, this drug is considered an "orphan" or specialty medication and may require acquisition through tropical medicine pharmacies or national health stockpiles (e.g., CDC Drug Service in the US).
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**Educational Disclaimer:** This information is for educational purposes only. Always verify current, institution-specific prescribing information, weight-based calculations, and local infectious disease, pharmacy, and therapeutics (P&T) committee protocols before prescribing or administering medication.
