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# Diloxanide Furoate
## Overview
Diloxanide furoate is a luminal amebicide used to eliminate *Entamoeba histolytica* cysts from the intestinal lumen. It is poorly absorbed systemically and is primarily effective against asymptomatic cyst passers. It is not effective for invasive (extraintestinal) amebiasis.
## Primary Indications
* Treatment of asymptomatic *Entamoeba histolytica* cyst carriage.
* Follow-up treatment after therapy with a systemic tissue amebicide (e.g., metronidazole, tinidazole) in symptomatic patients to clear remaining intraluminal 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 daily dose: 1,500 mg (500 mg per dose).
## Dose Adjustments
* **Renal/Hepatic Impairment:** No formal standardized adjustments exist. Use with caution in patients with severe hepatic impairment as the drug is metabolized in the liver. Always consult local hospital protocols.
## Contraindications
* Hypersensitivity to diloxanide furoate.
* Infants (safety not established in very young populations).
## Adverse Effects
* **Common:** Flatulence, abdominal bloating, nausea, vomiting, and diarrhea.
* **Rare:** Urticaria, pruritus, and elevated hepatic enzymes.
## Key Drug Interactions
* Minimal systemic absorption limits significant systemic drug-drug interactions.
* **Warfarin:** Theoretical risk of altered INR; monitor closely if used concomitantly.
## Monitoring
* Monitor for resolution of gastrointestinal symptoms.
* Repeat stool microscopy (ova and parasite exam) should be performed at the end of therapy and intermittently thereafter to confirm clearance of cysts.
## Clinical Pearls
* **Not for Invasive Disease:** It has no activity against trophozoites in liver abscesses or systemic tissues. Always pair with a tissue-active agent (e.g., metronidazole) if the patient is symptomatic or has invasive disease.
* **Administration:** Administer with or after meals to minimize gastrointestinal upset.
* **Availability:** Diloxanide furoate is not reliably available in all countries (e.g., unavailable in the U.S. except via CDC Drug Service for select cases). Consider paromomycin as an alternative luminal agent where available.
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**Educational Disclaimer:** This information is for educational purposes only. Always verify clinical guidelines, hospital protocols, and the most current prescribing information (e.g., manufacturer label, CDC guidelines) before prescribing or administering medication.
