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# Diloxanide Furoate
## Overview
Diloxanide furoate is a luminal amebicide used primarily to treat asymptomatic *Entamoeba histolytica* infections. It acts by inhibiting the hatching of cysts and the multiplication of trophozoites within the intestinal lumen. It has no effect on extra-intestinal (systemic) amebiasis.
## Primary Indications
* Treatment of asymptomatic cyst passers of *Entamoeba histolytica*.
* Used as a follow-up ("luminal") agent after treatment of symptomatic invasive amebiasis (e.g., following paromomycin or metronidazole therapy).
## Adult Dosing
* **Standard Regimen:** 500 mg orally three times daily for 10 days.
## Pediatric Dosing
* **Standard Regimen:** 20 mg/kg/day divided into three doses orally for 10 days.
* Maximum dosage: 500 mg per dose (1,500 mg/day).
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific guidelines exist. Use with caution in patients with severe hepatic impairment, as the drug is metabolized in the liver, though systemic absorption is minimal.
## Contraindications
* Hypersensitivity to diloxanide furoate.
* Severe hepatic disease (relative contraindication due to metabolism).
## Adverse Effects
* **Gastrointestinal:** Flatulence (highly common), nausea, vomiting, abdominal cramps, diarrhea.
* **Dermatologic:** Urticaria, pruritus.
* **Other:** Rare reports of diplopia, dizziness, or headache.
## Key Drug Interactions
* **Clinical Significance:** Minimal systemic absorption limits significant drug-drug interactions.
* **Pharmacokinetic considerations:** No major P450 interactions reported; however, efficacy may be affected by drugs that significantly alter intestinal transit time.
## Monitoring
* Monitor for resolution of gastrointestinal symptoms if treating mild symptomatic carriage.
* Stool microscopy should be repeated 2–4 weeks after completion of therapy to confirm clearance of cysts.
## Clinical Pearls
* **Invasive Disease:** Diloxanide furoate is **ineffective** for extra-intestinal amebiasis (e.g., liver abscess). Always ensure tissue-invasive amebiasis is treated with a systemic agent (e.g., metronidazole, tinidazole) first.
* **Availability:** Availability is restricted in many developed countries (often accessible via specialized tropical medicine pharmacies or CDC "orphan drug" programs).
* **Compliance:** The 10-day course is critical for complete eradication; document compliance to prevent recurrence.
* **Mechanism:** It is a dichloroacetamide derivative.
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**Disclaimer:** This information is for educational purposes for healthcare professionals. Dosing protocols can vary by region and individual patient factors. Always verify the current prescribing information or consult an infectious disease specialist and local pharmacy guidelines before prescribing or administering.
