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# Diloxanide furoate
## Overview
Diloxanide furoate is a luminal amebicide that acts by destroying *Entamoeba histolytica* cysts in the gastrointestinal tract. It is poorly absorbed systemically and is ineffective against invasive (tissue) extraluminal amebiasis.
## Primary Indications
Treatment of asymptomatic intestinal amoebiasis (cyst passers). It is often used as a follow-up agent after treatment with a systemic 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.
*Note: Maximum daily dose should not exceed 1500 mg.*
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific guidelines exist; use caution in severe hepatic impairment due to potential biliary excretion.
* **Elderly:** Use lowest effective dose; monitor for gastrointestinal tolerance.
## Contraindications
Hypersensitivity to diloxanide furoate. Safety in pregnancy has not been established; use only if clearly indicated and benefit outweighs risk.
## Adverse Effects
* **Common:** Flatulence, abdominal cramps, nausea, vomiting, and diarrhea.
* **Rare:** Urticaria, pruritus, and elevated alkaline phosphatase levels.
## Key Drug Interactions
There are no major clinically significant pharmacokinetic drug interactions documented due to its minimal systemic absorption.
## Monitoring
* Efficacy: Repeat stool microscopy for *E. histolytica* cysts 2–4 weeks after completion of therapy to confirm clearance.
* Tolerability: Monitor for persistent gastrointestinal distress.
## Clinical Pearls
* **Not for Invasive Disease:** Diloxanide furoate alone cannot treat amebic liver abscess or severe invasive colitis. It must be paired with a systemic tissue amebicide if invasive disease was present.
* **Administration:** Administer with or after food to improve gastrointestinal tolerance.
* **Availability:** Availability is restricted in many countries (e.g., United States) and may require sourcing through specialized import programs or tropical disease centers (e.g., CDC Drug Service). Always confirm availability via local pharmacy services.
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*Disclaimer: This information is for educational purposes only. Clinical guidelines and availability vary by region. Always verify dosages and indications against current institutional protocols, local formulary guidelines, and the manufacturer’s package insert before prescribing or administering medication.*
