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# Diloxanide Furoate
## Overview
Diloxanide furoate is a luminal amebicide used primarily to eliminate *Entamoeba histolytica* cysts from the intestinal lumen in asymptomatic cyst passers. It is poorly absorbed from the gastrointestinal tract, allowing it to exert high local concentrations in the colon. It is **not** effective against invasive (tissue) amebic disease (e.g., amebic liver abscess).
## Primary Indications
* Treatment of asymptomatic intestinal colonization (*E. histolytica*).
* Follow-up therapy after treatment of invasive amoebiasis (to clear luminal cysts).
## Adult Dosing
* **Standard dose:** 500 mg orally 3 times daily for 10 days.
## Pediatric Dosing
* **Standard dose:** 20 mg/kg/day orally in 3 divided doses for 10 days.
* *Note:* Maximum daily dose typically capped at 1500 mg/day (500 mg three times daily).
## Dose Adjustments
* **Renal/Hepatic Impairment:** No specific adjustment guidelines exist due to minimal systemic absorption; however, use with caution in patients with severe hepatic impairment due to limited pharmacokinetic data.
## Contraindications
* Hypersensitivity to diloxanide furoate.
* Severe hepatic disease (relative contraindication).
## Adverse Effects
* **Common:** Flatulence (frequently reported), nausea, vomiting, abdominal cramps, and diarrhea.
* **Rare:** Urticaria, pruritus, and rarely, elevated transaminases.
## Key Drug Interactions
* Minimal systemic absorption limits significant systemic drug-drug interactions.
* May theoretically increase the effects of some oral medications by altering gastrointestinal motility or flora, but clinically significant interactions remain undocumented.
## Monitoring
* Monitor for resolution of gastrointestinal symptoms.
* Repeat stool microscopy (ova and parasites) 2–4 weeks after treatment to confirm clearance of cysts.
* If symptoms persist or clinical status worsens, investigate for potential treatment failure or persistent tissue infection.
## Clinical Pearls
* **Luminal Agent Only:** Never use as monotherapy for symptomatic or invasive amoebiasis (e.g., dysentery or liver abscess). Must be used in conjunction with a systemic tissue amebicide (e.g., metronidazole, tinidazole).
* **Compliance:** The 10-day course must be completed to ensure eradication of luminal cysts.
* **Availability:** Availability varies significantly by country; it may be classified as an investigational drug or require special access protocols in some regions (e.g., CDC Drug Service in the U.S.).
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**Educational Disclaimer:** This information is for educational purposes and does not substitute for professional medical judgment. Always verify current prescribing information, institutional protocols, and local drug availability before prescribing or administering medication.
