Nurses Compass
Drug Guide
Diethylcarbamazine Citrate
Classification
Therapeutic: Antiparasitic
Pharmacological: Microfilaricide
FDA Approved Indications
- Lymphatic filariasis caused by Wuchereria bancrofti, Brugia malayi, and Wuchereria loa.
- Loiasis caused by Loa loa.
Mechanism of Action
Diethylcarbamazine enhances the host's immune response to microfilariae and adult worms, and affects microfilariae and some adult filarial worms by altering their surface structure and reducing their motility, leading to their destruction.
Dosage and Administration
Adult: Typically 6 mg/kg/day divided into 2 or 3 doses for 12 days, but dosing varies by indication and patient factors.
Pediatric: Dosing based on body weight, generally 6 mg/kg/day divided into 2 or 3 doses for 12 days.
Geriatric: Use with caution; dose adjustments based on renal and hepatic function.
Renal Impairment: Adjust dosage as needed, consult renal function.
Hepatic Impairment: Use with caution; no specific dosing guidelines established.
Pharmacokinetics
Absorption: Approximately 80% absorbed from the gastrointestinal tract.
Distribution: Widely distributed, including into cerebrospinal fluid.
Metabolism: Partially metabolized in the liver.
Excretion: Primarily via urine, some in feces.
Half Life: Approximately 8-12 hours.
Contraindications
- Hypersensitivity to diethylcarbamazine.
- Onchocerciasis (due to risk of severe reactions).
Precautions
- Caution in patients with epilepsy, since seizures have been reported.
- Monitor for allergic reactions, especially in patients with other parasitic infections.
Adverse Reactions - Common
- Gastrointestinal discomfort, nausea, vomiting (Common)
- Dizziness or headache (Common)
Adverse Reactions - Serious
- Severe allergic reactions including angioedema, urticaria (Rare)
- Neurotoxicity manifesting as seizures or neuropathy (Rare)
Drug-Drug Interactions
- Caution with other neurotoxic or immunosuppressive agents.
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Assess for contraindications, such as hypersensitivity or other parasitic infections that might contraindicate use.
Diagnoses:
- Risk for allergic reactions
- Ineffective health management due to lack of knowledge.
Implementation: Administer with food to reduce gastrointestinal upset. Monitor patient for adverse reactions and efficacy.
Evaluation: Monitor for clearance of microfilariae and clinical improvement.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Report any allergic reactions or severe side effects.
- Attend all follow-up appointments for evaluation.
Special Considerations
Black Box Warnings:
- Potential for severe allergic reactions in patients with onchocerciasis.
- Caution in patients with epilepsy.
Genetic Factors: N/A
Lab Test Interference: May affect microfilaria counts.
Overdose Management
Signs/Symptoms: Nausea, vomiting, dizziness, allergic reactions, seizures.
Treatment: Supportive care; activated charcoal may be considered if ingestion is recent; no specific antidote.
Storage and Handling
Storage: Store at room temperature, 20-25°C (68-77°F).
Stability: Stable under recommended storage conditions.