Albendazole (Albenza)
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Class(es)
Anthelmintic
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Clinical use(s)
FDA approved: echinococcosis, neurocysticercosis.
Off-label/clinical use: Ascariasis, capillaria, clonorchiasis, giardiasis, microsporidia (HIV), hymenolepis nana infection, loa loa, trichuriasis. -
Mechanism(s) of action
Causes parasitic death by binding to colchicine-sensitive site of beta tubulin inhibiting their polymerization into microtubules.
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Key adverse effects
Abdominal pain, headache, abnormal liver function tests, N/V, SJS.
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Key drug/food interactions
Ginseng, carbamazepine.
Grapefruit. -
Special considerations
Available orally only. Most clinical uses for this drug are off-label. Poorly absorbed; food greatly increases absorption.
Atovaquone (Mepron)
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Class(es)
Antiprotozoal
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Clinical use(s)
FDA approved: Pneumocystis jirovecii.
Off-label/clinical use: Babesiosis, toxoplasma encephalitis, malaria, toxoplasmosis . -
Mechanism(s) of action
Atovaquone is structurally similar to ubiquinone, which inhibits the mitochondrial electron-transport chain at the site of the cytochrome bc 1 complex (complex III) in plasmodium species. This may ultimately inhibit the synthesis of nucleic acid and ATP.
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Key adverse effects
Rash, diarrhea, N/V, headache, insomnia, fever, cough, rhinitis.
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Key drug/food interactions
Ritonavir, rifamycins, efavirenz.
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Special considerations
Only available as oral suspension.
Tinidazole (Tindamax)
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Class(es)
Nitroimidazole, antiprotozoal, amebicide
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Clinical use(s)
FDA approved: Bacterial vaginosis, giardia lamblia, trichomoniasis.
Off-label/clinical use: Helicobacter pylori, nongonococcal. -
Mechanism(s) of action
The free nitro radical produced is responsible for antiprotozoal activity. The mechanism against giardia and entamoeba is unknown.
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Key adverse effects
Nausea, altered taste, candida vaginitis.
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Key drug/food interactions
Fluorouracil, disulfiram.
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Special considerations
Black box warning: Carcinogenicity has been seen in mice treated with another nitroimidzole.
Renal impairment: HD dosing—administer additional one-half of recommended dose if administered before HD.
Praziquantel (Biltricide)
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Class(es)
Anthelmintic
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Clinical use(s)
FDA approved: Clonorchiasis, schistosomiasis, opisthorchis viverrini.
Off-label/clinical use: Cysticercosis, hymenolepiasis, fasciolopsis buski, intestinal fluke, taenia, paragonimus. -
Mechanism(s) of action
Praziquantel is rapidly taken up by helminths and also appears to increase permeability of helminth's cell membrane, leading to a loss of intracellular calcium.
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Key adverse effects
Dizziness (36%) abdominal pain, N/V, fever.
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Key drug/food interactions
Rifampin, phenytoin, carbamazepine, dexamethasone.
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Special considerations
Available as oral tablet only. Do not chew—bitter taste can cause gagging or vomiting. Use is not recommended in patients with a history of seizures (may exacerbate condition).
Chloroquine (Aralen phosphate)
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Class(es)
Antimalarials and amebicides.
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Clinical use(s)
FDA approved: Malaria, malaria prophylaxis, extraintestinal amebiasis.
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Mechanism(s) of action
Therapeutic effect may result from DNA interaction. Its MOA against plasmodial activity is unknown.
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Key adverse effects
N/V/D, tinnitus (common), many cardiovascular effects (serious), retinal disorder (serious).
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Key drug/food interactions
Concurrent use with many QT prolonging drugs is contraindicated.
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Special considerations
Patient should not take antacids within 4 h before or after chloroquine phosphate. Contraindicated for indications other than acute malaria in the presence of retinal or visual field changes. Monitor ophthalmologic exams; baseline and every 3 months during prolonged therapy.