Antihelminthic Drugs
Subclass, Drug Mechanism of Action
A benzimidazole carbamate
DOC for hydatid disease and
cysticercosis
Also used in the tx of
Albendazole pinworm and hookworm
infections, ascariasis,
trichuriasis, and
strongyloidiasis
Alternative to
triclabendazole for the tx of
Bithionol fascioliasis (sheep liver fluke)
and an alternative to
praziquantel for the tx of
paragonimiasis
A synthetic piperazine
derivative
Diethylcarbamazine DOC for filariasis, loiasis, and
tropical eosinophilia
Citrate Excreted in the urine as
unchanged drug and the N-
oxide metabolite
Tetracycline antibiotic
Doxycycline Significant macrofilaricidal
activity against W. bancrofti
DOC for strongyloidiasis and
onchoceriasis
A semisynthetic macrocyclic
lactone derived from the soil
Ivermectin actinomycete Streptomyces
avermitilis
Effects
Empty stomach when used
against intraluminal
parasites
Fatty meal when used
against tissue parasites
Drug should be taken after
meal
Excretion of the drug and its
metabolites is almost
exclusively in the feces
Paralyzes nematodes and
arthropods by intensifying y-
aminobutyric acid (GABA)-
mediated transmission of
signals in peripheral nerves
Clinical Applications P, T, I
Ascariasis, trichuriasis,
hookworm, and pinworm
infections
Hydatid disease
Neurocysticercosis
DOC for cutaneous larva
migrans
Wuchereria bancrofti, Brugia Leukocytosis is common and
malayi, Brugia timori, and eosinophilia may increase
Loa-loa with tx, proteinuria may also
Tropical eosinophilia occur, mazzoti reaction
Mansonella streptocerca
Onchoceriasis Mazzoti reaction
Strongyloidiasis
1
 A synthetic benzimidazole
Less than 10% of orally
Mebendazole administered mebendazole
is absorbed
An organophosphate
compound
Metrifonate Safe, low-cost alternative
(Trichlorfon) drug for the tx of
Schistosoma haematobium
infections
A salicylamide derivative
nd
2 -line drug for the tx of
most tapeworm infections
Niclosamide
A semisynthetic
tetrahydroquinolone
Oxamniquine An alternative to
praziquantel for the tx of S.
mansoni infections
An alternative for the tx of
ascariasis, with cure rates
Piperazine over 90% when taken for 2
days, but it is not
recommended for other
helminth infections
A synthetic isoquinolone-
pyrazine derivative
Praziquantel Effective in the tx of
schistosome infections of all
species and most other
Excreted mostly in the urine,
principally as decarboxylated
derivatives
Absorption is increase if the
drug is ingested with a fatty
meal
Clearance appears to be
through nonenzymatic
transformation to
dichlorvos, its active
metabolite
Active against both mature
and immature stages of S.
mansoni but does not
appear to be cercaricidal
Piperazine causes paralysis
of ascaris by blocking
acetylcholine at the
myoneural junction; live
worms are expelled by
peristalsis
Taken with liquie after a
ameal; they should be
swallowed without chewing
because their bitter taste
can induce retching and
Ascariasis, trichuriasis,
hookworm and pinworm
infections, and some
helminthic infection
Taenia saginata, Taenia
solium, and
Diphyllobothrium latum
Hymenolepis diminuta and
Dipylidium caninum
Intestinal fluke infections
Fasciolopsis buski,
Heterophyes heterophyes,
and Metagonimus
yokogawai
Safe and effective in all
stages of S. mansoni disease,
including advanced
hepatosplenomegaly
DOC for H. nana infections
and the first drug to be
highly effective
Schistosomiasis,
clonorchiasis,
2
 trematode and cestode
infections, including
cysticercosis
DOC for all forms of
schistosomiasis
A tetrahydropyrimidine
derivative
Pyrantel Pamoate/ Broad-spectrum
antihelminthic highly
Oxantel Pamoate effective for the tx of
pinworm, ascaris, and
Trichostrongylus orientalis
infections
A benzimidazole compound
An alternative to ivermectin
or albendazole for the tx of
strongyloidiasis and
Thiabendazole cutaneous larva migrans
vomiting opisthorchiasis,
paragonimiasis, taeniasis,
diphyllobothriasis,
neurocysticercosis
Hymenolepis nana
Hydatid disease
Depolarizing muscular
blocking (Ach) agents
Drug is almost completely Irreversible liver failure and
metabolized in the liver to fatal Stevens-Johnson
the 5-hydroxy form; 90% is syndrome have been
excreted in the urine in 48 reported
hours, largely as the
glucuronide or sulfonate
conjugate