CHAPTER 53: CLINICAL PHARMACOLOGY OF THE ANTIHELMINTHIC DRUGS

Thiabendazole is much more toxic than

other benzimidazoles. Common adverse
OUTLINE effects include dizziness, anorexia,
I Introduction nausea, and vomiting.
II Types of Antihelminthic Drugs
A Antinematodal To make it short: Microtubule assembly inhibitor
i ALBENDAZOLE, MEBENDAZOLE AND
THIABENDAZOLE
ii IVERMECTIN IVERMECTIN
iii PIPERAZINE - A drug of choice for: threadworms and
iv PYRANTEL PAMOATE onchocerciasis
v DIETHYLCARBAMAZINE CITRATE
B Antitrematodal - An alternative drug against roundworms,
i OXAMNIQUINE pinworms and whipworms available only for oral
ii PRAZIQUANTEL administration in humans and is also rapidly
iii BITHIONOL absorbed
iv METRIFONATE
C Anticestodal
i NICLOSAMIDE ● Mechanism of Action:
○ GABA Agonist
● Side Effects:
Helminths is a general term for worms. Three main ○ In threadworm treatment side effects
groups of helminths: include: fatigue, dizziness, nausea,
vomiting, abdominal pain, and rashes
1. Nematodes - round words ○ In onchocerciasis treatment side effects
2. Trematodes - flukes include: Mazzotti reaction which is
3. Cestodes - tapeworms associated with pruritus, skin rash,
fever, fatigue, lymphadenopathy,
TYPES OF ANTIHELMINTHIC DRUGS arthralgia, tachycardia, hypotension,
edema, and abdominal pain
Antinematodal
● Drugs used in the treatment or control of ● Contraindications
nematode infestations ○ Best to avoid concomitant use of
Antitrematodal ivermectin with other drugs that
● Drugs used in the treatment or control of enhance GABA activity, eg, barbiturates,
trematode infestations benzodiazepines, and valproic acid
Anticestodal ○ Should not be used during pregnancy.
● Drugs used in the treatment or control of
cestode infestations Unsaon pagpagawas? Through peristalsis.
Malibang man gyud ka. So, kung ma-paralyze, dili
ANTINEMATODAL kalihok, once nga malibang ka, madala ra na sya sa
imong tae kay paralyze na sya This is a better way to
ALBENDAZOLE, MEBENDAZOLE AND eliminate your intestinal infestation, your worms. Imo ra
THIABENDAZOLE silang iparalyze, you may not try to kill the worms. Imo ra
- A drug of choice for: Ascariasis, Pinworms, silang iparalyze, dili na sila kalihok, once na malibang ka
Hookworms and whipworms Also a 1st line muagi ra na sila with the tae. Once you try to kill the
therapy for Neurocysticercosis and worm without paralyzing them, mairritate na sila, they
echinococcus. become erratic and they move everywhere- manggawas
sa ilong, baba. Makita ni siya sa mga patients labi na sa
● Mechanism of Action: mga bata nga daghan kaayong mga bitok unya
○ Inhibits formation of Microtubules butangan nimo ug irritants. These days, wala na kaayoy
antihelminthic preparation nga ingon ana lang. The worst
● Side effects: they can give nowadays is combined agents that
○ Both Albendazole and mebendazole are paralyzes the worm and agents that kill the worm-
nearly free of significant adverse effects combined na sya. Rather than just kill the worm without

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 CHAPTER 55: IMMUNOLOGY
paralyzing, kung di pa sila mamatay they could become ○ Caution is advised when using
erratic.This is a good drug because it only paralyzes the diethylcarbamazine in patients with
worm. hypertension or renal disease.

Arthralgia means joint pain. Arthro - means joint, algia - ANTITREMATODAL

pain = joint pain
Myalgia; myo = muscle, algia - pain = muscle pain Your trematodes are actually called your roundwormy
kay lingin man ni siya: ascaris, hookworms, pinworms
(round in nature, structure). Your kugwa or kigwa,
kanang sa lubot nga mangatol kaayo kay mga gagmay
na bitok, as in super gagmay, mura syag buhok
PIPERAZINE kagamay nga bitok unya katol gani kaayo. Usually
- An alternative drug for: the treatment of mangatol na sya at night around 9 in the evening
ascariasis because mao nay time na manggawas ng bitok sa lubot
nimo to lay their eggs. Important to know the life cycle of
● Mechanism of Action: your pinworm (kigwa) because this is the time nga
○ Blocks the acetylcholine at the manggawas sila sa imo nga anus. The problem is
myoneural junction pananglitan mangitlog sila magabie, ang bata pd or even
● Side Effects: adults nga naapektohan mangatol sa lubot dayon
○ In threadworm treatment side effects matagak sa inyo nga beddings, so mustay siya sa
include: fatigue, dizziness, nausea, beddings. The following morning, inyong iarrange inyong
vomiting, abdominal pain, and rashes beddings and iyabyab ang habol, mulutaw na inyong
○ In onchocerciasis treatment side mga eggs sa mga whipworm so manglutaw na ang egg
effects include: Mazzotti reaction which diha unya mainhale sa uban nga gapuyo sa balay then
is associated with pruritus, skin rash, mainfected pd sila. In cases of identification of a single
fever, fatigue, lymphadenopathy, household member nga naay infestation of this worm,
arthralgia, tachycardia, hypotension, everybody must be treated even if you dont show signs
edema, and abdominal pain and symptoms of whipworm infections, you must be
● Contraindications: treated. Anyway, single dose raman ni- either
○ should not be given to pregnant women, albendazole and mebendazole ang ihatag. Again, all
patients with impaired renal function, members of the household kay mutakod2 naman ni siya.
and those with a history of epilepsy or Once inhaled, matrap rani sa throat, sa mucus
chronic neurologic disease. membrane then matulon or ighan or throat clearing then
it will develop there dayon cycle develops again. Balik
Ascariasis - ordinary bitok we have; caused by ascaris balik ra.
lumbricoides
OXAMNIQUINE
PYRANTEL PAMOATE Alternative drug to praziquantel for treatment against:
- A drug of choice for: Ascariasis, pinworm, both mature and immature stages of S Manosi infections
hookworms and trichostrongylus orientalis ● Not effective against S. haematobium or S.
Japonicum
● Mechanism of Action: ● Oxamniquine has been effective in instances of
○ Neuromuscular Blocking Agent praziquantel resistance
● Side effects
○ often mild and last only for a short time, Mechanism of Action:
side effects includes headaches, GI ● Mechanism of Action is Unknown but it causes
symptoms and weakness contraction and paralysis of worms
● Contraindications Side effects:
○ Use with caution in liver dysfunction ● CNS symptoms (eg. dizziness and drowsiness)
and discoloration of urine
DIETHYLCARBAMAZINE CITRATE ● Seizures (rare)
- A drug of choice for: filariasis, loiasis, and Contraindications and Cautions:
tropical eosinophilia ● Caution in patients whose work or activity
● Mechanism of Action: requires mental alertness
○ Immunosuppressive effects ● Caution is advised when using oxamniquine in
patients with history of seizures
● Side effects:
○ generally mild and transient includes This is a liver fluke; ang schistosoma is a fluke. The
headache, malaise, anorexia, most common type of schistosoma in the Philippines is
weakness, nausea, vomiting, and your haematobium and japonicum. Praziquantel is the
dizziness. drug of choice.
● Contraindications

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 CHAPTER 55: IMMUNOLOGY
You get infested with schistosoma not infected kay mga - Effective as a prophylactic agent when given
worms man. Transmission would happen sa larva nga monthly to children in highly endemic area
musulod sa imoha nga tiil, kana btaw if weighed on mud,
inhabited by your schistosoma nga snail, ang vector niya
is a snail dayon murelease ang snails ug larva diha sa Mechanism of Action:
tubig dayon galakaw lakaw ka sa tubig nga naay larva, ● Cholinesterase inhibitor
then musulod sa imo nga tiil, sa imo nga pores, then Side effects:
travel sa imo nga liver. How to prevent: need nga dili mo ● Mild and transient
taak sa tubig and areas nga naay infestations with ● GI symptoms, dizziness, skin rash, nausea ,
nematodes. headache
Contraindications and Cautions:
PRAZIQUANTEL ● contraindicated in pregnant women
A drug of choice for: treatment of schistosome infections
of all species and other cestode and trematode ANTICESTODAL
infections
● Plasma concentrations increases when taken Your cestodes are actually your flatworms. These are
with high-carbohydrate meal or with cimetidine flatworms or tapeworms.

Mechanism of Action: NICLOSAMIDE

● Increases calcium permeability of parasite - A second line treatment against most tapeworm
infections
Side effects: Mechanism of Action:
● Mild and transient ● Adult worms are rapidly killed by inhibition of
● Headache, dizziness, drowsiness, GI symptoms oxidative phosphorylation
● Pruritus, fever, urticaria, rashes, arthralgia and Side effects:
myalgia (rare) ● Mild and transient
Contraindications: ● GI symptoms, diarrhea, vomiting, headache
● Caution is advised when using Praziquantel in Contraindications and Cautions:
patients doing activities that require physical ● Patients should not consume alcohol during
coordination and alertness (Eg. Driving) therapy
● Safety has not been established in pregnancy or
Mao ni akong giingon nga drug of choice for your for children younger than 2 years
schistosoma infection.
Oxidative phosphorylation is still for ATP production
BITHIONOL
- An alternative treatment to triclabendazole for
treatment of: fascioliasis (sheep liver fluke
- An alternative treatment to praziquantel for
treatment of: paragonimiasis (lung fluke
infection)
Mechanism of Action:
● Inhibits ATP production
Side effects:
● Mild and transient
● GI symptoms, headache, skin rash, nausea
Contraindications:
● Should be used with caution in children younger
than 8 years old

This case is of flatworms, these are generally liver fluke.

These are actually flukes in nature. This fascioliasis is
caused by your fasciolopsis buski. Your paragonimiasis
is caused by Paragonimus westermani or what you call
your lung fluke. I haven’t seen it here in the philippines
but just for the sake of discussion you may just mention
it.

If it inhibits your atp production wala siyay pagkaon

METRIFONATE
- An alternative for treatment of: Schistosoma
haematobium