Diethylcarbamazine: Treat Filarial Diseases

Diethylcarbamazine is an anthelmintic medication used to treat filarial diseases caused by parasitic worm infections. Filarial diseases are caused by microscopic thread-like worms (filariae) transmitted through the bites of blood-feeding insects. These worms infest various tissues in the body, including the lymphatic system, skin, eyes, liver, lung, chest, and abdominal cavities.

The exact mechanism by which diethylcarbamazine kills the filariae and microfilariae is not clear. Diethylcarbamazine is believed to immobilize the worm’s muscles and alter its skin membranes, enhancing the host immune system’s ability to kill the worms. Some of the drug reactions may be related to the intensity of the infection.

Filarial infections are prevalent in tropical regions. Diethylcarbamazine is not approved by the FDA and is not commercially available in the U.S. because these types of infections are rare in the country.

Diethylcarbamazine is available from the CDC Drug Service for patients via an investigational new drug (IND) protocol for the treatment of certain filarial diseases and for prophylactic use in persons at increased risk for loiasis.

Conditions treated with Diethylcarbamazine:

• Lymphatic filariasis of the lymphatic system caused by infection with Wuchereria bancrofti, Brugia malayi, or Brugia timori
• Tropical pulmonary eosinophilia caused by the above filariae entering the lungs
• Loiasis caused by Loa loa, also known as the eye worm
• Streptocerciasis caused by infection with Mansonella streptocerca
• Visceral larva migrans, also known as toxocariasis, caused by roundworms found in the intestines of dogs and cats like Toxocara canis and T. cati

Warnings

• Do not use in patients with hypersensitivity to diethylcarbamazine or any of its components
• Do not use to treat patients with onchocerciasis, also known as river blindness, caused by the parasite Onchocerca volvulus; can result in a severe potentially life-threatening allergic response known as Mazzotti reaction with symptoms including rashes, itching, fever, rapid heartbeat, and low blood pressure
• Brain damage (encephalopathy) and severe neurologic adverse reactions have been reported in the treatment of loiasis with high microfilarial load; microfilarial load should be reduced through blood filtering procedure or treatment with albendazole before initiating diethylcarbamazine
• Some symptoms of loiasis such as Calabar swelling and itching may increase briefly during treatment; using antihistamines and corticosteroids simultaneously during the first week of treatment may decrease these symptoms
• Use with caution in patients with cardiac disorders
• Use with caution in patients with renal impairment; dosage reduction recommended
• Diethylcarbamazine excretion is lower in alkaline urine; dose reduction may be required in patients on diets that promote alkalinization of the urine

Side Effects

Side effects of diethylcarbamazine include dizziness, headache, fever, joint pain, muscle pain, nausea, and vomiting. Less common side effects include abdominal pain, decreased appetite, diarrhea, cardiovascular collapse, orthostatic hypotension, rapid heart rate, dermatitis, itching, urticaria, and skin edema.

Consult your doctor if you experience any serious side effects or adverse reactions.

Dosages

Tablet

Adult:

Filarial Diseases

• Day 1: 50 mg orally after meals
• Day 2: 50 mg orally three times daily
• Day 3: 100 mg orally three times daily
• Day 4-14: 6 mg/kg/day orally divided three times daily

Loiasis

• Day 1: 50 mg orally after meals
• Day 2: 50 mg orally three times daily
• Day 3: 100 mg orally three times daily
• Day 4-21: 9 mg/kg/day orally divided three times daily

Streptocerciasis

• 6 mg/kg orally once daily for 14 days

Adult and Pediatric:

Tropical Pulmonary Eosinophilia

• 6 mg/kg/day divided three times daily for 14 days

Visceral Larva Migrans

• 6 mg/kg/day orally divided three times daily for 7-10 days

Pediatric:

Filarial Diseases

• Day 1: 1 mg/kg orally after meals
• Day 2: 1 mg/kg orally three times daily
• Day 3: 1-2 mg/kg orally three times daily
• Day 4-14: 6 mg/kg/day orally divided three times daily

Loiasis

• Day 1: 1 mg/kg orally after meals
• Day 2: 1 mg/kg orally three times daily
• Day 3: 1-2 mg/kg orally three times daily
• Day 4-21: 9 mg/kg/day orally divided three times daily

Overdose

• Seek immediate medical help or contact Poison Control in case of overdose.

Drug Interactions

Inform your doctor of all medications you are currently taking to avoid possible drug interactions.

• Diethylcarbamazine has no listed severe interactions with other drugs.
• Diethylcarbamazine has no listed serious interactions with other drugs.
• Diethylcarbamazine has moderate interactions with at least 71 different drugs.
• Diethylcarbamazine has mild interactions with at least 101 different drugs.

For more information on drug interactions, consult the RxList Drug Interaction Checker. Always consult your doctor or health care provider before making changes to your medication regimen.

Pregnancy and Breastfeeding

• Do not use diethylcarbamazine during pregnancy
• Avoid exposure to infection and infected areas during pregnancy
• Maternal filarial infection can be transmitted to the fetus; eradicate infection before pregnancy or administer treatment after delivery
• Avoid using diethylcarbamazine while breastfeeding as it is unknown if the drug is present in breast milk

Additional Information

• Diethylcarbamazine is not commercially available in the U.S.
• Contact the CDC for more information on obtaining diethylcarbamazine

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Summary

Diethylcarbamazine is an anthelmintic medication used to treat filarial diseases caused by parasitic worm infections. Side effects include dizziness, headache, fever, joint pain, muscle pain, nausea, and vomiting. Use with caution in patients with cardiac disorders or renal impairment. Do not use diethylcarbamazine during pregnancy or while breastfeeding. Diethylcarbamazine is not commercially available in the U.S.