Usage
- This combination medication is primarily prescribed for the treatment of diarrhea and dysentery, especially caused by Entamoeba histolytica (amoebiasis) and Giardia lamblia (giardiasis). It’s effective against both intestinal and extraintestinal amoebiasis. It can also be used for other parasitic infections in the gastrointestinal tract.
- Pharmacological Classification: Antiprotozoal, Antibacterial, Anti-flatulent.
- Mechanism of Action: Metronidazole acts as an antibiotic and antiprotozoal agent, disrupting DNA synthesis in anaerobic bacteria and protozoa. Diloxanide furoate is an amoebicide targeting Entamoeba histolytica trophozoites in the intestine. Dimethicone, an anti-flatulent, reduces the surface tension of gas bubbles, aiding their expulsion and relieving bloating.
Alternate Names
- Diloxanide furoate + Metronidazole + Dimethicone.
- Brand Names: Mylone. Several other brand names exist depending on the manufacturer.
How It Works
- Pharmacodynamics: Metronidazole disrupts DNA synthesis in anaerobic microorganisms. Diloxanide acts within the intestinal lumen to eliminate amoebas. Dimethicone reduces gas bubble surface tension, facilitating their expulsion and relieving bloating.
- Pharmacokinetics:
- Metronidazole: Well-absorbed orally, metabolized in the liver, excreted in urine and feces.
- Diloxanide furoate: Absorbed from the GI tract, hydrolyzed to diloxanide, conjugated, and excreted in urine.
- Dimethicone: Not systemically absorbed; acts locally in the GI tract and is eliminated in feces.
- Mode of Action: Metronidazole inhibits DNA synthesis. Diloxanide’s exact mechanism is unclear but it is directly amoebicidal. Dimethicone is not absorbed; it works locally in the gut lumen to reduce gas formation and aid expulsion.
- Elimination Pathways: Primarily renal for metronidazole and diloxanide; dimethicone is eliminated in feces.
Dosage
Standard Dosage
Adults: One tablet (containing 200-400 mg metronidazole, 250-500 mg diloxanide furoate, and 100 mg dimethicone) three times daily for 5-10 days.
Children: Dosage should be determined by a pediatrician based on weight or age. A common recommendation is 20 mg/kg daily of diloxanide, divided into three doses for 10 days.
Special Cases:
- Elderly Patients: Dose adjustments may be needed due to age-related decline in hepatic and renal function.
- Patients with Renal Impairment: Dose adjustments may be needed based on the degree of impairment.
- Patients with Hepatic Dysfunction: Use with caution; dose adjustment may be required, especially in severe liver disease.
- Patients with Comorbid Conditions: Consider interactions and contraindications with other conditions.
Clinical Use Cases
The primary use of this combination is for gastrointestinal infections. There are no standard dosage guidelines for intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.
Dosage Adjustments
Dose modifications may be necessary based on individual patient factors like renal or hepatic impairment.
Side Effects
Common Side Effects
- Nausea, headache, dry mouth, metallic taste, abdominal pain, diarrhea, flatulence, stomach upset.
Rare but Serious Side Effects
- Seizures, peripheral neuropathy (numbness, tingling), allergic reactions (rash, itching, swelling, difficulty breathing), darkened urine.
Long-Term Effects
- Long-term use of metronidazole may rarely cause peripheral neuropathy.
Adverse Drug Reactions (ADR)
- Severe allergic reactions, seizures, and severe peripheral neuropathy require immediate medical attention.
Contraindications
- Hypersensitivity to any component; neurological disorders (e.g., epilepsy, multiple sclerosis); severe liver disease; Cockayne syndrome.
Drug Interactions
- Alcohol (disulfiram-like reaction); disulfiram; anticoagulants (e.g., warfarin); antimanic agents (e.g., lithium); anticonvulsants (e.g., phenytoin, phenobarbital); cimetidine; busulfan, fluorouracil, mycophenolate. Several other drugs may interact; consult drug interaction resources for a full list.
Pregnancy and Breastfeeding
- Pregnancy: Safety not fully established. Use only if clearly needed and under close medical supervision.
- Breastfeeding: Limited information available. Consult a physician before use.
Drug Profile Summary
- Mechanism of Action: Metronidazole: Disrupts DNA synthesis. Diloxanide: Luminal amoebicide. Dimethicone: Anti-flatulent.
- Side Effects: Nausea, headache, dry mouth, metallic taste, abdominal pain, diarrhea.
- Contraindications: Hypersensitivity, neurological disorders, severe liver disease.
- Drug Interactions: Alcohol, disulfiram, anticoagulants, lithium, anticonvulsants.
- Pregnancy & Breastfeeding: Consult a physician before use.
- Dosage: Adults: One tablet TDS for 5-10 days. Pediatric: Consult a pediatrician.
- Monitoring Parameters: Liver function tests, complete blood count, neurological examination if long-term use.
Popular Combinations
This combination itself is commonly used.
Precautions
- General Precautions: Assess for hypersensitivity, liver/renal function, and neurological status.
- Specific Populations: Consult a physician for pregnant or breastfeeding women, children and elderly patients may require dosage adjustments.
- Lifestyle Considerations: Avoid alcohol during treatment and for a few days after.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Diloxanide + Dimethicone + Metronidazole?
A: Adults: One tablet (strength as prescribed) three times a day for 5-10 days. Pediatric dosage should be determined by a pediatrician.
Q2: What are the common side effects?
A: Nausea, dry mouth, headache, metallic taste, flatulence, abdominal discomfort, diarrhea.
Q3: Can this drug be used during pregnancy?
A: The safety during pregnancy isn’t fully established. Use only if clearly needed and under close medical supervision.
Q4: Are there any drug interactions I should be aware of?
A: Yes, this medication can interact with alcohol, disulfiram, anticoagulants, lithium, and anticonvulsants. Check for other potential interactions before prescribing.
Q5: What should I do if a dose is missed?
A: Take the missed dose as soon as remembered unless it’s almost time for the next dose. Don’t double the dose.
Q6: How should this medication be stored?
A: Store in a cool and dry place away from direct sunlight.
Q7: Can this combination be used in children?
A: Yes, but the dosage needs to be adjusted based on the child’s weight or age. Consult a pediatrician for appropriate dosing.
Q8: How does dimethicone contribute to this combination?
A: Dimethicone is an anti-flatulent that helps relieve gas and bloating, which can be associated with diarrhea and dysentery.
Q9: What if the patient’s symptoms don’t improve after the prescribed course?
A: Re-evaluate the diagnosis, consider other causes, and consult with specialists if needed. Alternative treatments may be required.
