Usage
Diloxanide + Tinidazole is prescribed for the treatment of intestinal amoebiasis (amoebic dysentery), an infection caused by the parasite Entamoeba histolytica. It can also be used for amebic liver abscess and giardiasis.
It belongs to the pharmacological classification of antiprotozoal agents, with tinidazole also having antibiotic properties.
Diloxanide acts as a luminal amoebicide, primarily effective against the non-invasive luminal forms of E. histolytica within the intestine. Tinidazole is a nitroimidazole antibiotic with activity against various protozoa and anaerobic bacteria. It disrupts DNA synthesis and function in susceptible organisms.
Alternate Names
No widely recognized alternate names exist for the combination. Brand names may include Amibactin BD, among others.
How It Works
Pharmacodynamics: Diloxanide exerts its amoebicidal effect within the intestinal lumen, primarily targeting the trophozoite and cyst forms of E. histolytica. Tinidazole disrupts DNA synthesis by forming cytotoxic free radicals, leading to microbial death. It is effective against the trophozoite form of E. histolytica in the tissues and lumen and provides broader coverage against other protozoa and anaerobic bacteria.
Pharmacokinetics: Diloxanide furoate, the prodrug of diloxanide, is well-absorbed orally and rapidly hydrolyzed to diloxanide. It is poorly metabolized and primarily excreted in the urine. Tinidazole is also well-absorbed orally, achieving peak plasma concentrations within a few hours. It is metabolized in the liver and excreted in the urine and feces.
Dosage
Standard Dosage
Adults: The typical dosage for intestinal amoebiasis is 500 mg of diloxanide and 600 mg of tinidazole, taken three times daily for 10 days. For amebic liver abscess, tinidazole 2 g daily for 3-5 days is used, often followed by a luminal amebicide.
Children: Pediatric dosing is based on weight, generally 20 mg/kg of diloxanide and variable dosing of tinidazole up to 50 mg/kg daily, divided into three doses, for 5-10 days.
Special Cases:
- Elderly Patients: Dose adjustments may be necessary based on renal and hepatic function.
- Patients with Renal Impairment: Caution advised, dose adjustments might be needed.
- Patients with Hepatic Dysfunction: Caution advised, dose reduction may be required in severe hepatic impairment.
- Patients with Comorbid Conditions: Exercise caution in patients with blood dyscrasias or neurological disorders.
Clinical Use Cases
The combination is specifically used for intestinal amoebiasis and amebic liver abscess. The clinical use cases mentioned (Intubation, Surgical Procedures, Mechanical Ventilation, ICU Use, Emergency Situations) are not relevant for this drug combination.
Side Effects
Common Side Effects:
Nausea, metallic taste, headache, dizziness, fatigue, abdominal pain, flatulence.
Rare but Serious Side Effects:
Severe skin reactions, neurological effects (peripheral neuropathy, ataxia), blood dyscrasias.
Long-Term Effects: Generally, no significant long-term effects are associated with short-term use.
Contraindications
Hypersensitivity to diloxanide, tinidazole, or other nitroimidazole derivatives. First trimester of pregnancy, active central nervous system diseases, blood dyscrasias.
Drug Interactions
Alcohol should be avoided during treatment and for several days after discontinuation. May interact with anticoagulants (warfarin), lithium, and certain other medications. Consult a drug interaction database for a complete list.
Pregnancy and Breastfeeding
Tinidazole: Should be avoided during the first trimester. Diloxanide: Caution is advised, benefits should outweigh potential risks. Both drugs are excreted in breast milk; use with caution.
Drug Profile Summary
- Mechanism of Action: Diloxanide: Luminal amoebicide. Tinidazole: Disrupts DNA synthesis in anaerobic microbes.
- Side Effects: Nausea, metallic taste, headache, dizziness. Rarely: neurological or hematological effects.
- Contraindications: Hypersensitivity, first trimester pregnancy, CNS diseases, blood dyscrasias.
- Drug Interactions: Alcohol, anticoagulants, lithium.
- Pregnancy & Breastfeeding: Use with caution if benefits outweigh risks.
- Dosage: See detailed section above.
- Monitoring Parameters: Monitor for signs of adverse effects, especially neurological symptoms and blood counts if indicated.
Popular Combinations
Diloxanide is often combined with metronidazole or tinidazole for comprehensive treatment of amoebiasis, targeting both luminal and tissue forms of the parasite.
Precautions
Assess for allergies, hepatic and renal function, and history of blood disorders. Caution in pregnancy and breastfeeding. Avoid alcohol. Patients might experience dizziness; advise against driving or operating machinery if affected.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Diloxanide + Tinidazole?
A: For adults, 500 mg diloxanide and 600 mg tinidazole three times daily for 10 days for intestinal amoebiasis. Pediatric doses are weight-based.
Q2: What are the common side effects?
A: Nausea, metallic taste, headache, dizziness, and fatigue.
Q3: Can it be used in pregnancy?
A: Use with caution, particularly during the first trimester. Consult a physician.
Q4: How does it work?
A: Diloxanide acts within the gut lumen, while tinidazole disrupts DNA synthesis in parasites.
Q5: What should be avoided while taking this medication?
A: Alcohol consumption should be strictly avoided.
Q6: Are there any drug interactions?
A: Yes, it can interact with certain medications like warfarin and lithium.
Q7: What if I miss a dose?
A: Take the missed dose as soon as remembered unless it is nearly time for the next dose.
Q8: What are the signs of an overdose?
A: Increased side effects like nausea, vomiting, ataxia, and paresthesia. Seek immediate medical attention.
Q9: Can it be used in children?
A: Yes, weight-based dosing is available.
Q10: What is the duration of treatment?
A: Typically 10 days for intestinal amoebiasis.
