1. ANTHELMINTIC DRUGS

2. Anthelminthic Drugs
May act by causing :
Paralysis of the worm.
Damaging the worm leading to partial digestion or
rejection by immune mechanisms.
Interfere with the metabolism of the worm.
*Worms or larvae live in tissues of host body like
muscles, viscera, meninges, subcutaneous tissues.

3.  Adult filariae live in the lymphatics, connective
tissue or mesentery of host and produce live
embryos or microfilariae, which goes to blood
stream.
 They are ingested by mosquitoes or similar
insects, they develop to larvae in 2o host and
pass to mouth parts of insect and re-injected to
humans

4. Ascaris lumbricoids ( common round worm)

5. filariasis

6. Hookworm

7. Pinworm male ,female

8. Tapeworm

9. whipworm

10. Dircrocoelium dendriticum

11. Fasiola hepatica

12. Tricuris tricura

13. Trichinela spiralis

14. elephantiasis

15. Hydateid cyct

16. cysticercosis

17. ANTHELMINTIC DRUGS
M-mebendazole
A-albendazole
N-niclosamide
I-ivermectin
P-praziquantel
A-albendazole
L-levamisole
P- pyrental pamoate
D-diethylcarbamazine
mnemonic:MANIPAL PD

18. ALBENDAZOLE
Broad spectrum oral anthelmintic
 Drug of choice for treatment of hydatid
disease and cysticercosis, it is also used for
the treatment of ascariasis, tricurasis and
strongyloidiasis, pinworm, hookworm

19. Mechanism Of Action
 Inhibits microtubule synthesis by binding to β-tubulin.
 Inhibits mitochondrial reductase causing reduced
glucose transport.. Intestinal parasites are immobilized
and die slowly.
 Larvicidal in hydatid ,cysticercosis , ascariasis and
hook worm infections.
 Ovicidal in ascariasis ,hookworm , trichuriasis

20. Pharmacokinetics
 Benzimidazole carbamate
 Administered orally, absorption increased
with a fatty meal
 Metabolized in the liver to the active
metabolite albendazole sulfoxide

21. Pharmacokinetics
 Plasma half life is 8-12 hours
 Sulfoxide is mostly protein bound
distributes well to tissues and enters
bile, CSF & hydatid cysts.
 Metabolites are excreted in urine

22. Clinical uses
 Used on empty stomach when used against
intraluminal parasites but with a fatty meal when used
against tissue parasites.
 In ascariasis, trichuriasis, hookworm, pin worm
infections : children over 2 yrs & adults (single dose
400mg, repeated for 2-3 day in heavy ascaris infection
. For 2 wks for pin worm infection
2. Hydatid diseases:
drug of choice for medical therapy& adjunctive to
surgical removal or aspiration of cysts.

23. 3. Neurocysticercosis:
Used with corticosteroid to decrease the
inflammation caused by dying organism and it also
reduces the duration of course for 21 days
4. Other infections: Drug of choice in cutaneous and
visceral larva migrans , intestinal capillariasis, giardiasis
& taeniasis.

24. Adverse Effects
 In short term(1-3 days): Mild epigastric
pain,diarrhea, nausea, headache & insomnia.
 In long term use : For hydatid cyst and cysticercosis :
abdominal pain, headache ,fever ,fatigue, alopecia ,
increased liver enzymes , pancytopenia. Blood counts
and liver enzymes should be followed.
 Not given during pregnancy, hypersensitive people to
benzimidazole drugs & children under 2 years .

25. MEBENDAZOLE (Vermox)
 Synthetic benzimidazole
 Wide spectrum and low incidence of adverse
effects
Mechanism of action:
Inhibits microtubule synthesis .
It kills hookworm, pin worm, ascaris and trichuris
eggs.

26. Pharmacokinetics
Less than 10% of orally administered drug is
absorbed
 Absorption increases with fatty meal.
 Absorbed drug is 90 % protein bound
 Converted to inactive metabolites .
 Half- life of 2-6 hours
 Excreted mostly in urine .

27. Clinical Uses
It is taken orally before or after meal , tablets
should be chewed before swallowing.
 Pinworm , trichuriasis, hookworm &
ascaris infections.
 In adults and children over 2 yrs cure rate is
90-100 % except hookworm it is less.

28. Adverse Effects & Precautions
 Short term therapy.Mild GI disturbance.
 High dose : hypersensitivity reactions, agranulocytosis ,
alopecia ,elevation of liver enzymes .
 Used with caution under 2yrs of age may cause convulsion.
Contraindicated in pregnancy.
 Enzyme inducers and inhibitors affect plasma level of the
drug.

29. Thiabendazole
 Benzimidazole
 Chelating agent and form stable complexes
with metals including iron, but does not bind
with calcium.
 Rapidly absorbed
 Half- life of 1-2 hrs
 Completely metabolized in liver and 90% is
excreted in urine
 Can also absorbed through skin

30. Mechanism Of Action
 Similar to other benzimidazoles. It is ovicidal for
some parasites
Clinical uses:
 Should be given after meals .and tablets should be
chewed
 Strongyloidal infections & cutaneous larva
migrans .Thiabendazole cream is applied topically
or drug can be given orally for 2 days.

31. Adverse Effects & Contraindications
 More toxic than other benzamidazoles
 GI disturbances
 Pruritus, headache, drowsiness, psychoneurotic
symptoms.
 Irreversible liver failure.
 Fatal Stevens –Johnson syndrome
 Not used in young children , pregnancy, hepatic
and renal diseases.

32. PYRANTEL PAMOATE
 Broad spectrum
Pharmacokinetics:
 Poorly absorbed from GIT
 Half of the drug is excreted unchanged in the feces.
Mechanism of action:
 Result in paralysis of worms. It is a neuromuscular blocking
agent
Efficacy
 Very effective against luminal organisms( mature or immature
forms).
 Not effective against migratory stages in the tissues or against
ova

33. Clinical uses
Pin worm given orally with or without food
 Ascariasis
 Hookworm

34. Adverse Effects
 Infrequent mild transient GI disturbance
 Drowsiness, headache, insomnia, rash, fever
Contraindications & Cautions
 Should be used with caution in liver dysfunction.
 Pregnancy
 Children under 2 years of age

35. PIPERAZINE
 Only recommended for the treatment of ascariasis
cure rate 90% for 2 days treatment.
 Readily absorbed orally and excreted mostly
unchanged in urine
MOA: Causes paralysis of ascaris by blocking Ach at
myoneural junction, the live worms expelled by
normal peristalsis.
Treatment is continued for 3-4 days or repeated after
one week in case of heavy infections.

36. Adverse Effects
 GI disturbance
 Neurotoxicity, allergic reactions .
Contraindications
 Epilepsy or a history of epilepsy
 Impaired liver or kidney functions
 Pregnancy
 Chronic neurologic disease

37. NICLOSAMIDE
 Second-line drug for treatment of most
tapeworm infections.
Mechanism of action:
 Adult worm( not ova) is rapidly killed by
inhibition of oxidative phosphorylation .
Pharmacokinetics:
 Poorly absorbed from gut & excreted in urine.

38. Clinical Uses
 Treatment of most forms of tapeworms.
 Not effective against cysticercosis or hydatic
disease.
 Given in the morning on empty stomach.
 Purgative is necessary to purge all dead segments&
prevent liberation of ova.

39. Adverse effects & Contraindications
 Mild, infrequent and transitory GI disturbance
 Alcohol consumption should be avoided
 Not indicated in children under 2 yrs of age or in
pregnancy.

40. DIETHYL CARBAMAZINE
 Drug of choice for the treatment of filariasis and
tropical eosinophilia.
Pharmacokinetics:
 Rapidly absorbed from gut
 Half- life is 2-3 hours
 The drug should be given after meals
 It is excreted in urine as unchanged or metabolite.
 Dosage is reduced in urinary alkalosis and renal
impairment.

41. Mechanism Of Action
 Immobilizes microfilariae and alters their surface
structure, displacing them from tissues & making them
susceptible to destruction by host defense mechanism
 It has immunosuppressive effects

42. Adverse Effects
 Fever, malaise, papular rash, headache, GI disturbance,
cough. Chest, muscle, joint pain
 Leucocytosis
 Retinal hemorrhage
 Encephalopathy
 Lymphangitis and lymphadenopathy.
 It is not teratogenic
 C/I: Hypertension, Renal disease patient with
lymphangitis

43. IVERMECTIN
 Drug of choice for treatment of strongyloidiasis
 Macrocyclic lactone ring
 Given only orally
 Rapidly absorbed
 Does not cross BBB.
 Half- life is 16 hrs
 Excretion is mainly in feces.

44. Mechanism Of Action
 Acts on the parasites glutamate-gated Cl- channel
receptors . Chloride influx increased, hyperpolarization
occurs , resulting in paralysis of the worm.
Or
 Paralyze nematodes by intensifying GABA- mediated
transmission of signals in peripheral nerves.

45. Clinical uses
 Drug of choice for cutaneous larva migrans &
strongyloidiasis.
 Onchocerciasis
 It is also used for scabies, lice .
 Filariasis.

46. Adverse Effects
 Fatigue, dizziness, GI disturbance
 Killing of microfilaria result in a Mazotti
reaction ( fever, headache, dizziness,
somnolence, hypotension, tachycardia,
peripheral edema)
 Corneal opacities & other eye lesions.

47. Contraindications & Cautions
 Concomitant use with other drugs that enhance
GABA
e.g Barbiturates, bnzodiazepines, valproic acid.
 Pregnancy
 Meningitis
 Children under 5 years of age.

48. BITHIONOL
Drug of choice for the treatment of fascioliasis ( sheep liver
fluke)
PK: It is orally administered and excreted in urine.
A/E:GI disturbance ( N., V., D., A.)
Dizziness, headache
Skin rashes, urticaria, Leucopenia
C/I and precautions:
Hepatitis , leucopenia
Used with caution in children under 8 years of age.