Drug reference

Diethylcarbamazine

Anthelmintic · Antifilarial

Also known as Diethylcarbamazine citrate

AnthelminticAntifilarial

CDSCO approved

EXCRETION

—

not curated

INTERACTIONS

1 major

SEVERE in our sources

PREGNANCY

—

not curated

Top interactions

IvermectinSevereDatabaseKimi deep-research + Cla · p1822, p1824

Mechanism

Diethylcarbamazine (DEC) rapidly immobilizes and kills microfilariae of Wuchereria bancrofti, Brugia malayi, and Loa loa by altering the microfilarial surface membrane, making them susceptible to host immune destruction. It enhances adherence and cytotoxicity of eosinophils and other immune cells toward opsonized parasites, with activity possibly mediated through arachidonic acid pathway modulation. Adult worms are killed more slowly and may require multiple treatment courses, making DEC primarily microfilaricidal.

Indications

Loa loa infectionsWuchereria bancrofti infectionsBrugia malayi infectionslymphatic filariasis (Wuchereria bancrofti, Brugia malayi, Brugia timori)loiasisMansonella streptocercaActive lymphatic filariasis (microfilaremia, antigen positivity, or adult worms on ultrasound)Tropical pulmonary eosinophiliaProphylaxis for loiasis

Dosing

Adult: Initially 1 mg/kg daily by mouth on the first day, then increased gradually over 3 days. For Wuchereria bancrofti and Brugia malayi infections, the dose is increased to 6 mg/kg daily in divided doses.
Pediatric: Children over 1 month: Initially 1 mg/kg daily by mouth on the first day, then increased gradually over 3 days. For Wuchereria bancrofti and Brugia malayi infections, the dose is increased to 6 mg/kg daily in divided doses.

Pharmacokinetics

Onset

peak plasma concentrations reached within 1–2 h

Half-life

2 to 10 h (depending on urinary pH)

Bioavailability

well absorbed after oral administration

Metabolism

Rapid and extensive; a major metabolite, DEC-N-oxide, is active.

Excretion

Metabolites are excreted in urine.

Contraindications

Onchocerciasis
locations where filariasis coexists with either onchocerciasis or loiasis (for ivermectin/diethylcarbamazine/albendazole combination)

Side effects

Common

Febrile reaction (especially in heavy infections)anorexianauseaheadachevomitinglymphangitisswellinglymphoid abscessesskin wheals (in loiasis)dose-related nauseafeverchillsarthralgiasheadaches

Serious

Encephalopathy (in heavy Loa loa infection)
Cerebral involvement
retinal hemorrhage
life-threatening encephalopathy (in heavy Loa loa infections)
Mazzotti reaction (in onchocerciasis)
fever
chills
arthralgias
headache
severe encephalopathic complications (in patients with high Loa loa microfilaremia)

Pregnancy & lactation

Lactation

Appears to be safe for use during pregnancy.

Drug interactions

Ivermectin

Severe

Database

Concurrent use with ivermectin in patients with high Loa loa microfilarial loads dramatically increases risk of fatal encephalopathy/meningoencephalitis. Both are microfilaricidal.

Do NOT co-administer ivermectin and DEC in Loa loa-endemic areas without first assessing Loa loa microfilarial load. If Loa loa load >30,000/mL, avoid both drugs or pretreat with albendazole to reduce load.

Source: Kimi deep-research + Cla · p1822, p1824