Stibogluconate sodium

Valproic acid/salts Losartan Meglumine antimoniate Piroxicam Procainamide Salicylates Sodium stibogluconate Zalcitabine... 

Drugs used for trypanosomiasis include nifurtimox, suramin, melarsoprol and pentamidine. The first choice agent for treating leishmaniasis is sodium stibogluconate. Alternatives are amphotericin B (see Section V.a) and pentamidine. 

Sodium stibogluconate is a pentavalent antimo-nial compound. It is a prodrug as the pentavalent an-timonial has to be reduced to a divalent antimony compound. Sodium stibogluconate is used to deal leishmaniasis and is only available for adminisda-tion by injection. It is excreted in the urine. In general it is tolerated fairly well. Adverse effects include pain at the injection site and gasdointestinal complaints. Cardiac arrhythmias can occur and renal and hepatic function should be monitored. 

Pentamidine is an alternative drug for visceral leishmaniasis, especially when sodium stibogluconate has failed or is contraindicated. Pentamidine is also a reserve agent for the treatment of trypanosomiasis before the CNS is invaded. This characteristic largely restricts its use to Gambian trypanosomiasis. 

No pentavalent antimonial is licensed for use, but sodium stibogluconate is available from the Parasitic Disease Drug Service of the Centers for Disease Control (CDC) for treatment of leishmaniasis. While the pentavalent antimony compounds can be given intravenously or intramuscularly, local infiltration of the lesion in cutaneous leishmaniasis is highly effective. Because of the lower toxicity of liposomal amphotericin B, this drug is considered a first-line choice for vis-cerotropic leishmaniasis rather than the antimonials. 

Visceral (L donovani, L chagasi, L infantum) Sodium stibogluconate, 20 mg/kg/d IV or IM for 28 days Meglumine antimonate... 

Pentamidine is an alternative to sodium stibogluconate in the treatment of visceral leishmaniasis, with similar efficacy, although resistance has been reported. The drug has been successful in some cases that have failed therapy with antimonials. The dosage is 2-4 mg/kg intramuscularly daily or every other day for up to 15 doses, and a second course may be necessary. Pentamidine has also shown success against cutaneous leishmaniasis, but it is not routinely used for this purpose. 

This important antifungal drug (see Chapter 48) is an alternative therapy for visceral leishmaniasis, especially in parts of India with high-level resistance to sodium stibogluconate. Liposomal amphotericin has shown excellent efficacy at a dosage of 3 mg/kg/d intravenously on days 1-5, 14, and 21. Nonliposomal amphotericin (1 mg/kg intravenously every other day for 30 days) is much less expensive, also efficacious, and widely used in India. Amphotericin is also used for cutaneous leishmaniasis in some areas. The use of amphotericin, and especially liposomal preparations, is limited in developing countries by difficulty of administration, cost, and toxicity. 

Leishmaniasis Skin mucocutaneous tissues viscera Amphotericin B Itraconazole, ketoconazole pentamidine, sodium stibogluconate... 

Cutaneous (L major, L tropica, L mexicana, L braziliensis) Sodium stibogluconate,4 20 mg/kg/d IV or IM for 20 days Meglumine antimonate2 or- Ketoconazole or- Pentamidine... 

This important antifungal drug (see Chapter 48 Antifungal Agents) is an alternative therapy for visceral leishmaniasis, especially in parts of India with high-level resistance to sodium stibogluconate, but its use is limited in developing countries by difficulty of administration, cost, and toxicity. 

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