Fever suramin

Suramin is administered after a 200-mg intravenous test dose. Regimens that have been used include 1 g on days 1, 3, 7, 14, and 21 or 1 g each week for 5 weeks. Combination therapy with pentamidine may improve efficacy. Suramin can also be used for chemoprophylaxis against African trypanosomiasis. Adverse effects are common. Immediate reactions can include fatigue, nausea, vomiting, and, more rarely, seizures, shock, and death. Later reactions include fever, rash, headache, paresthesias, neuropathies, renal abnormalities including proteinuria, chronic diarrhea, hemolytic anemia, and agranulocytosis. 

Suramin was not effective in one phase II study in advanced renal cell carcinoma, in which it was given in a fixed dose plus hydrocortisone to 22 patients (19 men, three women, aged 30-74 years) (11). Three patients had grade 4 toxicity (hypersensitivity, urethral obstruction, hypotension, and neutropenic sepsis). Eleven developed grade 3 toxicity, mainly abdominal pain, anemia, diarrhea, erythema, dyspnea, fatigue, and fever. 

Frequent adverse effects of suramin were rash, chills, fever, and taste disturbance. In contrast to the results of earlier studies, in which different suramin dosage regimens were used, neurological, renal, hepatic, and coagulation abnormahties were rare. 

The side effects of suramin are fever, joint pains, photophobia, peripheral neuropathy and allergic reactions. The later phase of drug therapy may cause kidney damage and exfoliative dermatitis. The use of this drug has been recommended only under medical supervision. 

Suramin is the drug of choice for the early hemolymphatic stage of both Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense infections before nervous system invasion occurs [17 ]. The dose is 15-20 mg/kg/week, given intravenously, up to a maximum single dose of 1 g. Suramin, which is excreted by the kidneys, binds to plasma proteins and can persist in the circulation in low concentrations for as long as 3 months. A single course for an adult is usually 5 g, never to exceed 7 g. The primary adverse reactions are fever, rash, conjunctivitis, renal insufficiency, abdominal pain, paresthesia, and muscle pain. 

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