Nifurtimox (Lampit)

Generic Name: Nifurtimox

Nifurtimox is a medication used to treat Chagas disease and sleeping sickness. For sleeping sickness it is used together with eflornithine in nifurtimox-eflornithine combination treatment. In Chagas disease it is a second line option to benznidazole. It is given by mouth.


Nifurtimox.svg

Common side effects include abdominal pain, headache, nausea, and weight loss. There are concerns from animal studies that it may increase the risk of cancer but these concerns have not be found in human trials. Nifurtimox is not recommended in pregnancy or in those with significant kidney or liver problems. It is a type of nitrofuran.

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Nifurtimox forms a nitro-anion radical metabolite that reacts with nucleic acids of the parasite causing significant break down of DNA. Its mechanism is similar to that proposed for the antibacterial action of nitrofuran agents. Nifurtimox undergoes reduction and creates oxygen radicals such as superoxide. These radicals are toxic to T. cruzi. Mammalian cells are protected by presence of catalase, glutathione, peroxidases, and superoxide dismutase. Accumulation of hydrogen peroxide to cytotoxic levels results in parasite death.

Nifurtimox has been used to treat Chagas disease, when it is given for 30 to 60 days. However, long term use of Nifurtimox does increase chances of adverse events like gastrointestinal and neurological side effects. Due to the low tolerance and completion rate of Nifurtimox, benznidazole is now being more considered for those who have Chagas disease and require long term treatment.

Nifurtimox has also been used to treat African trypanosomiasis (sleeping sickness), and is active in the second stage of the disease (central nervous system involvement). When nifurtimox is given on its own, about half of all patients will relapse, but the combination of melarsoprol with nifurtimox appears to be efficacious. Trials are awaited comparing melarsoprol/nifurtimox against melarsoprol alone for African sleeping sickness.

Combination therapy with eflornithine and nifurtimox is safer and easier than treatment with eflornithine alone, and appears to be equally or more effective. It has been recommended as first-line treatment for second-stage African trypanosomiasis

Anorexia (50-60% can limit completion of therapy)

Frequency Not Defined

Ataxia

Convulsions

Depression

Fatigue

Headache

Memory impairment

Paresthesia

Sleep disorder

Tremor

Polyneuritis

Weakness

Pruritic dermatitis

Rash

Gastralgia

Vomiting

Myalgia

Pulmonary infiltrates

Pleural effusion (rare)

Adult Dosage Forms & Strengths

tablet

  • 30mg
  • 120mg

Pediatric Dosage Forms & Strengths

tablet

  • 30mg
  • 120mg

Gastrointestinal complaints include nausea, vomiting, abdominal pain, anorexia, and weight loss. Possible neurologic symptoms include insomnia, twitching, restlessness, paraesthesias, disorientation, and seizures. Rashes also occur. These symptoms generally disappear when the dosage is reduced or therapy is stopped.

Active or history of peripheral neuropathy

Active or history of seizures & cerebral impairment, such as behavioral disorders, epilepsy, or psychoses

Hepatic impairment

Renal impairment

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