Meglumine Antimoniate

Aka: Meglumine Antimoniate, Glucantime

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II. Indications

  1. Intralesional injection
    1. Simple Cutaneous Leishmaniasis
  2. Intravenous or Intramuscular
    1. Complex or Diffuse Cutaneous Leishmaniasis
    2. Mucosal Leishmaniasis
    3. Leishmania braziliensis
    4. Visceral Leishmaniasis in high resistance regions (esp. East Africa)
    5. Visceral Leishmaniasis (alternative to first-line agents)

III. Mechanism

  1. Pentavalent antimony (Sb) based Antiprotozoal with activity against Leishmaniasis
    1. Other antimony compound (Stibogluconate) for Leishmaniasis is no longer available
  2. Prodrug, reduced from pentavalent to trivalent form, interferes with Protozoal metabolic pathways
    1. Interacts with Protozoal trypanothione (thiol group) critical for its Redox Reactions
    2. Disrupts cellular processes resulting in cellular death

IV. Medications

  1. Injection solution: 1.5 g/5 ml in 5 ml ampules (Antimony 0.405 g/5 ml)
  2. Dosing is based on Antimony component (every 75 mg Meglumine Antimoniate contains 20 mg Antimony)

V. Dosing: Intralesional Injection

  1. Inject undiluted solution intralesionally (up to 20 mg/kg total or 850 mg of antimony component) weekly for 5-10 weeks
  2. May be combined with Cryotherapy

VI. Dosing: IV or IM

  1. Precautions
    1. Dilute intravenous doses in 50 ml D5W or NS prior to administration
    2. Administer over >=10 minutes
  2. Meglumine Antimoniate 20 mg/kg/day up to 850 mg (of antimony component) IV or IM
  3. Duration
    1. Mucosal or Visceral Leishmaniasis: 28 days
    2. Cutaneous Leishmaniasis: 20 days

VII. Adverse Effects

  1. Common
    1. Fatigue and malaise
    2. Headache
    3. Gastrointestinal (Nausea, Anorexia, abominal pain)
  2. Associated Lab abnormalities (see monitoring below)
    1. Hepatic transaminase increase (AST, ALT)
    2. Serum Lipase (and Amylase) increased
    3. Cytopenia
    4. EKG abnormalities (QTc Prolongation)

VIII. Safety

  1. Pregnancy
    1. Avoid in pregnancy (suspected to be Teratogenic)
  2. Lactation
    1. Likely safe in Lactation given low milk concentrations
    2. Consider avoiding Breast Feeding young infants (age <2 months) while taking Meglumine Antimoniate
  3. Monitoring: Baseline and weekly labs
    1. Serum Creatinine
    2. Liver Function Tests
    3. Serum Lipase or amylase
    4. Complete Blood Count
    5. Electrocardiogram

IX. Resources

  1. Glucantime Drug Profile (ASTMH)
    1. https://www.astmh.org/getmedia/35e1061e-82f7-4fc2-b05b-e3845e5aad8f/Glucantime-Drug-Profile.pdf

X. References

  1. Freedman (2025) Sanford Guide, accessed 7/13/2025 on IOS

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