II. Indications
-
African Trypanosomiasis
- Used in NECT combination with Eflornithine
-
American Trypanosomiasis (Chagas Disease, T. cruzi)
- FDA approved in U.S. for use in children age <18 years (and at least 2.5 kg)
III. Contraindications
- Pregnancy
IV. Mechanism
- Nitrofuran derivative with Antiprotozoal activity
- Nifurtimox is cytotoxic to targeted Protozoa
- Nifurtimox is reduced by Protozoal enzymes to a free radical, triggering cytotoxic superoxide anion (02-)
- Superoxides alkylate parasitic Nucleic Acids and Proteins, disrupting Protozoal Cell Structure and function
V. Medications
- Tablets: 30 mg, 120 mg
VI. Dosing: American Trypanosomiasis (age <18 years)
-
General
- Avoid in weight <2.5 kg
- Dose to closest available 1/2 tablet
- Weight <41 kg
- Give 10-20 mg/kg DIVIDED three times daily orally with food for 60 days
- Weight >41 kg
- Give 8-10 mg/kg DIVIDED three times daily orally with food for 60 days
VII. Dosing: West African Trypanosomiasis
- See Eflornithine
- See African Trypanosomiasis
- Eflornithine renal dose adjustment needed for eGFR <30 ml/min
-
NECT (Eflornithine/Nifurtimox)
- Indications
- Severe Stage 2 West African Trypanosomiasis with CSF Leukocytes >100 wbc/uL (any age)
- Dosing
- Eflornithine 400 mg/kg/day IV divided every 12 hours for 7 days AND
- Nifurtimox 15 mg/kg/day divided every 8 hours for 10 days
- Indications
VIII. Adverse Effects
- Gastrointestinal
- Decreased appetite
- Nausea and Vomiting
- Abdominal Pain
- Miscellaneous
IX. Safety
- Pregnancy
- Avoid in pregnancy based on animal studies (Miscarriage, IUGR risk, skeletal malformations)
- Lactation