II. Indications

  1. African Trypanosomiasis
    1. Used in NECT combination with Eflornithine
  2. American Trypanosomiasis (Chagas Disease, T. cruzi)
    1. FDA approved in U.S. for use in children age <18 years (and at least 2.5 kg)

III. Contraindications

  1. Pregnancy

IV. Mechanism

  1. Nitrofuran derivative with Antiprotozoal activity
  2. Nifurtimox is cytotoxic to targeted Protozoa
    1. Nifurtimox is reduced by Protozoal enzymes to a free radical, triggering cytotoxic superoxide anion (02-)
    2. Superoxides alkylate parasitic Nucleic Acids and Proteins, disrupting Protozoal Cell Structure and function

V. Medications

  1. Tablets: 30 mg, 120 mg

VI. Dosing: American Trypanosomiasis (age <18 years)

  1. General
    1. Avoid in weight <2.5 kg
    2. Dose to closest available 1/2 tablet
  2. Weight <41 kg
    1. Give 10-20 mg/kg DIVIDED three times daily orally with food for 60 days
  3. Weight >41 kg
    1. Give 8-10 mg/kg DIVIDED three times daily orally with food for 60 days

VII. Dosing: West African Trypanosomiasis

  1. See Eflornithine
  2. See African Trypanosomiasis
  3. Eflornithine renal dose adjustment needed for eGFR <30 ml/min
  4. NECT (Eflornithine/Nifurtimox)
    1. Indications
      1. Severe Stage 2 West African Trypanosomiasis with CSF Leukocytes >100 wbc/uL (any age)
    2. Dosing
      1. Eflornithine 400 mg/kg/day IV divided every 12 hours for 7 days AND
      2. Nifurtimox 15 mg/kg/day divided every 8 hours for 10 days

VIII. Adverse Effects

  1. Gastrointestinal
    1. Decreased appetite
    2. Nausea and Vomiting
    3. Abdominal Pain
  2. Miscellaneous
    1. Headache
    2. Fever
    3. Rash

IX. Safety

  1. Pregnancy
    1. Avoid in pregnancy based on animal studies (Miscarriage, IUGR risk, skeletal malformations)
  2. Lactation
    1. Is present in Breastmilk (at <15% of the recommended pediatric dose), with no reported adverse effects
    2. Monitor for decreased oral intake, Vomiting, rash, fever and irritability

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