Suramin

Aka: Suramin

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II. Indications

  1. Onchocerca Volvulus
  2. African Trypanosomiasis
    1. Stage 1 East African Trypansomiasis only in age < 6 years or weight <20 kg
    2. Fexindazole is preferred as first-line therapy in most other cases of trypanosomiasis

III. Mechanism

  1. Polysulphonated naphthylurea
  2. Antiparasitic activity (primary use)
    1. Used in limited cases of African Trypanosomiasis
  3. Possible antineoplastic activity
    1. Suramin blocks growth factor binding
      1. Inhibits endothelial cell proliferation and migration
        1. Insulin-Like Growth Factor I (IGF-I)
        2. Epidermal growth factor (EGF)
        3. Platelet-derived growth factor (PDGF)
        4. Tumor growth factor-beta (TGF-beta)
      2. Inhibits Angiogenesis
        1. Vascular Endothelial Growth Factor (VEGF)
    2. Other Suramin effects
      1. Inhibits Retroviral reverse transcriptase
      2. Inhibits topoisomerases
      3. Inhibits steroidogenesis

IV. Pharmacokinetics

  1. Does not cross the blood brain barrier (no CNS Infection effects)

V. Dosing

  1. First Test Dose: 5 mg/kg IV and observe for Hypersensitivity Reaction
  2. Next: 20 mg/kg (up to 1 g) on days 1, 3, 7, 14 and 21

VI. Adverse Effects

  1. Serious
    1. Agranulocytosis
    2. Exfoliative Dermatitis
    3. Hemolytic Anemia
    4. Severe Hypersensitivity Reaction (including Anaphylaxis)
  2. Common
    1. Fever
    2. Malaise
    3. Joint Pain
    4. Rash
    5. Headache
    6. Paresthesias
    7. Nephrotoxicity
    8. Hepatotoxicity

VII. Safety

  1. Pregnancy
    1. Teratogenic in animal studies (avoid)
  2. Lactation
    1. Unknown safety (avoid)

VIII. Resources

  1. African Trypanosomiasis (WHO)
    1. https://www.who.int/news-room/fact-sheets/detail/trypanosomiasis-human-african-(sleeping-sickness)
  2. African Trypanosomiasis (Stat Pearls)
    1. https://www.ncbi.nlm.nih.gov/books/NBK535413/

IX. References

  1. Gladwin, Trattler and Mahan (2014) Clinical Microbiology, Medmaster, Fl, p. 349
  2. (2025) Sanford Guide, accessed 7/11/2025 on IOS
  3. Ortiz-Martínez (2023) Curr Trop Med Rep 10(4):222-34 +PMID: 38939748 [PubMed]

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