Stibogluconate

Aka: Stibogluconate, Sodium Stibogluconate, Sodium Antimony Gluconate

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II. Background

  1. Sodium Stibogluconate has been discontinued worldwide and is no longer available
  2. Use Meglumine Antimoniate (Glucantime) instead

III. Indications

  1. Leishmaniasis

IV. Mechanism

  1. Antimony (Sb) based Antiprotozoal with activity against Leishmaniasis
  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

V. Dosing

  1. Precautions
    1. Dilute intravenous doses in 50 ml D5W or NS prior to administration
    2. Administer over >=10 minutes
  2. Cutaneous Leishmaniasis
    1. Stibogluconate Sodium (Pentostam) 20 mg/kg/day for 20 days
  3. Visceral Leishmaniasis
    1. Initial Course
      1. Adult: 10 mg/kg IV/IM daily for 20-30 days
      2. Child: 20 mg/kg IV/IM daily for 20-30 days
    2. Relapse
      1. Treat for 40-60 days

VI. 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)

VII. 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

VIII. Resources

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

IX. References

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

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