Diethylcarbamazine

Diethylcarbamazine
Names
Other namesN, N-diethyl-4-methyl-1-piperazine carboxamide
IUPAC name
  • N,N-diethyl-4-methylpiperazine-1-carboxamide
Clinical data
Main usesLymphatic filariasis[1]
Routes of
use		by mouth
Defined daily dose400 mg[2]
External links
AHFS/Drugs.comMicromedex Detailed Consumer Information
Legal
Legal status
  • In general: ℞ (Prescription only)
Chemical and physical data
FormulaC10H21N3O
Molar mass199.298 g·mol−1
3D model (JSmol)
Melting point47 to 49 °C (117 to 120 °F)
SMILES
  • C1CN(C)CCN1C(=O)N(CC)CC
InChI
  • InChI=1S/C10H21N3O/c1-4-12(5-2)10(14)13-8-6-11(3)7-9-13/h4-9H2,1-3H3 checkY
  • Key:RCKMWOKWVGPNJF-UHFFFAOYSA-N checkY

Diethylcarbamazine (DEC) is a medication used in the treatment of filariasis including lymphatic filariasis, tropical pulmonary eosinophilia, and loiasis.[3] It may also be used for prevention of loiasis in those at high risk.[3] While it has been used for onchocerciasis (river blindness), ivermectin is preferred.[4] It is taken by mouth.[5]

Common side effects include itching, facial swelling, headaches, and feeling tired.[6] Other side effects include vision loss and dizziness.[6] It is a recommended treatment in pregnancy and appears to be safe for the baby.[7][8] The World Health Organization; however, recommends waiting until after pregnancy for treatment when feasible.[4] It is made from 4-methyl-piperazine.[9]

Diethylcarbamazine was discovered in 1947.[10] It is on the World Health Organization's List of Essential Medicines.[11] The wholesale cost in the developing world is around one US penny per dose.[5] It is not commercially available in the United States but can be acquired from the Center for Disease Control.[3]

Medical uses

DEC is indicated for treatment of individual patients with certain filarial diseases, including lymphatic filariasis caused by infection with Wuchereria bancrofti, Brugia malayi, or Brugia timori; tropical pulmonary eosinophilia; and loiasis.

In cases of onchocerciasis, another common filarial parasite, the drug is effective.

DEC continues to be the mainstay for treatment of patients with lymphatic filariasis and loiasis.

Now, the WHO recommends prescribing DEC to people who are infected with microfilariae of filarial parasites and also to control transmission of infection in filariasis-endemic areas.

Dosage

The defined daily dose is 400 mg (by mouth).[2] The dose in those over the age of 10 is 1 mg/kg on the first day which is than increased to 2 mg/kg three times a day over the next three days.[1] In those under 10 years old the dose is half of this.[1] Treatment duration is between six and 12 days.[1]

Side effects

Contraindications are previous history of heart problems, gastrointestinal problems, and allergies.

Pregnancy and breastfeeding

It is recommended that use be delayed until after pregnancy.[1] Use during breastfeeding is not recommended.[1]

Mechanism

DEC is an inhibitor of arachidonic acid metabolism in microfilariae. This makes the microfilariae more susceptible to innate immune attack, but does not kill the parasites outright.[12]

Society and culture

In India and China, diethylcarbamazine has been added to salt to combat lymphatic filariasis.[13]

Trade names

  • Hetrazan
  • Carbilazine
  • Caricide
  • Cypip
  • Ethodryl
  • Notézine
  • Spatonin
  • Filaribits
  • Banocide Forte
  • Eofil

Veterinary medicine

DEC is also used to prevent heartworm in dogs.

References

  1. 1 2 3 4 5 6 "DIETHYLCARBAMAZINE oral - Essential drugs". medicalguidelines.msf.org. Archived from the original on 28 August 2021. Retrieved 30 August 2020.
  2. 1 2 "WHOCC - ATC/DDD Index". www.whocc.no. Archived from the original on 23 January 2021. Retrieved 21 September 2020.
  3. 1 2 3 "Our Formulary Infectious Diseases Laboratories CDC". www.cdc.gov. 22 September 2016. Archived from the original on 16 December 2016. Retrieved 7 December 2016.
  4. 1 2 World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. p. 91. hdl:10665/44053. ISBN 9789241547659.
  5. 1 2 "Diethylcarbamazine Citrate". International Drug Price Indicator Guide. Archived from the original on 22 January 2018. Retrieved 1 December 2016.
  6. 1 2 "Diethylcarbamazine Advanced Patient Information - Drugs.com". www.drugs.com. Archived from the original on 20 December 2016. Retrieved 8 December 2016.
  7. ↑ Sweet, Richard L.; Gibbs, Ronald S. (2009). Infectious Diseases of the Female Genital Tract. Lippincott Williams & Wilkins. p. 382. ISBN 9780781778152. Archived from the original on 2017-09-10.
  8. ↑ Herbert-Ashton, Marilyn; Clarkson, Nancy Elaine (2005). Quick Look Nursing: Pharmacology. Jones & Bartlett Learning. p. 48. ISBN 9780763735951. Archived from the original on 2017-09-10.
  9. ↑ "WHO Model Prescribing Information: Drugs Used in Parasitic Diseases - Second Edition: Helminths: Lymphatic filariasis: Diethylcarbamazine". apps.who.int. 1995. p. 152. Archived from the original on 20 November 2016. Retrieved 8 December 2016.
  10. ↑ Busvine, James (2012). Disease Transmission by Insects: Its Discovery and 90 Years of Effort to Prevent it. Springer Science & Business Media. p. 260. ISBN 9783642457166. Archived from the original on 2017-09-10.
  11. ↑ World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  12. ↑ El-Shahawi, G. A.; Abdel-Latif, M; Saad, A. H.; Bahgat, M (2010). "Setaria equina: In vivo effect of diethylcarbamazine citrate on microfilariae in albino rats". Experimental Parasitology. 126 (4): 603–10. doi:10.1016/j.exppara.2010.06.022. PMID 20599991.
  13. ↑ Archived 2013-10-30 at the Wayback Machine WHO: Unfulfilled potential: using diethylcarbamazine-fortified salt to eliminate lymphatic filariasis
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