Anti-Inflammatory and Anti-infective Agents: Mechanism of Drug Action

Anti-Parasitic
PROTOZOA – single-celled organisms that pass through several stages in their life cycles, including at
least one phase as a human parasite (very common)

 Tropical Areas - most prevalent; many people suffer multiple infestations (Africa, Asia, or South
America with fully developed protozoal infections)
o may also survive and reproduce in any area where people live in very crowded and
unsanitary conditions

Antiprotozoal Agents:
CHILDREN

 very sensitive to the effects of most antiprotozoal drugs, and more severe reactions can be
expected when these drugs are used in children.
 Many do not have proven safety and efficacy in children, and extreme caution should be used.
 Traveling: the CDC or local health department should be consulted
ADULTS

 be well advised about the need for prophylaxis against various protozoal infections and the need
for immediate treatment if the disease is contracted
 helpful to mark calendars as reminders of the days before, during, and after exposure on which
the drugs should be taken.
 Pregnant and nursing women should not use these drugs unless the benefit clearly outweighs the
potential risk to the fetus or neonate.
o be advised of the serious risks to the fetus associated with both preventive therapy and
treatment of acute attacks, as well as the risks associated with contracting the disease.
 Women of childbearing age should be advised to use barrier contraceptives if any of these drugs
are used

OLDER ADULTS

 more susceptible to the adverse effects associated with these drugs. (monitored closely)
 Patients with hepatic dysfunction are at increased risk for worsening hepatic problems and toxic
effects of many of these drugs.
 If hepatic dysfunction is expected (extreme age, alcohol abuse, use of other hepatotoxic drugs),
the dose may need to be lowered and the patient monitored more frequently

DISEASE: MALARIA
- killed hundreds of millions of people and even changed the course of history remains endemic

HISTORY CHECK!
The progress of several African battles and the building of the Panama Canal were altered by outbreaks of
malaria
 Anti-Inflammatory and Anti-infective Agents: Mechanism of Drug Action

Transmission: bite of a female Anopheles mosquito

4 Protozoal Parasites (genus Plasmodium)
• Plasmodium falciparum – (most dangerous) Infection with this protozoan results in an
acute, rapidly fulminating disease with high fever, severe hypotension, swelling and
reddening of the limbs, loss of red blood cells, and even death.
• Plasmodium vivax – (milder) seldom results in death
• Plasmodium malariae - (endemic) very mild signs and symptoms in the local
population; cause more acute disease in travelers to endemic areas.
• Plasmodium ovale, which is rarely seen, seems to be in the process of being eradicated.
Life Cycle of Plasmodium:
1. Mosquito bites a human who is infected with malaria, it sucks blood infested with gametocytes
(male and female forms of the Plasmodium)
2. Gametocytes mate in the stomach of the mosquito and produce a zygote that goes through several
phases before forming sporozoites (spore animals) that make their way to the mosquito’s salivary
glands.
3. The next person who is bitten by that mosquito is injected with thousands of sporozoites.
4. Sporozoites travel through the bloodstream, where they quickly become lodged in the human
liver and other tissues and invade the cells.
5. Inside human cells, the organisms undergo asexual cell division and reproduction.
6. Next 7 to 10 days, these primary tissue organisms called schizonts grow and multiply within their
invaded cells, using the cell for needed nutrients (as trophozoites).
7. Merozoites are then formed from the primary schizonts and burst from invaded cells when they
rupture because of overexpansion.
8. These enter the circulation and invade red blood cells. Here they continue to divide until the
blood cells also burst, sending more merozoites into the circulation to invade yet more red blood
cells.
9. At this point, the acute malarial attack occurs.
NOTE: The rupture of the red blood cells causes chills and fever related to the pyrogenic effects of the
protozoa and the toxic effects of the red blood cell components on the system.
This cycle of chills and fever usually occurs about every 72 hours.

With P. vivax and P. malariae malaria - longer period. Many of the tissue schizonts lay dormant until they
eventually find their way to the liver, where they multiply and then invade more red blood cells, again
causing the acute cycle.
With P. falciparum malaria, there are no extrahepatic sites for the schizonts.
If the patient survives an acute attack, no prolonged periods of relapse occur. The first attack of this type
of malaria can destroy so many red blood cells that the patient’s capillaries become clogged and the
circulation to vital organs is interrupted, leading to death.
TREATMENT: ANTIMALARIALS
- usually given in combination form to attack the Plasmodium at various stages of its life cycle.
 Anti-Inflammatory and Anti-infective Agents: Mechanism of Drug Action

TYPES:

 Schizonticidal - acting against the red-blood-cell phase of the life cycle

 Gametocytocidal - acting against the gametocytes
 Sporontocidal - acting against the parasites that are developing in the mosquito
 Work against tissue schizonts as prophylactic or antirelapse agents.

HISTORY CHECK!
Quinine (generic) was the first drug found to be effective in the treatment of malaria; it is no longer available.

Therapeutic Actions and Indications

 Chloroquine (Aralen) – mainstay of antimalarial therapy; directly toxic to parasites that absorb
it (acidic)
MECHANISM:
o Enters human red blood cells and changes the metabolic pathways necessary for
Plasmodium reproduction
EFFECTS:
 Decreases the ability of the parasite to synthesize DNA, leading to a blockage of
reproduction
 Hydroxychloroquine (Plaquenil) – used in combination therapy (primaquine) for greatest
effectiveness
MECHANISM:
o inhibits parasite reproduction
o blocking the synthesis of protein production
 Mefloquine (Lariam) - combination therapy: used in malarial prevention and treatment
MECHANISM:
o increases the acidity of plasmodial food vacuoles, causing cell rupture and death. In
 Primaquine (generic) - (very old) similar to quinine
MECHANISM:
o Disrupts the mitochondria of the Plasmodium
o Causes death of gametocytes and exoerythrocytic (outside of the red blood cell) forms
and prevents other forms from reproducing.
 Pyrimethamine (Daraprim) - used in combination with agents that act more rapidly to suppress
malaria
MECHANISM:
o blockings the use of folic acid in protein synthesis by the Plasmodium

PHARMACOKINETICS

 Chloroquine - readily absorbed from the gastrointestinal (GI) tract, with peak serum levels
occurring in 1 to 6 hours.
AREA CONCENTRATION:
 Liver  Kidney
 Spleen  Brain
 Anti-Inflammatory and Anti-infective Agents: Mechanism of Drug Action

EXCRETION: very slowly in the urine (unchanged drug)

 Hydroxychloroquine - readily absorbed from the GI tract, with peak serum levels occurring in 1
to 6 hours.
EXCRETION: very slowly in the urine (unchanged drug)

 Mefloquine - mixture of molecules that are absorbed, metabolized, and excreted at different
rates. The terminal half-life is 13 to 24 days.
AREA CONCENTRATION: Liver (metabolism)
NOTE: need caution in patients with hepatic dysfunction.

 Primaquine - readily absorbed and metabolized in the liver.

EXCRETION: urine
NOTE: Safety for use during pregnancy has not been established.

 Pyrimethamine - readily absorbed from the GI tract, with peak levels occurring within 2 to 6
hours. It is metabolized in the liver and has a half-life of 4 days. It usually maintains suppressive
concentrations in the body for about 2 weeks.

CONTRAINDICATIONS AND CAUTIONS

 Presence of known Patient Allergy to any of these drugs
 Liver Disease or Alcoholism - Parasitic invasion of the liver and the need for the hepatic
metabolism to prevent toxicity
 Lactation - can enter breast milk and could be toxic to the infant
o Another method of feeding the baby should be used if treatment is necessary.
 Avoided during state of Pregnancy including 2 months after completion of therapy -associated
with birth defects.
o Mefloquine (teratogenic in preclinical studies)
 Patients with retinal disease or damage - affect vision and the retina, and the likelihood of
problems increases if the retina is already damaged
 Psoriasis or Porphyria – skin damage; or with damage to mucous membranes, which can occur as
a result of the effects of the drug on proteins and protein synthesis.
ADVERSE EFFECTS
 Central nervous system (CNS): headache and dizziness; vomiting caused by the products of cell
death and protein changes
 Immune reaction effects (release of merozoites): fever, shaking, chills, and malaise.
 Gastrointestinal Tract: Nausea, vomiting, dyspepsia, and anorexia

 Hepatic dysfunction: toxic effects of the drug on the liver and the effects of the disease on the
liver.
 Dermatological effects: rash, pruritus, and loss of hair (changes in protein synthesis of the hair
follicles)
 Visual changes: possible blindness related to retinal damage from the drug
 Ototoxicity: nerve damage
 Cinchonism (nausea, vomiting, tinnitus, andvertigo): may occur with high levels of
hydroxychloroquine or primaquine.
 Risk for Cardiac Toxicity and Convulsions: quinine derivatives + quinine
 Anti-Inflammatory and Anti-infective Agents: Mechanism of Drug Action

 Increased bone marrow suppression: antifolate drugs (methotrexate, sulfonamides, etc.) +

pyrimethamine
NOTE: Discontinue pyrimethamine if signs of folate deficiency develop (diarrhea, fatigue, weight
loss, anemia).

DISEASE: AMEBIASIS / AMEBIC DYSENTERY

- intestinal infection
Transmission: Entamoeba histolytica (E. histolytica) via cystic stage fecal matter from water or
ground
2 LIFE STAGES:
 Cystic (dormant stage) - live for long periods outside the body or in the human intestine (stage
where transmission starts the disease)
 Trophozoite - human large intestine (ideal environment)

1. Cysts are swallowed and pass, unaffected by gastric acid, into the intestine. Some of these cysts
are passed in fecal matter, and some of them become trophozoites that grow and reproduce.
2. Trophozoites migrate into the mucosa of the colon, where they penetrate into the intestinal wall,
forming erosions.
a. Release a chemical that dissolves mucosal cells, and eventually they eat away tissue until
they reach the vascular system, which carries them throughout the body.
3. The trophozoites lodge in the liver, lungs, heart, brain, and so on.
NOTE:
 Early signs of amebiasis include mild to fulminate diarrhea.
 Worst Case: protozoan is able to invade extraintestinal tissue, it can dissolve the tissue and
eventually cause death.
 Some individuals can become carriers. These people seem to be resistant to the intestinal invasion
but pass the cysts on in the stool.

DISEASE: LEISHMANIASIS
TRANSMISSION: protozoan that is passed from sand flies to humans.
LIFE CYCLE:
1. Sand fly injects asexual form of this flagellated protozoan (promastigote), into the body of a
human
2. It is rapidly attacked and digested by human macrophages. Inside the macrophages, the
promastigote divides, developing many new forms called amastigotes, which keep dividing and
eventually kill the macrophage, releasing the amastigotes into the system to be devoured by more
macrophages.
3. These amastigotes can cause serious lesions in the skin, the viscera, or the mucous membranes of
the host.

DISEASE: TRYPANOSOMIASIS
TRANSMISSION: infection with Trypanosoma.
Two parasitic protozoal species cause very serious and often fatal diseases in humans:
 African sleeping sickness - by Trypanosoma brucei gambiense
TRANSMISSION: transmitted by the tsetse fly.
 Anti-Inflammatory and Anti-infective Agents: Mechanism of Drug Action

LIFE CYCLE: After the pathogenic organism has lived and grown in human blood, it eventually
invades the CNS, leading to an acute inflammation that results in lethargy, prolonged sleep, and
even death.
 Chagas disease - severe cardiomyopathy by Trypanosoma cruzi, is almost endemic in many
South American countries.
TRANSMISSION: common housefly

DISEASE: TRICHOMONIASIS
TRANSMISSION: spread during sexual intercourse of Trichomonas vaginalis - flagellated protozoan
that is a common cause of vaginitis.
 Infection in Men: no signs and symptoms
 Infection in Women: reddened, inflamed vaginal mucosa, itching, burning, and a yellowish-green
discharge.

DISEASE: GIARDIASIS
TRANSMISSION: through contaminated water or food of Giardia lamblia cysts (most commonly
diagnosed intestinal parasite in US)
LIFE CYCLE:
1. Forms cysts, which survive outside the body and allow transmission
2. Trophozoites, which break out of the cysts in the upper small intestine and eventually cause signs
and symptoms of disease.
Diarrhea, rotten egg–smelling stool, and pale and mucus-filled stool are commonly seen. Some patients
experience epigastric distress, weight loss, and malnutrition as a result of the invasion of the mucosa.
DISEASE: PNEUMOCYSTIS CARINII PNEUMONIA
- most common opportunistic infection in patients with AIDS
TRANSMISSION: Pneumocystis carinii (endemic protozoan that does not usually cause illness in
humans)
- When an individual’s immune system becomes suppressed because of acquired immune
deficiency syndrome (AIDS) or AIDS-related complex (ARC), the use of immunosuppressant
drugs, or advanced age, this parasite is able to invade the lungs, leading to severe inflammation
and the condition known as Pneumocystis carinii pneumonia (PCP).

OTHER TREATMENTS / ANTIPROTOZOAL AGENTS

 Chloroquine - effective against extraintestinal amebiasis,
 Pyrimethamine - treating toxoplasmosis.
 Tetracyclines and Aminoglycosides - treating these conditions at various stages of the disease.

Other antiprotozoals include

 Atovaquone (Mepron) – prevention and treatment of Pneumocystis carinii pneumonia and used
in combination with proguanil for treatment of chloroquine-resistant malaria
 Metronidazole (Flagyl, MetroGel, Noritate) – Treatment of amebiasis, trichomoniasis, giardiasis
 Nitazoxanide (Alinia) -Treatment of diarrhea associated with Crypstosporidium pavrum /
Giardia lamblia
 Pentamidine (Pentam 300, NebuPent) – Inhalation treatment of P.carinii pneumonia and as a
systemic agent in the treatment of trypanosomiasis and leishmaniasis
 Tinidazole (Tindamax) – treatment of trichomoniasis, giardiasis and amebiasis

Therapeutic Actions and Indications

 Anti-Inflammatory and Anti-infective Agents: Mechanism of Drug Action

- act to inhibit DNA synthesis in susceptible protozoa, interfering with the cell’s ability to
reproduce, subsequently leading to cell death
- indicated for the treatment of infections caused by susceptible protozoa.

PHARMACOKINETICS

 Atovaquone - slowly absorbed and is highly protein bound in circulation, with a half-life of 67 to
76 hours
EXCRETION: through feces
 Metronidazole - well absorbed orally, reaching peak levels in 1 to 2 hours. It is metabolized in
the liver with a half-life of 8 to 15 hours.
EXCRETION: primarily through the urine
 Nitazoxanide - rapidly absorbed after oral administration, reaching peak levels in 1 to 4 hours.
Nitazoxanide is metabolized in the liver; it has a half-life of 8 to 12 hours
EXCRETION: urine and feces
 Pentamidine - readily absorbed through the lungs.
EXCRETION: urine, with traces found up to 6 weeks
 Tinidazole - rapidly absorbed after oral administration, reaching peak levels within 60 to 90
minutes, with a half-life of 12 to 14 hours
EXCRETION: urine

CONTRAINDICATIONS AND CAUTIONS

 Presence of any known allergy or hypersensitivity to any of these drugs and pregnancy - effects
on developing fetal DNA and proteins (fetal abnormalities and even death)
 Caution when administering these drugs to patients with CNS disease - possible disease
exacerbation
 Hepatic disease - possible exacerbation
 Candidiasis - risk of superinfections
 Lactating Women - pass into breast milk and could have severe adverse effects on the infant.
 Safety and efficacy of pentamidine in children have not been established.
 Tinidazole and Metronidazole should never be combined with alcohol
o advised to avoid alcohol for at least 3 days after treatment has ended
 Metronidazole and tinidazole combined with oral anticoagulants - lead to increased bleeding
o patients should be monitored closely and dose adjustments made to the anticoagulant
during therapy and for up to 8 days after stopping therapy.
 Avoid Tinidazole / Metronidazole combined with Disulfiram – Psychotic Reactions
o 2 weeks should elapse between tinidazole therapy and the starting of disulfiram
 Used with caution in patients with renal dysfunction – could interfere with excretion of the drug.

ADVERSE EFFECTS

 CNS effects: headache, dizziness, ataxia, loss of coordination, and peripheral neuropathy
 GI effects: nausea, vomiting, diarrhea, unpleasant taste, cramps, and changes in liver function
 Superinfections also can occur when the normal flora are disrupted
 Anti-Inflammatory and Anti-infective Agents: Mechanism of Drug Action

Anthelmintic
HELMINTHIC INFECTIONS - infections in the gastrointestinal tract or other tissues due to worm
infestation (most common of all diseases)

 very common in tropical areas, but they are also often found in other regions, including countries
such as the US and CA.
 most live only in the intestinal tract of humans
2 Most Common Type of Helminths - cause intestine-invading worm infections; and tissue-invading
worms

 Nematodes / Roundworms) - cause diseases that range from mild to potentially fatal
 Pinworms  Ascaris
 Whipworms  Hookworms
 Threadworms

 Platyhelminths (or Flatworms) -

 Cestodes (Tapeworms) - human intestine
 Flukes (Schistosomes) - intestine and that also invade other tissues as part of their life
cycle
Proper Diagnosis: stool examination for ova (eggs) and parasites.
NOTE! important part of therapy for helminthic infections involves the prevention of reinfection or
spread of an existing infection.
 thorough hand washing after use of the toilet
 frequent laundering of bed linens and underwear in very hot, chlorine-treated water
 disinfection of toilets and bathroom areas after each use
 good personal hygiene to wash away ova

INTESTINE – INVADING WORMS:

NEMATODES

 Pinworm Infections – (most common on school-aged children) remain in the intestine

TRANMISSION: worm eggs are ingested (transfer by touching or by the inhalation and are then
swallowed)
EFFECTS: little discomfort except for perianal itching or occasionally vaginal itching

 Whipworms - attach to the wall of the colon

TRANMISSION: eggs found in the soil are ingested
EFFECTS: In large numbers, they cause colic and bloody diarrhea. In severe cases prolapse of
the intestinal wall and anemia related to blood loss

 Threadworms - cause more damage to humans than most of the other helminths.
TRANMISSION: as larvae found in the soil and inadvertently ingested. The larvae mature into
worms, and, after burrowing into the wall of the small intestine, female worms lay eggs.
 Anti-Inflammatory and Anti-infective Agents: Mechanism of Drug Action

EFFECTS: invade many body tissues, including the lungs, liver, and heart. In very severe cases,
death may occur from pneumonia or from lung or liver abscesses that result from larval invasion.
 Ascaris Worldwide – (most prevalent)
TRANSMISSION: occur wherever sanitation is poor. Eggs in the soil are ingested with
vegetables or other improperly washed foods.
NOTE! Many are unaware that they have this infestation unless they see a worm in their stool.
Eggs hatch in the small intestine and then make their way to the lungs, where they may cause
cough, fever, and other signs of a pulmonary infiltrate.
The larvae then migrate back to the intestine, where they grow to adult size (i.e., about as long
and as big around as an earthworm), causing abdominal distention and pain.
In the most severe cases, intestinal obstruction by masses of worms can occur
 Hookworms – attach to the small intestine of infected individuals suck blood from the walls of
the intestine, damaging the intestinal wall and leading to severe anemia with lethargy, weakness,
and fatigue
TRANSMISSION: found in the soil, where they hatch into a larva that molts and becomes
infective. The larvae penetrate the skin and then enter the blood and within about a week reach
the intestine
EFFECTS: Malabsorption problems may occur as the small intestinal mucosa is altered.
Treatment for anemia and fluid and electrolyte disturbances is an important part of the therapy for
this infection.

PLATYHELMINTS

 Cestodes - segmented flatworms with a head, or scolex, and a variable number of segments that
grow from the head.
TRANSMISSION: enter the body as larvae that are found in undercooked meat or fish; they
sometimes form worms that are several yards long, persons with a tapeworm may experience
some abdominal discomfort and distention, as well as weight loss because the worm eats ingested
nutrients.
NOTE! Many infected patients require a great deal of psychological support when they excrete
parts of the tapeworm or when the worm occasionally exits through the mouth or nose.

DISEASE: TISSUE – INVADING WORMS

 Trichinosis - disease caused by ingestion of the encysted larvae of the roundworm, Trichinella
spiralis, in undercooked pork.
Once ingested, the larvae are deposited in the intestinal mucosa, pass into the bloodstream, and
are carried throughout the body. They can penetrate skeletal muscle and can cause an
inflammatory reaction in cardiac muscle and in the brain. Fatal pneumonia, heart failure, and
encephalitis may occur.
NOTE! best treatment: prevention; from undercooked pork, freezing pork meat, monitoring the
food eaten by pigs, and instructing individuals about properly cooking pork can be most
beneficial.
 Filariasis - infection of the blood and tissues of healthy individuals by worm embryos, which
enter the body via insect bites. These thread-like embryos, or filariae, can overwhelm the
lymphatic system and cause massive inflammatory reactions. This may lead to severe swelling of
the hands, feet, legs, arms, scrotum, or breast—a condition called elephantiasis.
 Anti-Inflammatory and Anti-infective Agents: Mechanism of Drug Action

 Schistosomiasis - infection by a fluke that is carried by a snail.

o common problem in parts of Africa, Asia, and certain South American and Caribbean
countries that have climates and snails conducive to the life cycle of schistosomes
o Eggs that are excreted in the urine and feces of infected individuals hatch in fresh water
into a form that infects a certain snail. In the snail, larvae known as cercariae develop.
The snail sheds the cercariae back into the freshwater pond or lake.
TRANMISSION: People become infected when they come in contact with the infested
water.
o The larvae attach to the skin and quickly burrow into the bloodstream and lymphatics.
Then they move into the lungs, and later to the liver, where they mature into adult worms
that mate and migrate to the intestines and urinary bladder.
o The female worms then lay large numbers of eggs, which are expelled in the feces and
urine, and the cycle begins again.
o Signs and symptoms may include a pruritic rash, often called swimmer’s itch, where the
larva attaches to the skin. About 1 or 2 months later, affected individuals may experience
several weeks of fever, chills, headache, and other symptoms. Chronic or severe
infestation may lead to abdominal pain and diarrhea, as well as blockage of blood flow to
areas of the liver, lungs, and central nervous system (CNS). These blockages can lead to
liver and spleen enlargement, as well as signs of CNS and cardiac ischemia.
TREATMENT: ANTHELMINTICS
- act on metabolic pathways that are present in the invading worm but are absent or significantly
different in the human host.
 Albendazole (Albenza)
 Ivermectin (Stromectol)
 Mebendazole (Vermox)
 Praziquantel (Biltricide)
 Pyrantel (Antiminth, Pin-Rid, Pin-X, Reese’s Pinworm)
 Thiabendazole (Mintezol).
Therapeutic Actions and Indications

 very specific in the worms that they affect; they are not interchangeable for treating various
worm infections.
MECHANISM: interfere with metabolic processes in particular worms
PHARMACOKINETICS

 Mebendazole - chewable tablet, 3-day course can be repeated in 3 weeks if needed. Very little
amount is absorbed systemically, so adverse effects are few. The drug is not metabolized in the
body
EXCRETION: most amount are unchanged in the feces and small amount in urine.

 Albendazole - poorly absorbed from the gastrointestinal (GI) tract, reaching peak plasma levels
in about 5 hours. It is metabolized in the liver
EXCRETION: urine
 Anti-Inflammatory and Anti-infective Agents: Mechanism of Drug Action

 Ivermectin - readily absorbed from the GI tract and reaches peak plasma levels in 4 hours. It is
completely metabolized in the liver with a half-life of 16 hours
EXCRETION: feces
 Praziquantel - series of three oral doses at 4- to 6-hour intervals. It is rapidly absorbed from the
GI tract and reaches peak plasma levels within 1 to 3 hours. It is metabolized in the liver with a
half-life of 0.8 to 1.5 hours
EXCRETION: urine

 Pyrantel - poorly absorbed

EXCRETION: most amount are unchanged in the feces and small amount in urine

 Thiabendazole - readily absorbed from the GI tract, reaching peak levels in 1 to 2 hours. It is
completely metabolized in the liver
EXCRETION: urine

CONTRAINDICATIONS AND CAUTIONS

 Presence of known allergy to any of these drugs
 Lactation
 Pregnancy - reported associated fetal abnormalities or death.
o Women of childbearing age should be advised to use barrier contraceptives while taking
these drugs.
 Pyrantel has not been established as safe for use in children younger than 2 years.
 Albendazole should be used only after the causative worm has been identified - adverse effects on
the liver, which could be problematic if the patient has liver involvement.
o Caution in the presence of renal or hepatic disease that interferes with the metabolism or
excretion of drugs that are absorbed systemically and in cases of severe diarrhea and
malnourishment, which could alter the effects of the drug on the intestine and any
preexisting helminths.
ADVERSE EFFECTS
 Mebendazole and pyrantel, which are not absorbed systemically, may cause abdominal
discomfort, diarrhea, or pain but have very few other effects and are well tolerated.
 Anthelmintics that are absorbed systemically may cause the following effects:
 headache and dizziness
 fever
 shaking
 chills
 malaise associated with an immune reaction to the death of the worms
 rash
 pruritus / itch
 loss of hair.
 Stevens–Johnson syndrome - changes in protein synthesis by the liver; associated with
thiabendazole use and can be fatal.
 renal failure and severe bone marrow depression are associated with albendazole, which is toxic
to some human tissues. Patients taking this drug require careful monitoring.
Anti-Inflammatory and Anti-infective Agents: Mechanism of Drug Action

 Combinations of theophylline and thiabendazole may lead to increased theophylline levels, and
patients who take both of these drugs may require frequent monitoring and dose reduction of the
theophylline.
 The effects of albendazole increase if the drug is combined with dexamethasone, praziquantel, or
cimetidine.
o avoided if at all possible; if they are necessary, patients should be monitored closely