Pharm

Miltefosine

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Miltefosine, Impavido

  • Indications
  1. Leishmaniasis
  2. Ameba Infection (off-label)
    1. Naegleria fowleri
    2. Balamuthia mandrillaris
    3. Acanthamoeba
  • Contraindications
  1. Pregnancy
  2. Lactation
  3. Age under 12 years old
  4. Sjogren-Larsson Syndrome
  • Mechanism
  1. Alkyl-phosphocholine affects cellular membranes, interferes with cell mitosis and acts as an immunomodulator
  • Medications
  1. Capsules 50 mg in Blister packs
  • Dosing
  • Adults and Children (age >12 years)
  1. General
    1. Take with food
  2. Leishmaniasis (Visceral, cutaneous or mucosal)
    1. Weight 30 to 44 kg: Miltefosine 50 mg orally twice daily for 28 days
    2. Weight >=45 kg: Miltefosine 50 mg orally three times daily for 28 days
  3. Ameba infections (Naegleria fowleri, Balamuthia mandrillaris, Acanthamoeba)
    1. See CDC and other references for dosing
  • Adverse Effects
  1. Serum Creatinine Increase
    1. Monitor Serum Creatinine weekly for 4 weeks
  2. Increased Liver Function Tests
    1. Monitor transaminases and Serum Bilirubin
  3. Decreased Platelet Count (in Visceral Leishmaniasis)
    1. Monitor Platelet Count
  4. Common
    1. Vomiting and Diarrhea
  • Safety
  1. Avoid in Lactation for 5 months after last use
  2. Pregnancy Category D (avoid)
    1. Use reliable Contraception while taking Miltefosine and for 5 months after use
  • Drug Interactions
  1. Oral Contraceptives
    1. Decreased absorption if Vomiting and Diarrhea occur
  • Resources
  1. Miltefosine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bcb387ac-2e90-4f5e-94b2-d3635190678e
  • References
  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia