Miltefosine
Mechanism :
Exact mechanism unknown; likely interaction with phospholipids and steroids in parasitic cell membranes, inhibition of cytochrome c oxidase (mitochondrial function), and apoptosis-like cell death.
Indication :
- Leishmaniasis: In adolescents 12 years and older weighing at least 30 kg.
- Off-label: Free-living amebae (FLA) infections, including primary amoebic meningoencephalitis (PAM) caused by Naegleria fowleri, granulomatous amoebic encephalitis caused by Balamuthia mandrillaris, and Acanthamoeba spp.
Contraindications :
Hypersensitivity to miltefosine or any component of the formulation; Sjogren-Larsson syndrome; pregnancy.
Dosing :
Oral
Use in children ≥12 years
30 to 44 kg:
50 mg twice daily for 28 days.
≥45 kg:
50 mg 3 times daily for 28 days.
Adverse Effect :
Headache, dizziness, nausea, vomiting, diarrhea, abdominal pain, thrombocytopenia, increased serum transaminases, creatinine, pruritus, cellulitis, pyoderma, testicular pain and swelling.
Interaction :
No known significant interactions.
Hepatic Dose :
Specific guidelines for dosage adjustments in hepatic impairment are not available.