Updated: 11/28/2019

Anti-Helminth Drugs

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Snapshot
  • A 45-year-old man presents to the urgent care clinic with a skin rash, diarrhea, nausea, vomiting, and cough. He has a medical history notable for diabetes mellitus and hypertension. He recently visited his family’s farm in the countryside and walked around without shoes. He is asked to give a stool sample, and analysis of the sample showed rhabditiform larvae on microscopy but no eggs. He is started on an anti-helminthic medication. (Strongyloides infection)
Introduction
  • Drugs
    • pyrantel pamoate
    • ivermectin
    • mebendazole
    • praziquantel
    • diethylcarbamazine
    • niridazole
  • Clinical use
    • helminths
      • cestodes (tapeworms)
      • trematodes (flukes)
      • nematodes (roundworms)
 
Anti-Helminth Medications
Drug Mechanism of Action
Adverse Effects
Helminth
Pyrantel pamoate
  • Neuromuscular blocking agent, causing depolarization
  • Gastrointestinal upset
  • Headaches
  • Nematodes
    • Enterobius
    • Ancylostoma
    • Necator
Ivermectin
  • Binds to glutamate-gated chloride channels, causing hyperpolarization
  • Skin pruritus
  • Nematodes
    • Onchocerca (Rivermectin)
    • Strongyloides
Bendazole
  • Inhibits tubulin polymerization, interfering with microtubule formation
  • Gastrointestinal upset
  • Stevens-Johnson syndrome
  • Mebendazole
    •  nematodes
      • Enterobius
      • Ascaris
      • Toxocara
      • Trichuris
      • Trichinella
      • Strongyloides
      • Ancylostoma
      • Necator
  • Albendazole
    • cestodes
      • Taenia
      • Echinococcus
Praziquantel 
  • Increases cell membrane permeability of calcium and causes paralysis in the helminth
  • Gastrointestinal upset
  • Dizziness
  • Cestodes
    • Taenia
    • Diphyllobothrium
  • Trematodes
    • Schistosoma
    • Clonorchis
    • Paragonimus
Diethylcarbamazine
  • Inhibits arachidonic acid metabolism, making the helminth more susceptible to the host's innate immune system
  • Skin pruritus
  • Facial swelling
  • Headaches
  • Nematodes
    • Wucheria
    • Loa loa
Niridazole
  • Inhibits oogenesis and spermatogenesis
  • Central nervous system toxicity
  • Nematode
    • Dracunculus
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