INDICATIONS

FDA

FORMS

brand name

preparation

manufacturer

route

form

dosage^

cost*

Dehydroemetine

Dehydroemetine

Roche (not available from CDC)

IV

ampule

65/ml (1ml)

N/C

*Prices represent cost per unit specified, are representative of "Average Wholesale Price" (AWP).
^Dosage is indicated in mg unless otherwise noted.

USUAL ADULT DOSING

1-1.5 mg/kg/day (up to 90mg/day) IM or deep subcutaneous injection.

  • Note: contraindicated in patients with renal or cardiac impairments.
  • Telemetry/ECG cardiac monitoring recommended with administration.

ADULT RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

No data.

DOSING FOR GLOMERULAR FILTRATION OF 10-50

Not recommended.

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

Not recommended.

DOSING IN HEMODIALYSIS

No data.

DOSING IN PERITONEAL DIALYSIS

No data.

DOSING IN HEMOFILTRATION

No data.

PEDIATRIC DOSING

USUAL PEDIATRIC DOSING

Dose not established

ADVERSE DRUG REACTIONS

COMMON

  • Arrhythmia
  • Precordial pain
  • Pain at injection site
  • Muscle weakness

OCCASIONAL

  • GI: diarrhea; vomiting
  • Neuropathy
  • Heart failure
  • Headache
  • Dyspnea

DRUG INTERACTIONS

None reported.

PHARMACOLOGY

MECHANISM

Inhibits polypeptide chain elongation and mammalian cells.

PHARMACOKINETIC PARAMETERS

Absorption

Rapid absorption after intramuscular administration.

Metabolism and Excretion

Slow renal excretion.

Protein Binding

No data.

Cmax, Cmin, and AUC

No data.

T1/2

Unchanged emetine may be excreted in the urine for 40-60 days after administration.

Distribution

Well distributed into liver. Also distributed into spleen, lung and kidney.

DOSING FOR DECREASED HEPATIC FUNCTION

No data.

PREGNANCY RISK

X-Contraindicated, animal and human studies shows potential of teratogenicity.

BREAST FEEDING COMPATIBILITY

Contraindicated in breast feeding.

COMMENTS

  • Dehydroemetine (synthetic derivative of emetine) 65mg/ml IV (1ml vial no longer available from CDC). Emetine was originally derived from ipecac root.
  • Rarely used for invasive amebiasis due to severe local and systemic side effects most famously heart failure and arrhythmia (close EKG monitoring recommended) and availability of less toxic agents (e.g., metronidazole).
  • May be an option in the treatment of amebic dysentery and/or extraintestinal amebiasis that fails to respond to metronidazole.

References

  1. Jain NK et al: Hepatopulmonary amoebiasis. Efficacy of various treatment regimens containing dehydroemetine and/or metronidazole. J Assoc Physicians India 38:269, 1990  [PMID:2202709]

    Comment: The best therapeutic results were obtained with a combination of dehydroemetine and metronidazole. However, metronidazole was found to be comparable dehydroemetine.

  2. Yang WC, Dubick M: Mechanism of emetine cardiotoxicity. Pharmacol Ther 10:15, 1980  [PMID:6996003]

    Comment: Addresses major toxicity with this drug.

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Last updated: October 4, 2015