Hetrazan

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What diethylcarbamazine is

Diethylcarbamazine (DEC) is a piperazine derivative discovered in 1947 and the WHO first-line oral microfilaricide for lymphatic filariasis. It works through two mechanisms: (1) it sensitises microfilariae to host immune attack by altering their surface membranes, and (2) it activates the host arachidonic acid pathway leading to rapid clearance from peripheral blood. It also has slow macrofilaricidal activity against adult worms over multiple courses.

Indicaties

• Lymphatic filariasis — Wuchereria bancrofti, Brugia malayi, Brugia timori. Adult dose 6 mg/kg/day for 12 days, or single annual 6 mg/kg dose with albendazole 400 mg in mass drug administration (MDA) programmes.
• Tropical pulmonary eosinophilia (TPE) — hypersensitivity response to filarial antigens. 6 mg/kg/day in 3 divided doses for 14–21 days.
• Loiasis (Loa loa) — 8–10 mg/kg/day for 21 days, started at lower doses with steroid cover. Hospital-based treatment.
• Mansonelliasis (Mansonella streptocerca, perstans) — variable response.

Dosering

Bijwerkingen

DEC has TWO categories of adverse reaction:

Direct drug effects (mild, transient)

• Headache, malaise, anorexia, mild nausea
• Minor abdominal discomfort
• Joint and muscle aches

Microfilarial-killing reaction (Mazzotti-like, dose- and parasite-load-dependent)

• Fever (often within hours of first dose)
• Generalised pruritus, urticaria, papular rash
• Lymphadenitis and tender lymph nodes (swollen scrotal lymphatics in W. bancrofti males)
• Headache, dizziness, malaise
• Eosinophilia rebound
• In ocular filariasis or onchocerciasis: severe eye inflammation, can lead to blindness
• In high-burden Loa loa: severe encephalopathy, coma — preventable by pre-treatment screening

Manage Mazzotti-like reactions with paracetamol, antihistamines, and short oral corticosteroid courses (prednisolone 0.5–1 mg/kg/day) for severe cases. Do NOT stop DEC for mild reactions — they reflect parasite kill and will subside.

Contra-indicaties

• Confirmed onchocerciasis (use ivermectin)
• Loiasis with microfilarial density > 8,000/ml without specialist hospital care
• Pregnancy (relative — defer treatment until after delivery where possible)
• Severe renal or hepatic impairment without dose adjustment
• Children under 18 months

Geneesmiddelinteracties

Few significant interactions. Monitor INR if on warfarin. Co-administration with albendazole 400 mg single dose is the WHO MDA standard for lymphatic filariasis and is well tolerated.

Pregnancy and breastfeeding

• Pregnancy — limited data. WHO defers MDA until after delivery; treatment for active disease in pregnancy is decided case by case.
• Breastfeeding — small amounts excreted in milk; usually compatible if treatment is necessary.

Opslag

Store below 25 °C, dry, original blister. Tablets are stable for the full labelled shelf life when kept dry.

Waarom bestellen bij MedsBase

Hetrazan is supplied through a WHO-GMP certified manufacturer with full COA documentation. We ship worldwide in plain, discreet packaging, and every order is covered by our Reshipment Assurance Policy. Your statement descriptor when paying by card shows the regulated payment processor (a regulated card-payment processor), never "MedsBase" or any medication name.

Veelgestelde vragen

How quickly does Hetrazan kill the worms?

Microfilariae (the larval stage circulating in blood) are cleared from peripheral blood within hours to days. Adult worms are reduced more slowly over weeks; multiple courses or repeated annual MDA doses are usually needed to fully clear an established infection.

Why are some people told to take it with albendazole?

In WHO mass drug administration (MDA) for lymphatic filariasis, single-dose DEC 6 mg/kg + albendazole 400 mg is given annually for 5–6 years to interrupt transmission. The combination is more effective at suppressing microfilariae than DEC alone.

I have river blindness (onchocerciasis) — can I take Hetrazan?

No. DEC triggers a severe Mazzotti reaction in onchocerciasis, with intense skin reaction and irreversible eye damage. Ivermectin (Mectizan) is the WHO standard for onchocerciasis. Always confirm species before starting DEC.

I am from Central Africa — should I be tested for Loa loa first?

Yes if you are in or from Central Africa (Cameroon, Congo, Gabon, etc.). High-density Loa loa microfilaraemia + DEC can trigger fatal encephalopathy. A pre-treatment day-time blood film for microfilaria count is essential.

What should I expect during the first few days of treatment?

Mild fever, headache, itching and tender lymph nodes are common from microfilarial kill — they peak in the first 24–72 hours and settle. Take paracetamol; do not stop DEC unless reactions are severe (high fever, breathing difficulty, eye pain). Severe reactions need medical review and short oral steroid.

How is tropical pulmonary eosinophilia different from regular asthma?

TPE is a hypersensitivity response to filarial antigens — chronic dry cough, breathlessness and very high eosinophilia (often > 3,000/μL) in someone from a filaria-endemic area. Lung function suggests restriction or obstruction; chest X-ray shows reticulonodular opacities. DEC at 6 mg/kg/day for 14–21 days resolves both symptoms and eosinophilia in most cases.

How long does my filariasis treatment take to fully cure me?

A 12-day curative course often clears microfilariae and reduces adult worm burden, but established lymphatic damage (lymphedema, hydrocoele) is not reversed by DEC and needs supportive lymphatic care. Adult worm clearance can take multiple courses over years.

Is there a way to prevent filariasis?

Vector control (mosquito nets, indoor residual spraying) plus annual MDA with DEC + albendazole has eliminated transmission in many WHO-targeted areas. Personal prevention in endemic zones: long sleeves at dusk, repellent, bed nets.

Can I take it during pregnancy?

WHO defers MDA in pregnancy. Active disease in pregnancy is decided case-by-case with specialist input. Limited safety data; treatment is usually delayed where possible.

How is DEC different from ivermectin?

DEC is first-line for lymphatic filariasis (Wuchereria, Brugia) and tropical pulmonary eosinophilia. Ivermectin is first-line for onchocerciasis (river blindness) and strongyloidiasis, and is preferred over DEC in mixed infection areas because it does not trigger the dangerous Mazzotti reaction in onchocerciasis. The two drugs cover different parasites.

Other Antiparasitic & Anthelmintic Medications

• All Antiparasitic & Worm Treatments
• Vermact (ivermectin) — first-line for onchocerciasis and strongyloidiasis
• Ivecop (ivermectin) — alternative ivermectin brand
• Wormentel — broad-spectrum anthelmintic
• Prazihet (praziquantel) — for schistosomiasis and tapeworm
• Ivermectin + Fenbendazole Combo Pack

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