TINAMID WORM TABLETS CHEWABLE TABLETS

Indications

• Cestodiasis
• Tapeworm infections
• Taeniasis
• Hymenolepiasis
• Enterobiasis (Oxyuriasis)

Dosage

Children: For children, dosages should be determined based on specific recommendations from the BNF for Children, taking into account the child's age and weight.

Adults: The typical adult dosage of niclosamide is 2 grams taken as a single oral dose, after fasting for at least 2 hours. It is important to consult the BNF for specific recommendations.

Mechanism of action

Niclosamide exerts its action by uncoupling oxidative phosphorylation in the mitochondria of the tapeworms, inhibiting energy production and leading to the accumulation of lactic acid, which ultimately kills the parasites. It also inhibits glucose absorption by the tapeworm, further contributing to its cestocidal activity. Additionally, it may damage the DNA of the parasites, enhancing its efficacy.

Pharmacodynamics

As an antihelminth, niclosamide disrupts the metabolic processes of cestodes. By uncoupling the electron transport chain from ATP synthase, niclosamide prevents the synthesis of ATP, a critical energy source for the parasites. This results in impaired energy metabolism and contributes to the death of the worms.

Pharmacokinetics

Niclosamide is poorly absorbed from the gastrointestinal tract, which is beneficial for its intended use as it acts locally within the intestine. Following administration, the drug is largely excreted unchanged in the feces. Due to its limited systemic absorption, systemic side effects are uncommon.

Adverse effects

• Nausea
• Vomiting
• Abdominal pain
• Diarrhea
• Headache
• Dizziness

Precautions

• Use with caution in patients with liver impairment
• Monitor for gastrointestinal effects

Pregnancy

Niclosamide should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

It is not known whether niclosamide is excreted in human milk. Caution should be exercised when administering to nursing mothers.

Storage

Store in a tightly closed container at room temperature, away from excess heat and moisture.

Formulations

• Tablets

Mechanism of action

Niclosamide works by killing tapeworms on contact. Adult worms (but not ova) are rapidly killed, presumably due to uncoupling of oxidative phosphorylation or stimulation of ATPase activity. The killed worms are then passed in the stool or sometimes destroyed in the intestine. Niclosamide may work as a molluscicide by binding to and damaging DNA. Niclosamide has prominent activity against most of the cestodes that infect man; Enterobius (Oxyuris) vermicularis is also susceptible. At low concn, niclosamide stimulates oxygen uptake by Hymenolepis diminuta, but at higher concn respiration is inhibited and glucose uptake is blocked. The principal action of the drug may be to inhibit anaerobic phosphorylation of adenosine diphosphate (ADP) by the mitochondria of the parasite, an energy producing process that is dependent on CO2 fixation ... . Cestocidal activity is due to inhibition of absorption of glucose by the tapeworm and uncoupling of the oxidative phosphorylation process in the mitochondria of cestodes. Resultant blocking of the Krebs cycle leads to accumulation of lactic acid, which kills the tapeworm. ... overstimulation of adenosine triphosphatase (ATPase) activity of the mitochondria may be related to cestodal action of niclosamide.

Pharmacodynamics

Niclosamide is an antihelminth used against tapeworm infections. It may act by the uncoupling of the electron transport chain to ATP synthase. The disturbance of this crucial metabolic pathway prevents creation of adenosine tri-phosphate (ATP), an essential molecule that supplies energy for metabolism.