SURAMIN injectable

Prescription under medical supervision

Therapeutic action

– Trypanocide

Indications

– Haemolymphatic stage of African trypanosomiasis due to T. b. rhodesiense

Forms and strengths, route of administration

– Powder for injection in 1 g vial, to be dissolved in 10 ml of water for injection to obtain a 10% solution, for slow IV injection (or slow infusion in 500 ml of 0.9% NaCl). NEVER BY IM OR SC INJECTION.

Dosage and duration

– Patients must be treated in hospital, under close medical supervision.
– Child and adult: 4 to 5 mg/kg by slow IV at D1 (test dose) then, in the absence of reaction after the test dose, 20 mg/kg by slow IV at D3, D10, D17, D24 and D31 (max. 1 g per injection)

Contra-indications, adverse effects, precautions

– Do not administer in patients with severe renal or hepatic disease.
– May cause:
• anaphylactic reaction: administer a test dose before starting treatment. In the event of anaphylactic reaction, the patient should never receive suramin again;
• proteinuria (renal toxicity), diarrhoea, haematological disorders (haemolytic anaemia, agranulocytosis, etc.), eye disorders (photophobia, lachrymation), neurological disorders (paraesthesia, hyperaesthesia of the palms and soles, polyneuropathy), high fever, skin eruption, malaise, intense thirst, polyuria;
• local inflammation and necrosis when administered by IM or SC injection.
– Before each injection, check for proteinuria: moderate proteinuria is common at the start of treatment, heavy proteinuria calls for dose reduction and modification of treatment schedule; in the event of persisting heavy proteinuria, treatment should be discontinued.
– Ensure that the patient is well hydrated.
– Pregnancy: although suramin is toxic, it is recommended to treat pregnant women with rhodesiense trypanosomiasis at the haemolymphatic stage. Suramin is also used at the meningoencephalitic stage until the woman can be given melarsoprol after delivery, as melarsoprol is contra-indicated during pregnancy.

Remarks

– Suramin is not administered at the meningoencephalitic stage (except in pregnant women) as it poorly penetrates into the cerebrospinal fluid.
– Due to its toxicity, suramin is no longer used for the treatment of onchocerciasis.
– Storage: below 25 °C -