Entamizole DS Tablet 500mg/400mg

About Entamizole DS Tablet 500mg/400mg

Entamizole DS Tablet Uses

• Acute intestinal amoebiasis caused by Entamoeba histolytica
• Chronic intestinal amoebiasis and persistent cyst carriage
• Amoebic liver abscess (hepatic amoebiasis)
• Other systemic diseases caused by Entamoeba histolytica
• Giardiasis caused by Giardia lamblia, presenting as diarrhea and malabsorption
• Prevention of post-operative amoebic infections following intestinal surgery

Entamizole DS Tablet Benefits

• Combines two complementary mechanisms in one tablet, eliminating both luminal and invasive forms of the parasite simultaneously
• Clears both the active infection and the intestinal cyst stage, reducing the risk of relapse after treatment
• Effective against Giardia lamblia in addition to Entamoeba histolytica, covering the two most common intestinal parasites in Pakistan
• Relieves acute symptoms including severe diarrhea, abdominal cramping, and bloody stool within the first few days of treatment
• Treats systemic complications such as amoebic liver abscess that intestinal-only medicines cannot reach

What Experts Say

Entamizole DS contains two active agents that work at different sites and through distinct mechanisms to cover the full lifecycle of amoebic infection. Diloxanide Furoate is a luminal amoebicide. It acts directly within the intestinal lumen, disrupting the ability of amoebic cysts and trophozoites to absorb nutrients, which leads to their death. It is highly effective at clearing intestinal cyst carriage, the stage most responsible for ongoing transmission and relapse.

Metronidazole is a nitroimidazole antiprotozoal agent that penetrates systemic tissues. Once absorbed, it is converted into a reactive nitro radical that damages the DNA of anaerobic organisms, causing strand breakage and cell death. This mechanism makes Metronidazole effective against invasive trophozoites that have migrated from the gut wall into the bloodstream and established infection in organs such as the liver. Because Metronidazole is absorbed systemically while Diloxanide Furoate acts locally, their combination is clinically superior to either agent alone for treating mixed intestinal and systemic amoebic disease.

Clinicians prescribing Entamizole DS should be aware that Metronidazole produces a disulfiram-like reaction when combined with alcohol. Patients must be counseled to abstain from alcohol completely during the full 5 to 10 day treatment course. In patients with liver impairment, Metronidazole accumulates due to reduced hepatic clearance, and dose reduction or close monitoring may be required.

Drug Class

• Anti-Amoebic (Combination)
• Diloxanide Furoate: Dichloroacetamide Derivative, Luminal Amoebicide
• Metronidazole: Nitroimidazole, Antiprotozoal and Antibacterial

Packaging and Quantity

• 1 pack contains 15 tablets
• Each tablet contains Diloxanide Furoate 500mg and Metronidazole 400mg

When Not to Use Entamizole DS

• Known allergy or hypersensitivity to Diloxanide Furoate, Metronidazole, or any nitroimidazole derivative
• First trimester of pregnancy
• Breastfeeding mothers
• Patients with a history of seizures or central nervous system disorders
• Severe liver disease, as Metronidazole accumulates in hepatic impairment
• Current use of alcohol or disulfiram-containing preparations

Entamizole DS Tablet 500mg/400mg formula

• Diloxanide Furoate + Metronidazole

Available forms

• Tablets

How to use Entamizole DS Tablet 500mg/400mg?

• The tablet should be swallowed whole with a full glass of water.
• This medicine should always be taken after meals to reduce the risk of nausea and stomach upset.
• The full prescribed course must be completed even if symptoms improve before it ends.
• Alcohol must be strictly avoided throughout the entire course and for at least 48 hours after the last dose.
• A doctor should be consulted if symptoms do not begin to improve within 3 days of starting treatment.
• The standard adult dose is 1 tablet (500mg/400mg) three times daily after meals for 5 to 10 days, as directed by the doctor.
• The dose should not be increased or the course extended without medical advice.

Drug Interactions

Diloxanide Furoate has no clinically significant documented drug interactions. Metronidazole, however, has several important interactions. Key interactions include:

• Alcohol and disulfiram: causes a severe disulfiram-like reaction including flushing, vomiting, rapid heartbeat, and dizziness. Alcohol must be completely avoided during treatment and for 48 hours afterward.
• Warfarin and other anticoagulants: Metronidazole inhibits warfarin metabolism, significantly increasing bleeding risk. INR must be monitored closely.
• Lithium: Metronidazole can raise lithium blood levels, increasing the risk of lithium toxicity.
• Phenytoin and phenobarbital: these anticonvulsants accelerate Metronidazole metabolism, which may reduce its effectiveness.
• Cyclosporine: Metronidazole may increase cyclosporine blood levels, raising the risk of toxicity.
• Cimetidine: inhibits Metronidazole metabolism and may increase its blood levels.

Risks and warnings

• Pregnancy: Entamizole DS is contraindicated in the first trimester. Use in the second and third trimesters should only occur under direct medical supervision when the benefit clearly outweighs the risk.
• Breastfeeding: Metronidazole passes into breast milk. Breastfeeding should be stopped during treatment and for 24 to 48 hours after the last dose.
• Alcohol: A severe disulfiram-like reaction occurs when Metronidazole is combined with alcohol. Alcohol must be avoided completely during treatment and for at least 48 hours after finishing the course.
• Liver disease: Metronidazole is metabolized by the liver. Patients with significant liver impairment should use Entamizole DS with caution and under close medical supervision.
• Neurological conditions: Entamizole DS should not be used in patients with a history of seizures, epilepsy, or central nervous system disorders, as Metronidazole can lower the seizure threshold.
• Blood disorders: Metronidazole may reduce white blood cell counts with prolonged use. Blood counts should be monitored in patients requiring extended courses.
• Children: The standard DS formulation is intended for adults. Pediatric dosing should follow the prescribing doctor's guidance, and the lower-strength formulation may be more appropriate for children.
• Driving and machinery: Entamizole DS may cause dizziness and drowsiness. Caution is advised when driving or operating heavy machinery until individual response is known.

Entamizole DS Tablet Side Effects

Most patients tolerate Entamizole DS well at recommended doses. Side effects are generally mild and resolve after completing the course.

• Nausea or mild stomach discomfort
• Metallic or bitter taste in the mouth
• Headache or dizziness
• Loss of appetite
• Diarrhea or loose stools in the first few days of treatment
• Skin rash or itching in patients with hypersensitivity
• Dark or reddish-brown discoloration of urine (harmless and caused by Metronidazole metabolites)

Serious side effects are rare. Medical attention should be sought immediately if any of the following occur:

• Numbness, tingling, or weakness in the hands or feet, which may indicate peripheral neuropathy
• Seizures or unusual changes in behavior or mental state
• Signs of a severe allergic reaction including facial swelling, difficulty breathing, or widespread rash
• Yellowing of the skin or eyes, which may indicate liver involvement
• Unusual bruising or signs of low white blood cell count such as persistent fever or mouth sores

Storage Conditions

• Store at room temperature, below 25°C.
• Keep away from direct sunlight, heat, and moisture.
• Store in the original packaging to protect from humidity.
• Keep out of reach and sight of children.
• Do not use after the expiry date printed on the packaging.
• Do not store in the bathroom or near a kitchen sink.