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Melarsoprol

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Melarsoprol

  • See Also
  1. African Trypanosomiasis
  • Indications
  1. East African Trypanosomiasis (T. rhodesiense)
    1. Stage 2 AND (Age <6 years OR body weight >20kg)
    2. Fexindazole is preferred in other cases
  • Contraindications
  1. G6PD Deficiency
  2. Pregnancy
  • Mechanism
  1. Arsenical agent used in Trypanosomias
  • Dosing
  1. Melarsoprol 2.2 mg/kg/day IV for 10 days
  2. Consider Corticosteroid pretreatment to prevent encephalopathy
  3. Consider pretreatment with Suramin to treat blood stages before Melarsoprol
  • Pharmacokinetics
  1. Penetrates the blood brain barrier and CNS
  • Adverse Effects
  1. Encephalopathy (5-10% of patients)
    1. High mortality (>50%)
    2. Consider Corticosteroid pretreatment to prevent encephalopathy
  2. Jarisch-Herxheimer Reaction
  3. Hemolysis in G6PD Deficiency
  4. Blood Pressure elevation
  5. Gastrointestinal symptoms (Nausea, Vomiting, Abdominal Pain)
  6. Peripheral Neuropathy
  7. Pruritus
  8. Phlebitis
  • Safety
  1. Pregnancy
    1. Avoid unless used as rescue therapy in severe disease
  2. Lactation
    1. May continue to Breast feed while on therapy
  • Resources
  1. African Trypanosomiasis (WHO)
    1. https://www.who.int/news-room/fact-sheets/detail/trypanosomiasis-human-african-(sleeping-sickness)
  2. African Trypanosomiasis (Stat Pearls)
    1. https://www.ncbi.nlm.nih.gov/books/NBK535413/
  • References
  1. Gladwin, Trattler and Mahan (2014) Clinical Microbiology, Medmaster, Fl, p. 349
  2. Freedman (2025) Sanford Guide, accessed 7/11/2025 on IOS
  3. Ortiz-Martínez (2023) Curr Trop Med Rep 10(4):222-34 +PMID: 38939748 [PubMed]