Suramin Injectable: Dosing and Precautions

Therapeutic action

Trypanocide.

Indications

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

Forms and strengths, route of administration

Due to high toxicity and numerous adverse effects of suramin, patients must be treated in hospital under close medical supervision.

• 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% sodium chloride.
• Do not administer by IM or SC injection.

Dose and duration

• Child and adult: 4 to 5 mg/kg by slow IV at D1 as a 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, maximum 1 g per injection.

Contra-indications, adverse effects, precautions

• Do not administer in patients with severe renal or hepatic disease.
• May cause anaphylactic reaction. In the event of anaphylactic reaction, the patient should never receive suramin again.
• May cause proteinuria, diarrhoea, haematological disorders, eye disorders, neurological disorders, high fever, skin eruption, malaise, intense thirst, polyuria, and local inflammation or necrosis if given 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 the schedule, and persistent heavy proteinuria requires discontinuation.
• 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 melarsoprol can be given after delivery, as melarsoprol is contra-indicated during pregnancy.
• Suramin is not administered at the meningoencephalitic stage except in pregnant women because it poorly penetrates the cerebrospinal fluid.
• Due to its toxicity, suramin is no longer used for the treatment of onchocerciasis.