pyrimethamine (Daraprim, Fansidar)

Drug description
Pyrimethamine is used for the treatment and prevention of malaria. Pyrimethamine is also used to treat AIDS-related diarrhea and as one of a combination of drugs to treat Toxoplasma gondii, a protozoal infection. Many HIV+ have been exposed to toxoplasmosis (toxo), but are able to keep the infection in check until their immune systems become relatively weak. People can become infected with the toxo organism by coming in contact with feces, frequently found in dirt. Symptoms include headaches, fever, confusion, lack of energy, and, in some cases, inflammation of parts of the eyes. Toxo can also cause loss of mental status, seizures and paralysis. Toxoplasmosis can become resistant or unresponsive to existing treatments. Glaxo-Wellcome, Inc., which makes Daraprim, has an HIV Patient Assistance Program - call (800) 722-9294.

Side effects
Folic acid deficiency can cause a painful burning tongue, loss of taste, and anemia. Other side effects can be skin rash, fever, nervousness, loss of appetite, nausea, vomiting, diarrhea, bone marrow depression, and jaundice.

Dosage
Pyrimethamine comes in tablets combined with sulfadoxine called Fansidar. For treatment of Isosporiasis infection, adults take 50-75 mg of pyrimethamine daily, as needed to control or eliminate infection. For treatment of toxoplasmosis, usual dose is 25 mg daily. For AIDS related toxo, treatment begins with a loading dose of 100-200 mg in 2 divided doses daily for the first 2 days, then 50-75 mg daily. Maintenance treatment is 25 mg per day, sulfadiazine 4 grams per day, and leucovorin 10 mg per day.

How long it may take to work
For maintenance, treatment is ongoing. Maintenance treatment means you keep taking the drug to control an infection so that you don't become ill. For controlling malaria or toxo, continual use on a regular schedule for 4-6 weeks is usually necessary.

Managing side effects
Take with food if necessary to reduce stomach irritation. Take with a full glass of water or juice. Drug should be discontinued immediately if a skin rash or itching develops. Leucovorin should be taken daily to prevent anemia.

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