Stiboson

Indications

Sodium Stibogluconate is a pentavalent antimony medicine used to treat leishmaniasis, a parasitic disease spread by sandfly bites. It is used for visceral leishmaniasis (kala-azar), which affects the liver, spleen and bone marrow, and for cutaneous (skin) and mucocutaneous (skin and nose or mouth lining) leishmaniasis, including post kala-azar dermal leishmaniasis (PKDL).

How It Works

Inside the body the medicine is converted to a trivalent form of antimony, which interferes with the energy production and protective chemical systems of the Leishmania parasite, so the parasite dies. It also helps the body's immune cells kill the parasites.

Dosage and Administration

Sodium Stibogluconate is given only by a doctor or nurse, by slow injection into a vein or into a muscle, usually once a day for several weeks; for some skin lesions it may be injected directly into the sore. The dose is calculated from body weight and the course length depends on the type of leishmaniasis, as prescribed under national treatment guidelines. Heart tracing (ECG), blood counts and liver, kidney and pancreas tests are done during treatment.

Interactions

• Medicines that prolong the QT interval on the ECG (such as Amiodarone, some antipsychotics, Macrolide antibiotics and Fluoroquinolones) increase the risk of dangerous heart rhythms.
• Amphotericin B: giving it soon after antimony may increase heart toxicity; the doctor will space them.
• Other medicines toxic to the liver, kidneys or pancreas can add to side effects.

Contraindications

• Allergy to antimony compounds.
• Significant heart disease, especially heart rhythm problems or long QT.
• Severe kidney or liver disease.
• Pregnancy, unless the doctor decides there is no safer option.

Side Effects

Common: loss of appetite, nausea, vomiting, stomach pain, muscle and joint pain, headache, tiredness, metallic taste, and pain at the injection site. Blood tests may show raised liver and pancreas enzymes and changes in blood counts. ECG changes are common.

Get urgent medical help for fainting, palpitations or chest pain, severe stomach pain spreading to the back (possible pancreatitis), yellowing of the skin or eyes, unusual bleeding, very reduced urine, fever with cough or breathlessness, or swelling of the face or throat.

Pregnancy and Lactation

Antimony medicines can harm the unborn baby and are generally avoided in pregnancy; other treatments such as Amphotericin B are preferred. Pregnancy should be avoided during treatment. Small amounts may pass into breast milk; the doctor will advise on breastfeeding.

Precautions and Warnings

• Given only under medical supervision with regular ECG and blood tests.
• Use with extra care in older people, children, and people with HIV, malnutrition, or heart, liver, kidney or pancreas problems.
• Complete the full course; leishmaniasis can come back if treatment is stopped early.
• Resistance is common in some regions, so the doctor may choose another medicine.

Overdose

Overdose can cause severe vomiting, dangerous heart rhythms, kidney and liver damage and shock. It is treated in hospital with supportive care and, if needed, chelating agents.

Therapeutic Class

Antiprotozoal, pentavalent antimonial (antileishmanial).

Storage

Hospital medicine: store as directed on the pack, usually below 25°C, protected from light, do not freeze. Keep out of the reach of children.