VHOSPITAL.CLINIC · Parasite Treatment Drug

Miltefosine for Leishmaniasis

Miltefosine is the first oral treatment for visceral leishmaniasis, offering a significant advantage over IV amphotericin B in resource-limited settings where kala-azar is endemic.

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How Miltefosine Works Against Leishmaniasis

Miltefosine is an alkylphosphocholine that disrupts Leishmania membrane phospholipid metabolism, interferes with signal transduction pathways, and induces apoptosis-like death in the parasite.

Dosing Protocol

Adults (>25 kg): 2.5 mg/kg/day in 2–3 divided doses for 28 days. Adults: typically 50 mg twice daily (100 mg/day). Take with food to reduce nausea. Contraindicated in pregnancy.

This is a general reference. Always follow your physician's prescription and local treatment guidelines.

Side Effects

  • Nausea, vomiting, and diarrhoea (very common — take with food)
  • Elevated creatinine (monitor renal function)
  • Teratogenic — contraindicated in pregnancy and 3 months after treatment
  • Transaminase elevation

Red Flags

  • ⚠️Pregnancy (absolute contraindication)
  • ⚠️Severe vomiting preventing dose retention
  • ⚠️Significant renal impairment
  • ⚠️Treatment failure — fever and splenomegaly at day 28

FAQ: Miltefosine and Leishmaniasis

Why is miltefosine teratogenic?

Miltefosine has a long half-life (7 days) and accumulates in tissues. Animal studies show significant embryotoxicity and teratogenicity. Women of childbearing age must use contraception during treatment and for 3 months after.

How effective is miltefosine for visceral leishmaniasis?

Miltefosine achieves initial cure rates of 90–95% in the Indian subcontinent. However, relapse rates are higher (~15% at 6 months) than with amphotericin B, particularly in HIV co-infected patients.

Can miltefosine treat cutaneous leishmaniasis?

Yes. Miltefosine is also effective for cutaneous and mucosal leishmaniasis, particularly for L. braziliensis and L. donovani species. It is particularly valuable as an oral alternative to painful intralesional antimonials.

Other Treatments for Leishmaniasis

Symptoms Leishmaniasis Causes

Miltefosine treats Leishmaniasis, which can cause these symptoms:

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Medical References

Content on this page is informed by evidence-based clinical sources including: