Suramin is an antiparasitic medication that works without affecting the central nervous system to treat trypanosomiasis brought on by Trypanosoma brucei rhodesiense and Trypanosoma Brucei Gambiense.

Suramin Uses:

• It is recommended for the treatment of patients with early human African trypanosomiasis (sleeping sickness), which is caused by T. brucei rhodesiense or East African sleeping sickness, without the involvement of the central nervous system, as well as a substitute for infections brought on by T. brucei gambiense or West African sleeping sickness.

Suramin Dose in Adults

Suramin Dose as an alternative agent in the treatment of Trypanosomiasis, hemolymphatic stage, caused by T. brucei gambiense or T. brucei rhodesiense:

• Initial: 100 mg as a slow intravenous infusion (test dose), followed by 1 g on days 1, 3, 7, 14, and 21.
• Note:
  • For trypanosomiasis that affects the central nervous system, it is not advised.

Suramin Dose in Childrens

Suramin Dose as alternative agent in the treatment of Trypanosomiasis, hemolymphatic stage, caused by T. brucei gambiense or T. brucei rhodesiense:

• Initial: 2 mg/kg as a slow intravenous infusion (test dose), followed by 20 mg/kg up to a maximum dose of 1 g on days 1, 3, 7, 14, and 21.
• Note:
  • It is not recommended for trypanosomiasis with central nervous system involvement.

Pregnancy Category: D

• According to research on animal reproduction, the medication was teratogenic. Use of it during pregnancy or breast-feeding is not advised.
• During pregnancy and lactation, safer alternatives should be used.

Dose in Kidney Disease:

Avoid use in severe renal impairment.

Dose in Liver disease:

Avoid use in severe hepatic impairment.

Side effects of Suramin:

• Cardiovascular:

  • Shock

• Central Nervous System:

  • Dizziness
  • Fatigue
  • Headache
  • Loss Of Consciousness
  • Paresthesia
  • Peripheral Neuropathy

• Dermatologic:

  • Exfoliative Dermatitis
  • Pruritus
  • Urticaria

• Endocrine & Metabolic:

  • Polydipsia

• Gastrointestinal:

  • Diarrhea
  • Nausea
  • Stomatitis
  • Vomiting

• Genitourinary:

  • Nephrotoxicity
  • Proteinuria

• Hematologic & Oncologic:

  • Pancytopenia

• Hypersensitivity:

  • Hypersensitivity Reaction (Immediate)

• Ophthalmic:

  • Optic Atrophy

• Renal:

  • Polyuria
  • Renal Impairment

• Miscellaneous:

  • Fever

Contraindications to Suramin:

Allergy to suramin, or any other component of the formulation

Warnings and precautions

• Hypersensitivity reaction

  • During treatment, hypersensitivity reactions may be immediate and manifest as hypotension, shock or loss of consciousness.

• Toxicity in the renal system:

  • Secondary to the drug, proteinuria or nephrotoxicity can occur.

• Hepatic impairment

  • Patients suffering from hepatic impairment should not use it.

• Renal impairment

  • Patients suffering from renal impairment should not use it.

Monitoring parameters:

• Monitor for hypersensitivity reactions or immediate idiosyncratic reactions such as vomiting, hypotension, and loss of consciousness.
• BUN, serum creatinine, and urinalysis at baseline and weekly during the treatment
• CBC.

How to administer Suramin?

It is administered as a slow intravenous infusion.

Mechanism of action of Suramin:

• It is unknown what the drug does. It inhibits essential parasitic enzymes, which are vital for cellular reactions like respiration and glycolysis. 
• The drug targets enzymes involved in the reduction of reduced nicotinamide dinucleotide, (NADH), in the trypanosome parasite.
• When used to treat onchocerciasis, it has both macrofilaricidal as well as microfilaricidal properties. 
• It acts as an agonist of Ryanodine receptors, an inhibitor of P2 receptors, and follicle-stimulating hormone receptors [Ref].

Absorption:

• It is not absorbed when administered orally

Distribution:

• It does not penetrate the central nervous system.

Protein Binding:

• More than 99% of the drug is protein-bound.

Half-life elimination of the drug:

• 36 to 60 days

Suramin International Brand Names:

• Anatrypol
• Fourneau
• Belganyl
• Germanin
• Moranyl
• Naganin
• Naganine
• Naganol
• Naphuride

Suramin Brand Names in Pakistan:

No Brands Available in Pakistan.