Niratil

Niratil Uses, Dosage, Side Effects, Food Interaction and all others data.

Niratil is the active laevo-isomer of tetramisole. It works by paralysing susceptible intestinal worms which are then excreted from the intestines. Niratil also enhances cellular immune responses in humans.

Niratil is a synthetic imidazothiazole derivative that has been widely used in treatment of worm infestations in both humans and animals. As an anthelmintic, it probably works by targeting the nematode nicotinergic acetylcholine receptor. As an immunomodulator, it appears that Niratil is an immunostimulant which has been shown to increase NK cells and activated T-cells in patients receiving this adjuvantly along with 5FU for Stage III colon cancer.

Trade Name Niratil
Availability Discontinued
Generic Levamisole
Levamisole Other Names Levamisol, Levamisole, Levamisolum
Related Drugs Keytruda, carboplatin, capecitabine, pembrolizumab, fluorouracil, doxorubicin, cyclophosphamide, Avastin, Xeloda, vincristine
Type
Formula C11H12N2S
Weight Average: 204.291
Monoisotopic: 204.072119084
Protein binding

20-25%

Groups Approved, Investigational, Vet approved, Withdrawn
Therapeutic Class Anti-helminthic
Manufacturer
Available Country Austria, France
Last Updated: September 19, 2023 at 7:00 am
Niratil
Niratil

Uses

Niratil is a fast acting drug which acts on nematode nerve ganglia paralysing the worm’s musculature within seconds of contact. Unable to maintain their position, the worms are then ejected by normal peristaltic movement, usually within 24 hours of levamisole administration. Although it is certain that levamisole primarily influences the neuromuscular system of nematodes, it is possible that in some helminthes the inhibition of the fumarate reductase system contributes to the anthelmintic efficacy of levamisole. Niratil is used for the treatment of infections by the following gastrointestinal wormspecies:

  • Ascaris lumbricoides: Roundworm
  • Necator americanus: Hookworm
  • Ancylostoma duodenal: Hookworm
  • E nterobius vermicularis: Pinworm
  • Trichuris trichuria: Whipworm
  • Strongyloides stercoralis: Threadworm
  • Trichostrongylus colubriformis

Niratil is also used to associated treatment for these conditions: Adenocarcinoma of Colon, Ancylostoma duodenale infection, Ascaris lumbricoides infection, Carcinoma, Colorectal, Enterobius vermicularis infection, Necatoriasis due to necator americanus, Strongyloides Stercoralis Infection, Trichuris Infection

How Niratil works

The mechanism of action of levamisole as an antiparasitic agent appears to be tied to its agnositic activity towards the L-subtype nicotinic acetylcholine receptors in nematode muscles. This agonistic action reduces the capacity of the males to control their reproductive muscles and limits their ability to copulate. The mechanism of action of Niratil as an anticancer drug in combination with fluorouracil is unknown. The effects of levamisole on the immune system are complex. The drug appears to restore depressed immune function rather than to stimulate response to above-normal levels. Niratil can stimulate formation of antibodies to various antigens, enhance T-cell responses by stimulating T-cell activation and proliferation, potentiate monocyte and macrophage functions including phagocytosis and chemotaxis, and increase neutrophil mobility, adherence, and chemotaxis.

Dosage

Niratil dosage

The following doses of Niratil are given as a single administration, preferably after a light meal.

  • Age 1-4 year: 1 Tablets or5 mlSyrup
  • Age 5-15 year: 2 Tablets or10 mlSyrup
  • Age 16year and over: 3 Tablets or 15 mlSyrup

In cases of severe hookworm infection it is suggested that a second standard dose be given one or seven days after the first, whichever timing is feasible.

Side Effects

Side-effects are infrequent. They are usually mild and transient and include nausea, vomiting, abdominal pain, giddiness(dizziness) and headache. An encephalopathylike syndrome has been reported to have occurred in a few patients two or three weeks after treatment.

Toxicity

LD50 = 40 mg/kg (Pigs, subcutaneous); LD50 = 180 mg/kg (rat, oral)

Precaution

Effect on ability to drive or operate machinery: There is no evidence to suggest that Niratil , used for anthelmintic purpose, will produce sedation. Mild and transient giddiness is an infrequent side-effect of treatment. No precautions are suggested concerning the ability to drive or operate machinery.

In case of concurrent microfilaraemia transient fever may occur.

Interaction

May increase toxicity of phenytoin. Increases bioavailability of ivermectin; decreases bioavailability of albendazole. Alcohol causes disulfiram-like reaction.

Food Interaction

  • Take on an empty stomach.

Niratil Alcohol interaction

[Moderate] GENERALLY AVOID:

Case histories have suggested that levamisole is associated with some side effects (including headache, fever, shivers, and dizziness) that suggest an disulfiram-like interaction with alcohol.

These side effects could be alleviated by total abstinence from alcohol.

No mechanism has been established for this interaction.



Patients receiving levamisole should avoid alcohol.

Elimination Route

Niratil is rapidly absorbed (2 hours) from the gastrointestinal tract.

Half Life

4.4-5.6 hours (biphasic)

Pregnancy & Breastfeeding use

Although studies in animals have shown that Niratil produces no teratogenic effects, current medical practice requires that the benefits of any drug used during pregnancy should be weighed against the possible dangers.

Contraindication

There is no absolute contra-indication to the use of Niratil

Acute Overdose

Counter possible anticholinesterase activity with e.g. atropine. Control blood pressure and respiration . Do not use sedatives.

Storage Condition

Tablet: Store in room temperature and protect from moisture.

Syrup: Store in room temperature and protect from light.

Innovators Monograph

You find simplified version here Niratil

FAQ

What is Niratil used for?

Niratil is a medication used to treat parasitic worm infections, specifically ascariasis and hookworm infections. Niratil is an immunomodulatory agent that was used to treat various cancers before being withdrawn from the United States market in 2000 because of adverse effects.

Is Niratil safe for humans?

Although not available for human use, Niratil remains widely used in veterinary medicine for treating worms in livestock and domesticated animals. The Niratil can cause agranulocytosis, as well as vasculitis, which prompted the FDA ban on human use.

Is Niratil toxic?

Toxicity of Niratil is generally described as mild with nausea, diarrhea, and leukopenia being the most significant adverse effects with fatigue, dermatitis, and stomatitis also seen.

How does Niratil work?

Niratil works by suppressing the enzyme activity in the muscle of the worm, causing paralysis and death.

What are the common side effects of Niratil?

    Common side effects of Niratil are include:

  • Metallic taste
  • Nausea Anxiety or nervousness
  • Dizziness
  • Headache
  • Mental depression
  • Nightmares
  • Pain in joints or muscles
  • Skin rash or itching
  • Trouble in sleeping
  • Unusual tiredness or sleepiness
  • Vomiting
  • Blurred vision
  • Confusion
  • Convulsions (seizures)
  • Lip-smacking or puffing
  • Numbness, tingling, or pain in the face, hands, or feet
  • Paranoia (feelings of persecution)
  • Puffing of cheeks
  • Rapid or worm-like movements of the tongue
  • Trembling or shaking
  • Trouble in walking
  • Uncontrolled movements of arms and legs

Is Niratil safe during pregnancy?

Animal studies have revealed evidence of embryotoxicity. There are no controlled data in human pregnancy. Niratil should only be given during pregnancy when benefit outweighs risk.

Is Niratil safe during breastfeeding?

The World Health Organization recommends against breastfeeding with maternal Niratil therapy.

Can I drink alcohol with Niratil?

You should avoid drinking alcohol, it can increase some of the side effects of Niratil. This can cause nausea, dizziness, vomiting, and upset stomach. It is important to tell your doctor about all other medications you use, including vitamins and herbs.

Can I drive after taking Niratil?

Some people may feel dizzy or tired while taking this medicine. Do not drive unless you are feeling well.

How do I take Niratil?

Niratil has been prescribed to treat a variety of parasitic worm infections. It ought to be taken with food. Do not crush or chew or break the tablet. Swallow the whole thing with a full glass of wate.

How much Niratil should I take?

The recommended dose is 150mg/day, in 3 equally divided doses, by mouth for 3 days. Maintenance- three-day course every two weeks for a year.

How long does it take Niratil to work?

Niratil is readily absorbed from the gastrointestinal tract and metabolized in the liver. Its time to peak plasma concentration is 1.5–2 hours.

How long does Niratil stay in my system?

The plasma elimination half-life is fairly quick at 3–4 hours which can contribute to not detecting Niratil intoxication. The metabolite half-life is 16 hours. Niratil excretion is primarily through the kidneys, with about 70% being excreted over 3 days.

Can I take Niratil for a long time?

Do not take more or less of it, and do not take it more often than your doctor ordered. The exact amount of medicine you need has been carefully worked out.

How much Niratil should I take?

Maintenance- three-day course every two weeks for a year.

Who should not take Niratil?

Patients who have a reported allergy to any of the other ingredients in Niratil should stop taking it. In addition, patients with asthma should avoid using Niratil.

What happens if I miss a dose?

If you miss a dose of Niratil, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Call your doctor or pharmacist for instructions.

What happen if I take too much Niratil?

Taking too much may increase the chance of side effects, while taking too little may not improve your condition. If you vomit shortly after taking a dose of Niratil, check with your doctor. You will be told whether to take the dose again or to wait until the next scheduled dose.

Can Niratil affects my heart?

With a view to cardiac function, Niratil can cause right heart failure. Furthermore, effects on heart rate have been observed including severe bradycardia, tachycardia and ventricular fibrillation, as well as cardiac dysrhythmias.

Can Niratil affect my kidney?

Niratil laced Cocaine Led to ANCA Vasculitis and Kidney Damage.

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*** Taking medicines without doctor's advice can cause long-term problems.
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