Generic Name: Iodoquinol
Class: Amebicides
VA Class: AP109
Introduction
Amebicide, antiprotozoal.110
Uses for Yodoxin
Amebiasis
Treatment of amebiasis caused by Entamoeba histolytica.100 102 105 106 107 110
Used alone for treatment of asymptomatic intestinal amebiasis.100 102 105 106 107 Drugs of choice for asymptomatic cyst passers (intraluminal infections) are iodoquinol, paromomycin, or oral diloxanide furoate (not commercially available in the US).100 102 105 106 107 Paromomycin may be preferred in children or pregnant women.105 106
Should not be used alone for treatment of symptomatic intestinal amebiasis or extraintestinal amebiasis (including amebic liver abscess) caused by E. histolytica.100 102 105 106 107 Regimen of choice for symptomatic intestinal amebiasis or extraintestinal disease (including liver abscess) is treatment with a tissue amebicide (oral metronidazole or oral tinidazole) followed by treatment with a luminal amebicide (oral iodoquinol or oral paromomycin).100 102 105 106 107 Paromomycin may be preferred for such follow-up treatment in children or pregnant women.105 106
Some strains of Entamoeba are nonpathogenic (e.g., E. dispar, E. hartmanni) and asymptomatic intraluminal infections with these organisms generally do not require treatment.100 105 106 107
Balantidiasis
Treatment of balantidiasis† caused by Balantidium coli.100 102 106 Tetracycline is considered the drug of choice; alternatives are iodoquinol or metronidazole.100 102 106
Blastocystis hominis Infections
Has been used in the treatment of infections caused by Blastocystis hominis†.100 102 106 108 109
Clinical importance of B. hominis as a cause of GI pathology is controversial;100 102 106 108 109 unclear when treatment is indicated.100 106 108 Some clinicians suggest treatment be reserved for certain individuals (e.g., immunocompromised patients) when symptoms persist and no other pathogen or process is found to explain their GI symptoms.100 106
Treatment alternatives are metronidazole, co-trimoxazole, iodoquinol, or nitazoxanide.100 102 Metronidazole resistance may be common in some areas.102
Dientamoeba fragilis Infections
Treatment of infections caused by Dientamoeba fragilis†.102 106
Drugs of choice are iodoquinol, paromomycin, tetracycline, or metronidazole.102 106
Yodoxin Dosage and Administration
Administration
Oral Administration
Administer orally after a meal.102 110 Tablets may be crushed and mixed with applesauce or chocolate syrup.a
Dosage
Pediatric Patients
Amebiasis Caused by Entamoeba histolytica
Asymptomatic Amebiasis
Oral
30–40 mg/kg daily (maximum: 2 g daily) administered in 3 divided doses for 20 days.102 107
Manufacturer recommends 10–13.3 mg/kg 3 times daily (up to 1.95 g daily) for 20 days.110
Symptomatic Intestinal Amebiasis or Extraintestinal Amebiasis (Including Amebic Liver Abscess)
Oral
30–40 mg/kg daily (maximum: 2 g daily) administered in 3 divided doses for 20 days.102 107
Manufacturer recommends 10–13.3 mg/kg 3 times daily (up to 1.95 g daily) for 20 days.110
Used as follow-up after a tissue amebicide (oral metronidazole or oral tinidazole).100 102 105 106 107 (See Amebiasis under Uses.)
Balantidiasis†
Oral
30–40 mg/kg daily (maximum: 2 g daily) given in 3 divided doses for 20 days.102
Dientamoeba fragilis Infections†
Oral
30–40 mg/kg daily (maximum: 2 g daily) given in 3 divided doses for 20 days.102
Adults
Amebiasis Caused by Entamoeba histolytica
Asymptomatic Amebiasis
Oral
650 mg 3 times daily for 20 days.102 105 107 110
Symptomatic Intestinal Amebiasis or Extraintestinal Amebiasis (Including Amebic Liver Abscess)
Oral
650 mg 3 times daily for 20 days.102 105 107 110
Balantidiasis†
Oral
650 mg 3 times daily for 20 days.102
Blastocystis hominis Infections†
Oral
650 mg 3 times daily for 20 days.102 109
Dientamoeba fragilis Infections†
Oral
650 mg 3 times daily for 20 days.102
Prescribing Limits
Pediatric Patients
Amebiasis Caused by Entamoeba histolytica
Oral
Maximum 1.95110 or 2 g daily.102
Balantidiasis†
Oral
Maximum 2 g daily.102
Dientamoeba fragilis Infections†
Oral
Maximum 2 g daily.102
Special Populations
No special population dosage recommendations at this time.a
Cautions for Yodoxin
Contraindications
Known hypersensitivity to iodine and 8-hydroxyquinolines.110
Hepatic disease.110
Warnings/Precautions
Warnings
Optic Neuritis and Peripheral Neurotoxicity
Avoid long-term use.110 Prolonged, high dosage of halogenated 8-hydroxyquinolines has resulted in optic neuritis, optic atrophy, and peripheral neuropathy .110
Sensitivity Reactions
Hypersensitivity
Discontinue if hypersensitivity reactions occur.110
General Precautions
Thyroid Disease
Use with caution in individuals with thyroid disease.110 (See Laboratory Tests under Interactions.)
Nonspecific Diarrhea
Do not use for the treatment of nonspecific diarrhea.110
Specific Populations
Pregnancy
Category C.111
Lactation
Not known whether iodoquinol is distributed into milk,111 safe use during lactation not established.110
Pediatric Use
Do not exceed maximum daily dosage.110
Hepatic Impairment
Contraindicated in patients with hepatic disease.110
Common Adverse Effects
Iodism manifested by generalized furunculosis (iodine toxicoderma) and skin reactions (papular and pustular acneiform eruptions, bullae, vegetating or tuberous iododerma), urticaria and pruritus, GI effects (anorexia, nausea, vomiting, diarrhea, abdominal cramps, pruritus ani), fever, chills, headache, vertigo, thyroid enlargement, optic neuritis, optic atrophy, peripheral neuropathy.110 a
Interactions for Yodoxin
Laboratory Tests
Contains 64% organically-bound iodine.110 May interfere with certain thyroid function tests by increasing protein-bound serum iodine concentrations.110 This effect may persist for as long as 6 months after cessation of iodoquinol therapy.110
Yodoxin Pharmacokinetics
Absorption
Bioavailability
Poorly absorbed from the GI tract; majority of an oral dose is excreted in fecesa
Some systemic absorption may occur since increased blood concentrations of iodine have been reported.a
Distribution
Extent
Animal studies indicate the drug is distributed into tissues.a Free iodine appears in urine.a
Elimination
Elimination Route
Unabsorbed drug is eliminated in feces.a Glucuronide and sulfate conjugates of iodoquinol are eliminated in urine. a
Stability
Storage
Oral
Tablets
15–30°C110 in well-closed containers.a
Actions and SpectrumActions
A luminal or contact 8-hydroxyquinoline amebicide, acts primarily in the intestinal lumen.a Precise mechanism of action unknown.a
Amebicidal against Entamoeba histolytica.110 Active against both the trophozoite and encysted forms.110 Elimination of the cyst form probably results from destruction of the trophozoites.a
Advice to Patients
Importance of taking after a meal.110
Importance of completing full course of treatment, even if feeling better after a few days.a
Importance of notifying clinician of persistent or worsening symptoms of infection.a
Importance of informing clinicians if hypersensitivity reactions or rash occurs.110 a
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.110
Importance of informing patients of other important precautionary information. (See Cautions.)
Preparations
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Routes | Dosage Forms | Strengths | Brand Names | Manufacturer |
|---|---|---|---|---|
Oral | Tablets | 210 mg | Yodoxin | Glenwood |
650 mg | Yodoxin | Glenwood |
Disclaimer
This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.
The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.
AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions September 2009. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.
† Use is not currently included in the labeling approved by the US Food and Drug Administration.
References
100. American Academy of Pediatrics. 2006 Red Book: Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006.
102. Anon. Drugs for parasitic infections. From the Medical Letter website. 2008 Aug.
105. Ravdin JI. Amebiasis. Clin Infect Dis. 1995; 20:1453-66. [IDIS 349015] [PubMed 7548493]
106. Aucott JN. Amebiasis and “nonpathogenic” intestinal protozoa. Infect Dis Clin North Am. 1993; 7:67-85.
107. Reed SL. Amebiasis: an update. Clin Infect Dis. 1992; 14:385-93. [IDIS 292053] [PubMed 1554822]
108. Miller RA. Blastocystis hominis: an organism in search of a disease. Rev Infect Dis. 1988; 10:930-8. [IDIS 309903] [PubMed 3055191]
109. Grossman I, Weiss LM, Simon D et al. Blastocystis hominis in hospital employees. Am J Gastroenterol. 1992; 87:729-32. [PubMed 1590309]
110. Glenwood. Yodoxin (iodoquinol) tablets prescribing information. From manufacturer’s website. Accessed 2009 May 11.
111. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation. 8th ed. Baltimore, MD: Williams & Wilkins; 2008:843-4.
a. AHFS drug information 2009. McEvoy GK, ed. Iodoquinol. Bethesda, MD: American Society of Health-System Pharmacists; 2009:856-7.
More Yodoxin resources
- Yodoxin Side Effects (in more detail)
- Yodoxin Use in Pregnancy & Breastfeeding
- Yodoxin Drug Interactions
- Yodoxin Support Group
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- Yodoxin Concise Consumer Information (Cerner Multum)
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Compare Yodoxin with other medications
- Amebiasis
- Balantidium coli
- Blastocystis Infection
- Dientamoeba fragilis
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