Antimony in plasma and skin of patients with cutaneous leishmaniasis – relationship with side effects after treatment with meglumine antimoniate

Abstract

Summaryobjective To evaluate the levels of antimony in plasma and skin of patients being treated with pentavalent antimonials (Glucantime Ò ) and their relationship with side effects.methods We evaluated 19 patients treated endovenously at the conventional dose (20 mg Sb v ⁄ kg ⁄ day), two at a smaller dose (5 mg Sb v ⁄ kg ⁄ day) and three treated intralesionally (up to 4.0 ml ⁄ week). During treatment, patients underwent periodic blood exams and were interviewed weekly about the incidence of adverse symptoms. The levels of antimony in plasma and skin samples were determined by Inductively Coupled Plasma with Mass Spectrometry (ICP-MS).results The patients under conventional treatment presented a mean initial antimony plasma concentration of 3.39 lg ⁄ l; at the end of treatment, these levels were 0.21 before Glucantime Ò application and 125.8 mg after Glucantime Ò application. The mean antimony level in their skin at the end of the treatment was 9.24 lg ⁄ g. The main adverse symptoms were arthralgia and myalgia; laboratory results showed mainly lymphocytosis and eosinophilia.conclusions We found some significant correlations between antimony concentrations, adverse symptoms and laboratory alterations, strengthening the hypothesis of a dose-dependent relationship between antimony concentration in plasma and skin and side effects.keywords cutaneous leishmaniasis, side effects, antimony, inductively coupled plasma with mass spectrometry

Low versus high dose of antimony for American cutaneous leishmaniasis: A randomized controlled blind non-inferiority trial in Rio de Janeiro, Brazil

“…There were significant greater numbers of adverse events and major adverse events per subject, more major adverse events and more drug-related discontinuations in the high dose group. The dose dependent toxicity of antimony might account for the differences, and this result is consistent with previous studies [38, 39]. …”

Depot Subcutaneous Injection with Chalcone CH8-Loaded Poly(Lactic-Co-Glycolic Acid) Microspheres as a Single-Dose Treatment of Cutaneous Leishmaniasis

“…Surprisingly, during the three-dose meglumine antimoniate treatment, a slight weight loss was verified, and significantly elevated ALT was observed at the end of treatment, a finding indicative of hepatotoxicity. This is in line with various studies showing that systemic absorption of meglumine antimoniate occurs after intralesional administration, leading to systemic adverse effects during and after intralesional meglumine antimoniate that include nausea, vomiting, dyspnea, dizziness, and anaphylactic shock (13), as well as altered hepatic function and white cell count changes (42).…”

Clinical and Parasitological Features of Patients with American Cutaneous Leishmaniasis that Did Not Respond to Treatment with Meglumine Antimoniate

“…Epidemiological and clinical variables regarding disease characteristics, patients’ background and Glucantime tolerance did not show any remarkable features in patients under ATF, and had similar frequency and distribution as in other series of military patients with ACL who responded to AT and patient series’ from different American countries [ 9 , 13 , 32 – 35 ].…”