Drug Class: Anti-Amoebic + Antiprotozoal Dual Combination | Form: Oral Suspension 90ml | Prescription Status: Prescription Only (Rx) — DRAP Registered
What is Entamizole Suspension? Entamizole Suspension by Abbott Laboratories contains Diloxanide Furoate 250mg and Metronidazole Benzoate 320mg — equivalent to Metronidazole 200mg — per 5ml dose. This clinically rational dual-action combination simultaneously targets intestinal parasitic infections through two completely complementary mechanisms — Metronidazole kills actively dividing trophozoite forms of Entamoeba histolytica and Giardia lamblia causing acute symptoms, while Diloxanide Furoate acts as a luminal amoebicide eliminating the cyst form that persists in the bowel and causes reinfection and asymptomatic carrier states. This two-pronged approach achieves more complete eradication than either medicine alone — addressing both the invasive active infection and the residual cyst burden simultaneously. The suspension formulation with its pleasant taste makes it particularly suitable for children who cannot swallow tablets.
What is Entamizole Suspension Used For?
- Intestinal amoebiasis — Entamoeba histolytica infection causing amoebic dysentery (آنتوں کی اموئیباسس — خونی اسہال)
- Amoebic dysentery — bloody diarrhoea with mucus and cramping from E. histolytica (خونی پیچش)
- Giardiasis — Giardia lamblia intestinal infection causing chronic diarrhoea and bloating (جیارڈیا کا انفیکشن — پتلے دست)
- Asymptomatic amoebic cyst carriers — eliminating intestinal cyst burden to prevent spread and future relapse
- Amoebic colitis — intestinal wall inflammation from amoebic infection (آنتوں کی سوزش)
- Mixed intestinal infections — bacterial and protozoal combined gastrointestinal infections
How Does it Work? Metronidazole 200mg (as 320mg Benzoate) is a nitroimidazole antiprotozoal that enters parasitic cells and undergoes reductive activation — generating cytotoxic free radical intermediates that damage DNA and other critical cellular components in trophozoites of Entamoeba histolytica and Giardia lamblia — killing the actively invasive and symptom-causing forms of both parasites. Metronidazole Benzoate is the palatable ester form that hydrolyses to active Metronidazole after oral administration — providing equivalent therapeutic blood levels with significantly better taste than Metronidazole base for paediatric acceptance. Diloxanide Furoate 250mg acts specifically in the intestinal lumen — directly killing amoebic cysts that survive Metronidazole treatment and would otherwise cause treatment failure, relapse, and continued person-to-person transmission. Together they achieve complete eradication of both active infection and intestinal cyst reservoir.
Dosage and Administration
⚠️ Shake bottle well before every dose — measure accurately using the measuring cup or spoon provided. Take with or after food to reduce nausea. Complete the full prescribed course even if symptoms resolve early — stopping early leaves cysts that cause relapse. Never combine with alcohol — dangerous disulfiram-like reaction from Metronidazole component.
| Patient | Usual Dose | Frequency | Duration |
|---|---|---|---|
| Adults and children over 12 years | 10ml (500mg Diloxanide / 400mg Metronidazole) | Three times daily | 5 days |
| Children 6 to 10 years | 5ml (250mg Diloxanide / 200mg Metronidazole) | Three times daily | 5 days |
| Children 1 to 5 years | 2.5ml | Three times daily | 5 days |
| Giardiasis | As above by age/weight | Three times daily | 5 to 7 days |
Active Ingredients
| Ingredient | Strength per 5ml |
|---|---|
| Diloxanide Furoate BP | 250mg |
| Metronidazole Benzoate BP | 320mg (equivalent to Metronidazole 200mg) |
Who Should NOT Take Entamizole Suspension?
- Allergy to Metronidazole, Diloxanide Furoate, any nitroimidazole, or any component of the suspension
- First trimester of pregnancy — Metronidazole contraindicated in first trimester; use with caution in second and third trimester only if clearly necessary under doctor supervision
- Breastfeeding — Metronidazole passes into breast milk in significant amounts; breastfeeding should be suspended during treatment and for 24 to 48 hours after completing course
- Severe liver impairment — Metronidazole hepatically metabolised; accumulation and neurotoxicity risk
- History of blood dyscrasias — bone marrow suppression risk with Metronidazole
- History of neurological disease — peripheral neuropathy risk with Metronidazole
- Currently taking disulfiram — dangerous psychotic reaction risk
Side Effects
Common: Mild nausea and stomach discomfort — reduced by taking with food (متلی — کھانے کے ساتہ لینے سے کم ہوتی ہے), mild metallic or bitter taste in mouth from Metronidazole (منہ میں کڑواہٹ), mild headache, mild dizziness, mild diarrhoea during early treatment — usually temporary as infection clears.
Serious — Stop and seek emergency help immediately: Severe allergic reaction — sudden widespread rash, swelling of face or throat, difficulty breathing (فوری ہسپتال جائیں), severe neurological symptoms — peripheral neuropathy causing numbness and tingling in hands and feet with prolonged use (ہاتھوں اور پاؤں میں جھنجھناہٹ — فوری ڈاکٹر کو بتائیں), seizures or convulsions — Metronidazole encephalopathy (مرگی کے دورے — فوری ہسپتال جائیں), disulfiram-like reaction if alcohol consumed — severe flushing, vomiting, rapid heartbeat, and collapse (شراب پینے پر شدید ردعمل — فوری مدد لیں), severe liver toxicity — yellowing of skin or eyes (یرقان — فوری مدد لیں), blood disorders — unusual bruising or infections suggesting bone marrow suppression (فوری ڈاکٹر کو بتائیں).
Drug Interactions
| Medicine | Interaction |
|---|---|
| Alcohol (شراب) | Severe disulfiram-like reaction — flushing, severe vomiting, rapid heartbeat, and collapse; avoid alcohol completely during treatment and 48 hours after completing course |
| Disulfiram | Dangerous psychotic reaction and confusion — never combine with Metronidazole |
| Warfarin / blood thinners | Metronidazole significantly potentiates anticoagulant effect — serious bleeding risk; close INR monitoring essential |
| Lithium | Metronidazole increases Lithium blood levels — toxicity risk; monitor Lithium levels closely |
| Phenytoin / Phenobarbitone | Increase Metronidazole metabolism — reduced antiprotozoal effectiveness; Metronidazole also increases Phenytoin levels |
| Cyclosporine | Metronidazole increases Cyclosporine blood levels — nephrotoxicity risk |
| Fluorouracil | Metronidazole increases Fluorouracil toxicity — avoid combination |
| Busulfan | Metronidazole increases Busulfan blood levels — serious toxicity risk |
Storage: Store below 25°C in a cool, dry place. Protect from direct sunlight. Do not refrigerate or freeze. Keep bottle tightly closed after every use. Shake well before every dose. Keep out of reach of children (بچوں کی پہنچ سے دور رکھیں). Do not use after expiry date. Discard any remaining suspension after completing the prescribed course.
FAQs
Q: Why does Entamizole contain two medicines instead of just Metronidazole alone for amoebic infection? Metronidazole effectively kills invasive trophozoite forms causing acute dysentery symptoms — but it penetrates poorly into the intestinal lumen where amoebic cysts reside. Diloxanide Furoate specifically targets these luminal cysts that survive Metronidazole — without both components the cysts remain and cause relapse, reinfection of family contacts, and continued carrier transmission. The combination achieves complete eradication of both the active invasive infection and the persistent intestinal cyst reservoir simultaneously.
Q: Why must alcohol be completely avoided during Entamizole treatment? The Metronidazole component inhibits aldehyde dehydrogenase — the enzyme that breaks down acetaldehyde produced when alcohol is metabolised. Alcohol consumption causes dangerous accumulation of acetaldehyde producing a severe disulfiram-like reaction — sudden intense flushing, severe nausea and vomiting, rapid heartbeat, severe headache, and potentially dangerous collapse. Avoid all alcohol including beer, wine, spirits, and alcohol-containing medicines throughout treatment and for at least 48 hours after the final dose.
Q: Can Entamizole Suspension be given to very young children under 1 year for diarrhoea? Entamizole is not recommended for infants under 1 year — safety is not established in this age group and the aetiology of diarrhoea in very young infants requires careful medical evaluation rather than empirical antiprotozoal treatment. For children under 1 year with suspected parasitic gastrointestinal infection always consult a paediatrician for appropriate age-specific diagnosis and treatment rather than using combination antiprotozoal suspension without medical supervision.
Medical Disclaimer: This information is for general awareness only and does not replace medical advice. Always consult a qualified doctor or pharmacist before taking any prescription medicine.