Dicaris® Children

Overview of Dicaris (Levamisole) for Children

Introduction:
Dicaris, known generically as levamisole, is an anthelmintic medication primarily used to treat parasitic worm infections. Originally developed as a deworming agent for both humans and animals, levamisole has also been investigated for its immunomodulatory properties. While its use in children is less common today due to the availability of safer alternatives, it remains an important drug in certain clinical and veterinary contexts.

Mechanism of Action:
Levamisole works by paralyzing the muscles of parasitic worms, leading to their expulsion from the body. It acts as a nicotinic acetylcholine receptor agonist, causing sustained depolarization of the worm's neuromuscular junction, which results in spastic paralysis. Additionally, levamisole has been shown to modulate the immune system by stimulating T-cell differentiation and enhancing the activity of macrophages and neutrophils.

Indications for Use in Children:

1. Parasitic Infections:

   • Levamisole is effective against roundworm infections, particularly Ascaris lumbricoides (common roundworm) and Ancylostoma duodenale (hookworm). It has also been used to treat other nematode infections, though its use has declined in favor of newer anthelmintics like albendazole and mebendazole.

2. Immunomodulation:

   • In the past, levamisole was used as an adjuvant therapy in combination with fluorouracil (5-FU) for the treatment of colorectal cancer. Its immunomodulatory effects have also been explored in conditions like recurrent aphthous stomatitis and autoimmune disorders, though these uses are rare in pediatric populations.

Dosage and Administration:

• The dosage of levamisole for children is typically weight-based, usually ranging from 2.5 mg/kg to 5 mg/kg as a single dose or divided doses. It is often administered orally in tablet form or as a suspension.

• Treatment may be repeated after 7–14 days if necessary, depending on the severity of the infection and the child's response to therapy.

Safety and Side Effects:
Levamisole is generally well-tolerated, but it can cause side effects, particularly with prolonged use or higher doses. Common side effects in children include:

• Gastrointestinal disturbances (nausea, vomiting, abdominal pain)

• Headache

• Dizziness

• Fatigue

• Skin rashes

Rare but serious adverse effects include:

• Agranulocytosis (a severe reduction in white blood cells)

• Vasculitis (inflammation of blood vessels)

• Neurological symptoms (e.g., seizures, confusion)

Due to these risks, levamisole is no longer a first-line treatment for parasitic infections in children, especially in regions where safer alternatives are available.

Contraindications and Precautions:

• Levamisole should not be used in children with known hypersensitivity to the drug.

• It is contraindicated in children with severe liver or kidney impairment.

• Caution is advised in children with a history of blood disorders or autoimmune conditions.

Current Status and Alternatives:
In many countries, levamisole has been largely replaced by newer anthelmintic drugs such as albendazole and mebendazole, which have broader spectra of activity, fewer side effects, and simpler dosing regimens. However, levamisole may still be used in specific cases, particularly in resource-limited settings where cost and availability are concerns.

Conclusion:
While Dicaris (levamisole) was once a widely used anthelmintic for children, its role in modern medicine has diminished due to the availability of safer and more effective alternatives. Its use is now largely restricted to specific clinical scenarios or regions where other treatments are inaccessible. Healthcare providers must weigh the benefits and risks of levamisole carefully when considering its use in pediatric patients.