Apr 29, 2001
Being I am very weak,I am afraid of the possible toxic effects of pyrimethamine for toxoplasmosis treatment. Are there any alternatives to try or any studies or trails for alternate therapies,including any natural items that might help. Thank you for your help.
Response from Dr. Pavia
I am not sure why you are afraid of sulfadiazine and pyrimethamine. The most common side effect is anemia or low white blood count, but these can be treated with transfusion, erythropoietin (Epogen), or GCSF (Neupogen). We often give folinic acid (leucovorin) to prevent the effects on the bone marrow. Generally, it is uncommon to have generalized weakness from toxo therapy, and more often, you will regain strength as the toxo improves. Other side effects can include rash or GI upset.
There are several alternative treatments, including clindamycin with pyrimethamine, atovoquone (mepron), trimethoprim sulfa (septra,in very high doses), or azithromycin or clarithromyin given with pyrimethamine.
As you can see, atovoquone is the only well studied approach that avoids pyrimethamine. Septra has not been as well studied, but appears to be quite active.
Because the number of new cases of toxo has fallen, there are very few trials. I searched one data base of clinical trials and could not find any trials for Toxo.
I would generally advise starting therapy with sulfadiazine and pyrimethamine and seeing how it goes. It is the best studied, and probably the most effective treatment for toxo.
Good luck ATP
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