Triclabendazole

This case report describes two patients with Fasciola hepatica infection. One presented with abdominal discomfort and marked eosinophilia; the other with chest discomfort and marked eosinophilia. Abdominal CT showed hypodense liver lesions, and ultrasound‑guided liver biopsy suggested parasitic infection. Serological tests confirmed fascioliasis. Both patients were successfully treated with a single dose of triclabendazole, the drug of choice. The authors emphasize that acute fascioliasis should be suspected in patients with abdominal pain, marked eosinophilia, and hypodense hepatic lesions on CT, even in non‑endemic areas.

Fig. 1 Microscopic findings of the case one patient. (Park HJ, et al., 2021)

In vitro screening of parent drugs (e.g., montelukast, triclabendazole, ziprasidone) and their sulfoxide/sulfone metabolites showed that several metabolites retained or exhibited CYP inhibition. Montelukast sulfoxide and sulfone potently inhibited CYP2C8 (IC₅₀ 0.05 and 0.02 µM), while triclabendazole and its metabolites inhibited CYP2C9, CYP2C19, and CYP3A4. Metabolic fate experiments indicated that CYP2C9 and CYP3A4 were the main enzymes involved in further metabolism of these sulfoxide/sulfone compounds. The authors emphasize the need for risk assessment when co‑administering drugs that generate such metabolites.

Fig. 2 Schematic presentation of tiered assessment of drug-drug interaction potential of sulfoxide and/or sulfone metabolites of albendazole, triclabendazole, aldicarb, methiocarb, montelukast and ziprasidone. (Giri P, et al., 2018)