The patient is a woman who has been treated with bithionol (30 to 50 mg per kg bodyweight) on alter

Fråga: The patient is a woman who has been treated with bithionol (30 to 50 mg per kg bodyweight) on alternate days between March 31 and April 21 due to a liver fluke infection (fasciola hepatica). Now she is pregnant, with onset of the last menstrual cycle on April 15 and probable conception not earlier than one week after discontinuation of bithionol treatment. Is bithionol teratogenic?

Sammanfattning: There is no information about the safety of bithionol during pregnancy. In the present case, the exposure was before conception, even if low concentrations of bithionol or metabolites might have been present during very early pregnancy. However, it is generally believed that exposure to teratogenic drugs in this phase will either not effect the fetus or will induce a spontaneous abortion.

Svar: Bithionol is a dichlorophenol compound structurally related to hexachlorophene. The pharmacokinetics are not well known. Bithionol is readily absorbed from the gastrointestinal tract. It is glucuronidated in the liver and excreted by the kidneys (1). Side effects in the gastrointestinal tract are common as well as headache, dizziness and urticaria (1,2).

Bithionol has been used in thousands of patients in China for the treatment of paragonimiasis (2). However, there are no published reports concerning the safety of bithionol treatment during pregnancy. 1 Gustafsson LL, Beerman B, Abdi YA: Handbook of drugs for tropical parasitic infections. Taylor & Francis, London. 1987; page 20 2 Chung HL, Ho LY, Hsu CP, Ts´ao WJ: Recent progress in studies of paragonimus and paragonimiasis control in China. Chin Med J 1981: 94: 483-494