- Dexamethasone: Steady-state trough concentrations of Helal sulfoxide were about 56% higher when dexamethasone was coadministered with each dose of Helal. (7.1)
- Praziquantel: In the fed state increased mean maximum plasma concentration and area under the curve of Helal sulfoxide by about 50% in healthy subjects. (7.2)
- Cimetidine: Increased Helal sulfoxide concentrations in bile and cystic fluid by about 2-fold in hydatid cyst patients. (7.3)
- Theophylline: Helal induces cytochrome P450 1A in human hepatoma cells; therefore, it is recommended that plasma concentrations of theophylline be monitored during and after treatment. (5.5, 7.4)
What is Helal?
Helal is an anthelmintic (an-thel-MIN-tik) or anti- worm medication. It prevents newly hatched insect larvae (worms) from growing or multiplying in your body.
Helal is used to treat certain infections caused by worms such as pork tapeworm and dog tapeworm.
Helal may also be used for purposes not listed in this medication guide.
Category C. Helal is teratogenic in animals, but has not been well studied in humans. No increased morbidity reported in case reports of women inadvertently treated during pregnancy. The World Health Organization (WHO) endorses treatment of pregnant women in the second and third trimesters (but not the first) for intestinal helminthiasis/anemia, if clinically indicated.
What is the most important information I should know about Helal?
Helal should not be used during pregnancy, unless there is no alternate treatment. You may need to have a negative pregnancy test before starting this treatment.
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In the fed state, praziquantel (40 mg/kg) increased mean maximum plasma concentration and area under the curve of Helal sulfox >max and mean plasma elimination half-life of Helal sulfoxide were unchanged. The pharmacokinetics of praziquantel were unchanged following co-administration with Helal (400 mg).
Mechanism of Action
ALBENZA binds to the colchicine-sensitive site of β-tubulin inhibiting their polymerization into microtubules. The decrease in microtubules in the intestinal cells of the parasites decreases their absorptive function, especially the uptake of glucose by the adult and larval forms of the parasites, and also depletes glycogen storage. Insufficient glucose results in insufficient energy for the production of adenosine trisphosphate (ATP) and the parasite eventually dies.
Mechanism of Resistance
Parasitic resistance to Helal is caused by changes in amino acids that result in changes in the β-tubulin protein. This causes reduced binding of the drug to β-tubulin.
In the specified treatment indications Helal appears to be active against the larval forms of the following organisms:
Helal disease interactions
There are 4 disease interactions with Helal which include:
Where can I get more information?
Your pharmacist can provide more information about Helal.
Alopecia universalis was seen in a 70-year-old male on day 20 of daily treatment with Helal 15 mg/kg/day for Echinococcus. Alopecia fully recovered 1 month after stopping the medication .
Another case of alopecia in the form of telogen effluvium was reported in a 27-year-old female patient in her second week of a 2-week course of daily Helal 400 mg for treatment of cutaneous larva migrans. Remission was noted in 3 months will full restoration of normal hair observed at 11 months .
A novel case of psychosis in a 36-year-old female was documented after receiving a single dose of Helal 400 mg and ivermectin 12 mg for suspected helminthic infection. Symptoms of persecutory delusions and auditory hallucinations improved within 48 h and resolved within 1 week. Helal was the suspected cause given its ability to cross the blood–brain barrier .
Liver: A single case of toxic hepatitis was noted in Turkey after using Helal 800 mg/day for treatment of hydatid cysts .
Neurologic: Starting 3 days after treatment with Helal for presumed intestinal helminths, a patient experienced seizures (focal, myoclonic, generalised and status epilepticus) headache and contralateral hypoesthesia and ultimately expired. Postmortem analysis revealed neurocysticercosis, highlighting the importance of judicious use of the drug in populations living in areas with high rates of coinfection with Taenia solium .
In a randomised, double-blind, placebo-controlled trial to assess the effects of anthelmintic treatment in pregnancy and early childhood on early childhood response to immunisations and infectious diseases inc >Helal or placebo and praziquantel (PZQ) or placebo. Of their offspring 2016 aged 15 months to 5 years were then randomised to receive quarterly single-dose Helal or placebo; 2345 children were born during this time and 1622 remained in follow-up at 5 years of age. Almost 68% of women at enrolment (1705 of 2507) and 10.6% of children at age 5 were infected with at least one helminth. Treatment with Helal during pregnancy led to statistically significant higher eczema rates in offspring. Helminthic infections are known to elicit powerful type 2 immune reactions thus downregulating type 1 immune responses. This helps explain the lower rates of allergy and autoimmunity in populations with high helminthic infections in addition to the increased rate of eczema seen in offspring of pregnant women treated with Helal. Interestingly, lower rates of clinical malaria were found in children treated with quarterly Helal .
In a randomised, double-blind, placebo-controlled trial in Malaysia, 37 T. trichiura-infected children, aged 6–7 years received Helal 400 mg or placebo for 2 days. Twelve months after treatment a height discrepancy was noted between the two groups. The placebo group had a significantly greater increase in height compared to the treatment cohort (p = 0.04) .
A randomised, double-blind, placebo-controlled trial with 533 T. trichiura-infected children in Pemba, Tanzania, consisted of treatment with 1000 mg of nitazoxanide + placebo, placebo + 400 mg of Helal or 1000 mg of nitazoxanide on day 1 followed by 400 mg of Helal on day 2. Common side effects from Helal and nitazoxanide were headache, abdominal cramps, nausea, vertigo, diarrhoea, fever, allergic reaction, vomiting and fatigue . Cure rates for T. trichiura were equally low in all arms.