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Anti parasite medication?


ChomDo
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Does anyone living in Thailand have experiences of anti parasite medication? I have lived in Bangkok for 15 years and have never taken one, but heard that many take it yearly just in case there is something in the body. 

 

I was recommended a medicine called Zentel 400mg twice a day for 3 days. Does anyone have any experiences about this and if it might cause any side effects?

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I take Ivermectin.  Great dewormer and it kills two birds with one stone.  :thumbsup:

Or take albendazole.  OTC.  30 THB per dosage.  Before Ivermectin I took that twice a year.  Search for albendazole online for dosage and conditions it treat.  You usually need to take a dose with kills adult worms, wait a period, and then take another dose as most of these dewormers only kill adult worms.

Or
If you're not into reading medical literature (you should for correct usage and dosages) then -  Visit a doctor.

Edited by connda
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Depends what parasite you're going after.  The wife and I take Praziquantel.  Mainly because we often eat Isaan style food such as Pla-Som.  Liver fluke (Opisthorchis viverrini) is endemic in Isaan and is spread through partially-cooked fish in particular, although poor hygiene no doubt also spreads it to non fish eaters...

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Start with the lightest mebendazole, up to 500mg for one day. 
 

in several weeks take 4 pills of niclosamide. 
 

in another several weeks albendazole 400mg. Pill pill for one day is enough. Dont take yet that high dose 3x3 yet, if no symptoms. 
 

another few weeks praziquantel 1 pill. In several weeks 3 pills. 
 

the most expensive and the strongest is ivermectin. You can take it at the end, so in several month. 
 

after each medicine do observe parasite reaction, strong herx effect means you have killed some of them. Concentrate on that medicine for sometimes, until you dont experience herx anymore. 

at this stage worth to do tests, diagnosis and further cause of action, but chances of finding traces of parasite in the body is very low 10%. Hence some doctors concentrate on symptoms, not test
 

 

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Thanks for all the replies. This idea came up with my physiotherapist who suggested me to do so because it may help reduce muscle pains (if there are parasites present of course). He gave me the instructions to take Zentel 400mg 2x a day for 3 days and then repeat the process after a week as connda mentioned above. I know there are many other options but as he suggested this one and said he does it regularly, I would like to stick to it at least for the first time. Was just curious if anyone else here has done the exact same and if I should expect any side effects from this? 

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Albendazol has wide spectrum of action and is strong, hence can cause side effects. 
without clear symptoms or diagnosis should not be taken in large dose and for long. 
 

similar action has mebendazole, without potential side effects. It works only on the digestive tract, doesnt burden liver, and is good enough. Its the first medicine which should be taken. 

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1 hour ago, internationalism said:

Albendazol has wide spectrum of action and is strong, hence can cause side effects. 
without clear symptoms or diagnosis should not be taken in large dose and for long. 
 

similar action has mebendazole, without potential side effects. It works only on the digestive tract, doesnt burden liver, and is good enough. Its the first medicine which should be taken. 

Just saying, I've personally never experienced side-effects from Anthelmintics if taken at the correct dosages.  Zero. Nada.

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So read side effects of all those medicines, as each medicine has many. Compare them. 
Talk to a competent pharmacist or doctor. However, most of them dont have much clue, unless specialising in this narrow field. 
as albendazol is one of the strongest one, can cause strong herx effect, which should be avoided. 
It kills gut flora, as everything which lives there. So has properties of antibiotic. 
if somebody is seriously infected the strongest herx and chance for side effects. 
its an individual reaction, careful approach should be taken, if selfmedicating.
in time of pandemic you dont want to be admitted to hospital, those very doctors are overstreched.  
plenty of water week before starting treatment and week after. 
natural yougurt, fermented milk, cheese for flora. 
also the other probiotics, prebiotics. 
also antiparasitic diet. Avoiding sugar. 
treatment can be enhanced by special herbs

Edited by internationalism
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On 1/7/2022 at 12:48 PM, internationalism said:

So read side effects of all those medicines, as each medicine has many. Compare them. 
Talk to a competent pharmacist or doctor. However, most of them dont have much clue, unless specialising in this narrow field. 
as albendazol is one of the strongest one, can cause strong herx effect, which should be avoided. 
It kills gut flora, as everything which lives there. So has properties of antibiotic. 
if somebody is seriously infected the strongest herx and chance for side effects. 
its an individual reaction, careful approach should be taken, if selfmedicating.
in time of pandemic you dont want to be admitted to hospital, those very doctors are overstreched.  
plenty of water week before starting treatment and week after. 
natural yougurt, fermented milk, cheese for flora. 
also the other probiotics, prebiotics. 
also antiparasitic diet. Avoiding sugar. 
treatment can be enhanced by special herbs

Thanks for the all info. I was given a handout form the clinic I go to and I suppose I should follow the instructions they gave (two 3 days sets of Albendazol within a week). Actually the whole point of doing this was not about possible parasites but I was recommended a liver flush (detox cleansing of the gut) by doing the two day magnesium sulphate cleansing. The anti parasite medication before it was just a vital part to make sure no unwanted parasites remain in the body.  

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On 1/7/2022 at 7:20 AM, internationalism said:

 

the most expensive and the strongest is ivermectin.

Bottle 100x 5-mg tabs

70baht

Lazada.

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On 1/6/2022 at 5:59 PM, connda said:

I take Ivermectin.  Great dewormer and it kills two birds with one stone.  :thumbsup:

Or take albendazole.  OTC.  30 THB per dosage.  Before Ivermectin I took that twice a year.  Search for albendazole online for dosage and conditions it treat.  You usually need to take a dose with kills adult worms, wait a period, and then take another dose as most of these dewormers only kill adult worms.

 

Give it to the dog too,cannot overdose albendazole    35 baht 2 pills Facino

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Albemed over the table from your local pharmacy.

 

On 1/7/2022 at 4:27 AM, HauptmannUK said:

Praziquantel

The above drug made me ill for 24 hours post taking. Never again.

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On 1/7/2022 at 4:27 AM, HauptmannUK said:

Depends what parasite you're going after.  The wife and I take Praziquantel.  Mainly because we often eat Isaan style food such as Pla-Som.  Liver fluke (Opisthorchis viverrini) is endemic in Isaan and is spread through partially-cooked fish in particular, although poor hygiene no doubt also spreads it to non fish eaters...

OP, this is what you're hearing about, and the one you should get.  Once or twice a year, JIC 🤣

 

Depending on your diet of course.

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albendazoi is the medicine with the most side effects, in comparison to the others.

 

if prazi made you sick, it means, you have a tape worm or flukes.

Talk to doctor about this experience, run tests.

If only tape worms you can use niclosamide, but that doesnt work on flukes.

 

With all of them proper hydration for a week before and after the last dose. 

Clean liver, kidney, lower herx effect

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  • 2 weeks later...

So I'm done with my first 3 day set of Zentel and noticed nothing and didn't see anything suspicious floating in the toilet.

 

Now I'm wondering how important the second 3 days set is? I was recommended to repeat the procedure in 1 weeks time just in case to "kill the possibly remaining eggs of any parasites". 

 

Just to be clear again, there was no suspicion that I have any parasites to begin with but this was just a part of a bigger process suggested to me by my physiotherapist. 

 

Any experience about this? Should I really take another 3 days of Zentel after a week has passed?

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On 1/7/2022 at 4:27 AM, HauptmannUK said:

Depends what parasite you're going after.  The wife and I take Praziquantel.  Mainly because we often eat Isaan style food such as Pla-Som.  Liver fluke (Opisthorchis viverrini) is endemic in Isaan and is spread through partially-cooked fish in particular, although poor hygiene no doubt also spreads it to non fish eaters...

Actually, raw pla ra (rotten fish sauce) is probably the main way that liver flukes are transmitted. And it's used to make all kinds of sauces and as a flavoring in non-fish dishes. So not eating raw or semi-cooked fish probably won't protect someone living in Isan.

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2 hours ago, ChomDo said:

So I'm done with my first 3 day set of Zentel and noticed nothing and didn't see anything suspicious floating in the toilet.

 

Now I'm wondering how important the second 3 days set is? I was recommended to repeat the procedure in 1 weeks time just in case to "kill the possibly remaining eggs of any parasites". 

 

Just to be clear again, there was no suspicion that I have any parasites to begin with but this was just a part of a bigger process suggested to me by my physiotherapist. 

 

Any experience about this? Should I really take another 3 days of Zentel after a week has passed?

if there is no any suspicion having any parasites you should not take the strongest medicine in such high dose and for so many days. Don't do the second cycle. If you have already pill's do keep them when you really need them, they have long expiry dates.

 

if you live in bangkok 15 years you still might use anti-parasite medications to see, how you will react to each one. Strong reaction would indicate medicine is effective.

In about month time get up to 500mg mebendazole.

A few weeks after niclosamide 4 pills.

Another few weeks praziquantel 1 pill, after a week or two 3 pills.

At the end ivermectin 2 pills.

Note down reaction after each medicine. That would be useful to pass to a specialist doctor, before doing laboratory tests.

Each of them works on different parasites and in a different way. Often there is no other way to find out what parasites we might have, but by testing reaction to each medicine.

 

 

 

 

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1 hour ago, internationalism said:

if there is no any suspicion having any parasites you should not take the strongest medicine in such high dose and for so many days. Don't do the second cycle. If you have already pill's do keep them when you really need them, they have long expiry dates.

 

if you live in bangkok 15 years you still might use anti-parasite medications to see, how you will react to each one. Strong reaction would indicate medicine is effective.

In about month time get up to 500mg mebendazole.

A few weeks after niclosamide 4 pills.

Another few weeks praziquantel 1 pill, after a week or two 3 pills.

At the end ivermectin 2 pills.

Note down reaction after each medicine. That would be useful to pass to a specialist doctor, before doing laboratory tests.

Each of them works on different parasites and in a different way. Often there is no other way to find out what parasites we might have, but by testing reaction to each medicine.

 

 

 

 

Thanks for the advice. Where is all this info coming from if I may ask? I mean it's your own experience or you're a medical professional. Just interested because you seem to have very detailed suggestions about what to do.

 

Every pharmacy I asked said this is the normal dose and nothing to worry about it. I know I should not believe them too much but I'm doing this because my American physiotherapist suggested to do so (just in case). He and his patients do the same several times a year so that's why I'm going with this advice.

 

I was told that you can't often see the parasites in your stool (in the toilet) so it's advised to take the second 3 day set just to be sure the medicine has done it's work.

 

What's the risk in taking another 3 day course of Zentel? I mean it seems to be the recommended way, but you were referring to it being too strong. Bad for the liver or what?

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i am not medical professional, but I know a lot about those medicines. Read net, talk to professionals and patients.

I do also do take all those medicines.

Read a leaflet about albendazol. When self-medicating, no any symptoms, no tests, diagnosis just 1 pill every few months is sufficient as prophylaxis. Yes, can have numerous side effects. In cases when it has to be used for long, each cycle should be done after liver enzyme tests. On gut flora it works as antibiotics do - weakens your immune system if taken needlessly.

 

Mebendazol should be used as first medicine, works similarly, but stays only in a digestive tract, doesn't burden kidneys, liver.

 

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The usual dose of albendazole for empiric treatment of parasites is once daily for between 1 to 3 days.

 

Taking 2 3 day courses within a week is definitely exceeding recommended dosage.

 

Albendazole is systemically absorbed and can rarely be toxic to the liver (not as rarely if people exceed normal dosage).

 

 

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18 hours ago, internationalism said:

i am not medical professional, but I know a lot about those medicines. Read net, talk to professionals and patients.

I do also do take all those medicines.

Read a leaflet about albendazol. When self-medicating, no any symptoms, no tests, diagnosis just 1 pill every few months is sufficient as prophylaxis. Yes, can have numerous side effects. In cases when it has to be used for long, each cycle should be done after liver enzyme tests. On gut flora it works as antibiotics do - weakens your immune system if taken needlessly.

 

Mebendazol should be used as first medicine, works similarly, but stays only in a digestive tract, doesn't burden kidneys, liver.

 

Thanks for clarifying! I'm just wondering why 3-4 pharmacies agreed that the dose recommended to me by the physio clinic was normal. Now I'm wondering if I should skip the second 3 day course. My physician said, you don't usually see any actual parasites in the stool so not taking the second cycle might leave you unsure. Does this make sense then?

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17 hours ago, Sheryl said:

The usual dose of albendazole for empiric treatment of parasites is once daily for between 1 to 3 days.

 

Taking 2 3 day courses within a week is definitely exceeding recommended dosage.

 

Albendazole is systemically absorbed and can rarely be toxic to the liver (not as rarely if people exceed normal dosage).

 

 

Thanks Sheryl, So can you tell me how I can be sure then that the first 3 days of Zentel 400mg x2 times a day has been effective? If we can't often see the actual worms in the stool and it says everywhere that the second 3 days set is important to make sure the possible remaining eggs are also killed from your body. Can you clarify this.

 

I don't want to be exceeding any safe dosage but this one that I was recommended seems to be common and now that I've taken one set of 3 days I just want to make sure that doesn't go to waste.

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if you tell a pharmacist, that you were advised by some medic to take 2x3, they will fully agree, because they don't know nothing about you and would not undermine this medic.

another problem is, that they don't know much about dosage. The more you buy the more happy they are.

They even mix up names of medicines with similar sounding - for example I ask pharmacist for mebendazol and she gives me albendazol. Or ask for an antibiotic roxithromicine and she brings me azithromicine. Happens all the time, especially if they don't speak english. They would remember only thai trade names, but don't have clue about the name of an active substance. So often you here "mai me" because they don't have a clue. So many times I have to point with my hand to medicine, because they don't understand. Writing the name sometimes helps.

I have pointed you already 3x to read leaflet for albendazol, it's 1 second search and 5 minutes read to know almost everything about dosage and side effects. Some patients have to take this medicines daily to the end of their life, for you just 1 tablet from time to time is enough. 

You have already overdosed by 5 pills. Doing more is counterproductive. You will weaken your body natural defence in the gut, and some parasites will move into. If not some virus earlier, within days.

Edited by internationalism
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1 hour ago, Sheryl said:

 

It does not say this "everywhere", in fact it doers not say this in any accepted medical text.

 

The dose of albendazoel varies according to the (lab identified) parasite being treated. There is no "three days twice" protocol for any of them.

 

Odds are you do not have parasites to begin with and the treatment is doing nothing.

 

If you did have parasites, the mature worms  might or might not  be visible to the naked eye depending on type of parasite.  Parasite eggs never are.

 

Since you are so concerned about this, the best thing to do would be to have a lab test of the stool for ova & parasites. Needs 3 separate samples one three different days. Most labs can do it.

 

Odds are the tests will come back negative, but if they should come back positive for anything at least then you would know exactly what parasite to treat for.

 

So you're saying that it's not true that the possible remaining eggs won't be destroyed with the first by the first 3 day set or you just mean that taking another set for 3 days is too harmful? 

 

I'm not concerned about parasites to begin with but I'm about to do a 2 day "liver flush detox" with Epsom salts and my physiotherapist said it would be very important to make sure to take this parasite medication (with the dosage explained). This was just to make sure that there is nothing harmful like that remaining in the body. I don't expect I have parasites to begin with but I've lived in BKK 15 years and never done one so I thought it's a good time to do it.

 

Having done the first set now with the dosage that is considered "an overdose" here, I just don't want that to go to waist and possibly leave uncached eggs in my body (if it was the case). I also don't want to risk taking it if it's really so dangerous as you guys mention here. Now I'm just getting mixed advice from different places.

 

Could you let me know what's the risk of taking the second 3 day set? If it's really bad for me then sure, I'll skip it but I would be left with a feeling of leaving the process half done.

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3 minutes ago, ChomDo said:

So you're saying that it's not true that the possible remaining eggs won't be destroyed with the first by the first 3 day set or you just mean that taking another set for 3 days is too harmful? 

 

I'm not concerned about parasites to begin with but I'm about to do a 2 day "liver flush detox" with Epsom salts and my physiotherapist said it would be very important to make sure to take this parasite medication (with the dosage explained). This was just to make sure that there is nothing harmful like that remaining in the body. I don't expect I have parasites to begin with but I've lived in BKK 15 years and never done one so I thought it's a good time to do it.

 

Having done the first set now with the dosage that is considered "an overdose" here, I just don't want that to go to waist and possibly leave uncached eggs in my body (if it was the case). I also don't want to risk taking it if it's really so dangerous as you guys mention here. Now I'm just getting mixed advice from different places.

 

Could you let me know what's the risk of taking the second 3 day set? If it's really bad for me then sure, I'll skip it but I would be left with a feeling of leaving the process half done.

When you ask about "remaining eggs" specifically which parasite are you referring to and why do you suspect  you have it to begin with?

 

Your physiotherapist has no expertise in this area. I doubt he or she could even tell you specifically which "parasites" they are recommending you take this for, much less provide medical reference for the suggested regimen.

 

For nematodes, a single dose of albendazole is adequate for complete cure.

 

For helminths (hookworm) and strongyloides, a three day course is usually sufificient for complete cure.

 

For trichuris (whipworm),  3 day regimen is necessary. In rare causes with heavy infestaion a 5  or 7 day course may be needed. However a heavy infestation would not be asymptomatic.

 

By the way, a "liver flush" does not in  any way cleanse your liver. It is basically just an osmotic laxative. You'll have diarrhea, and the oil taken with the flush will stimulate release of bile which, together with the oil, will produce blobs in your watery stool. These are not -- as some proponents  will try to claim -- gallstones or "liver stones", they are just the natural result of saponification of the oil by bile. If you are healthy and are careful to rehydrate enough afterwrads, the "liver flush" likely won't do you any harm, but nothing is being cleansed or detoxified by it.

 

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19 hours ago, Sheryl said:

When you ask about "remaining eggs" specifically which parasite are you referring to and why do you suspect  you have it to begin with?

 

Your physiotherapist has no expertise in this area. I doubt he or she could even tell you specifically which "parasites" they are recommending you take this for, much less provide medical reference for the suggested regimen.

 

For nematodes, a single dose of albendazole is adequate for complete cure.

 

For helminths (hookworm) and strongyloides, a three day course is usually sufificient for complete cure.

 

For trichuris (whipworm),  3 day regimen is necessary. In rare causes with heavy infestaion a 5  or 7 day course may be needed. However a heavy infestation would not be asymptomatic.

 

By the way, a "liver flush" does not in  any way cleanse your liver. It is basically just an osmotic laxative. You'll have diarrhea, and the oil taken with the flush will stimulate release of bile which, together with the oil, will produce blobs in your watery stool. These are not -- as some proponents  will try to claim -- gallstones or "liver stones", they are just the natural result of saponification of the oil by bile. If you are healthy and are careful to rehydrate enough afterwrads, the "liver flush" likely won't do you any harm, but nothing is being cleansed or detoxified by it.

 

Thanks again for your detailed reply. I remember you giving me good advice related to some earlier medical issues I had so I trust you know this stuff well.

 

I really don't suspect parasites nor do I assume I would be in the need of a liver flush (I have a healthy diet, in my 30s and fit). The problem is that I've had close to 20 years of chronic back issues, the latest one being a very problematic SI-joint dysfunction that does not respond to traditional treatment (been trough every possible treatment). So this time I was suggested to try "anything it takes" and I said why not because I just want to improve my condition.

 

My current physiotherapist recommended a "detox" or "liver cleanse" to possibly reduce inflammation in the body. This was the only reason I decided to go trough this whole process. Just in case it would help. According to him, the toxins in the liver can cause chronic pain to be worse. Basically, I'm not expecting any miracle cure from this but the clinic mentioned that some patients with chronic back pain had gotten significant relieve from the liver flush (altho not just one time). 

 

Even if this doesn't help for the pain, I get to start my new anti inflammatory diet with a cleaner system which I think sounds like a good idea to me. The liver flush process itself tho sounds tough to me since you're basically emptying your intestine and not eating for 24hrs.  

 

Does this sound at all like a smart thing to do in my case? I'm at the point with this SI joint issue that I would be willing to try any "less common" treatment methods like this. 

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3 hours ago, Sheryl said:

"Liver flush" will not remove toxins from the liver nor from anywhere else in the body. Pure quackery.

 

The liver as a matter of course removes toxins from the body, that is its job and there is no need whatsoever to meddle with this.

 

It is highly unlikely that "toxins" in the body are causing your pain.

 

And diet has at best only  small effects on inflammation.

 

Are your inflammation markers (ESR, CRP) elevated?

 

I do emphathize with your SI joint issues, I have this myself.  But (assuming SI joint is the culprit) the effective treatments are: stretches/physiotherapy, steroid injections and, rarely and as a last resort (and if diagnosis is sure) --  surgery.

 

It can be very difficult to distinguish between pain from the SI joint and pain from the lumbar spine. (And one can have problems in both areas -- I did) Have you seen a really good spinal specialist and had MRI of the lumbar spine recently?

 

Reverting to your question -- no, this is not a smart thing to do. Probably won't hurt you, but it is a complete waste of money and frankly, you are being conned. There is a a lot of money to be made from sufferers of chronic pain and unfortunately a lot of unscrupoulous people taking advantage of this. They get away with it partly due to placebo effect and partly because people (often desperate for relief)  accept their claims with no evidence.

 

I can assure you there is absolutely no evidence that "liver flushes" reduce inflammation or pain. If anything, since it stresses the body, it will create a mild temporary inflammatory response.

 

Dietary improvements  can slightly reduce inflammation if the diet to start with is bad, but the improvements needed are probably a far cry from (and far less  complicated than) what you will be told to do. See  https://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation.

 

Note too that diet is more influential if there is an underlying over-reaction of the immune system. With orthopedic problems more often there is not, rather there is inflammation not because the immune system is in any way haywire but rather because the immune system is responding normally to an underlying structural problem with localized inflammation.

 

Proper (as opposed to fad) anti-inflammatory diets are healthy balanced diets and good in any case so nothing to lose by them, but really you need to get to the underlying cause. If nerves are inflamed because they are being pinched by bone, no diet and no "alternative" cures are going to help.

 

 

 

 

 

 

Thanks again for the detailed answer and knowledge. This just makes it all more confusing. Why would I be conned when I'm doing the "liver cleansing" procedure at home with simple Magnesium sulphate that I bought from the pharmacy for around 100b and olive oil. Nobody is making any money here.

 

The advice or more like a suggestion was given to me by a well-known American chiropractor who's been working in the industry for some 30 years. I would really think he knows what he's talking about. He didn't say that there's any guaranteed results from doing this home remedy but mentioned that he has had some difficult cases like mine who have gotten relieve out of it.

 

The handout given to me mentions "that for some cases cleaning out the bile ducts in the liver and gall bladder might help because congestion in these structures refers pain to the neck and back". 

 

I've been trough 10-15 years of running around specialist and what not without any help until an Australian chiropractor finally found that I had SI joint dysfunction 2 years ago. All the fancy doctors and orthopaedics I went to never bothered checking for that. So since then I have not wanted to see any doctors about this. Various MRIs have been taking including the lover back. 

 

Why I went to see this chiropractor is because 2 years ago I got rid of the pain totally with the help of my previous chiropractor but she moved back to AUS. That time the painless period lasted for about 6 months and then it was back to normal with everything from sitting to walking being a problem. 

 

So as I mentioned, now I'm willing to do anything it takes to get rid of this issue. Sitting is the worst and I have to be at the computer long hours so it's a massive issue. 

 

Please if you do have more ideas or names of someone you can suggest, I would be glad to give it a try?

 

Actually the clinic I was going to now kind of said there's no point for me to come back right now because they can't really help me. The liver flush idea was something they suggested I should try to see if it has any positive effect.

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Assuming you are in Thailand, Dr. Tayard at the Spine Center at Bangkok International Hospital would most definitely check for SI joint issues, he did for me. And if your pain is due to sacroilitis then  he can do intra-joint injection which, along with physio,  is the usual treatment. Be sure to bring most recent MRI (on CD, nto just the report) with you.

 

https://www.bangkokhospital.com/en/doctor/dr-tayard-buranakarl

 

Do not  confuse chiropracty with physiotherapy, they are not the same thing. I don't mean this as a criticism of chiro, but they are different disciplines with different treatments and even the most experienced chiropracter is not a qualified physiotherapist.

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