Sodium Stibogluconate
**Sodium stibogluconate** is a pentavalent antimonial compound primarily utilized as an **antileishmanial** agent in both human and veterinary medicine. * It is considered a traditional mainstay for the treatment of both cutaneous and visceral leishmaniasis in dogs. * The drug is known for having a narrow therapeutic index, with a high potential for serious adverse effects. > **Clinical Pearl:** In the United States, this drug is not commercially available. It must be obtained directly from the Centers for Disease Control and Prevention (CDC) under specific protocols, and it may or may not be released for use in domestic animals.
Mechanism: The exact mechanism of action of sodium stibogluconate remains incompletely elucidated. * **Prodrug Hypothesis:** It is widely hypothesized to act as a prodrug, where the pentavalent antimony (SbV) is reduced to the more toxic trivalent antimony (SbIII) within the host macrophage or the parasite itself. * **Bioenergetic Disruption:** It is believed to interfere with the parasite's bioenergetics by reducing **ATP and GTP synthesis** in susceptible *Leishmania* amastigotes, ultimately leading to parasite death.
Dosing by species
- Treatment of cutaneous leishmaniasis · 30-50 mg/kg IV or SC daily · IV/SC · q24h · 3-4 weeks
- Treatment of visceral leishmaniasis · 30-50 mg/kg IV or SC q24h · IV/SC · q24h · one month · Has severe side effects and may not be obtainable in the USA; allopurinol alone is usually used initially.
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Routes of administration
Contraindications
- Pre-existing cardiac arrhythmias
- Significantly impaired renal function
- Previous serious adverse reaction to a dose of stibogluconate
- Severe renal impairment
- Severe hepatic impairment
Adverse effects
- Increased AST levels
- Pain on injection
- Musculoskeletal pain
- Hemolytic anemia
- Leukopenia
- Vomiting
- Diarrhea
- Pancreatitis
- Myocardial injury and arrhythmias
- Renal toxicity
- Shock
- Sudden death
- Thrombophlebitis (with IV administration)
- Nephrotoxicity
- Hepatotoxicity
- Injection site pain
- Lethargy
Drug interactions
- Amphotericin B · Increased risk of nephrotoxicity · major
- Allopurinol · Synergistic antileishmanial effect (often used together clinically) · minor
Monitoring
- CBC
- Liver enzymes (especially AST)
- Renal function tests
- ECG (for myocardial injury/arrhythmias)
- Bone marrow cultures for Leishmania
- Clinical efficacy
- Renal function (BUN, Creatinine, SDMA, Urinalysis)
- Hepatic enzymes (ALT, AST, ALP)
- Pancreatic enzymes (cPLI, Lipase)
- ECG (for arrhythmias)
Overdose
In the unlikely event of a parenterally administered overdose, it is suggested to immediately contact an animal poison control center. * **Chelation Therapy:** Potentially, antimony toxicity can be managed by chelating agents such as **dimercaptosuccinic acid (DMSA)** or **d-penicillamine** to enhance excretion.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.