thyroid gland enlargement have been attributed to its iodine content. The recognition of severe neurotoxicity with the related drug, clioquinol, in Japan in the 1960s, must give cause for caution in its use.

Meglumine antimonate is a pentavalent antimony compound, similar to sodium stibogluconate.

Melarsoprol, a trivalent organic arsenical, acts through its high affinity for sulphydryl groups of enzymes. Adverse effects include encephalopathy, myocardial damage, proteinuria and hypertension.

Mepacrine (quinacrine) was formerly used as an antimalarial. It may cause gastrointestinal upset, occasional acute toxic psychosis, hepatitis and aplastic anaemia.

Nifurtimox is a nitrofuran derivative. Adverse effects include: anorexia, nausea, vomiting, gastric pain, insomnia, headache, vertigo, excitability, myalgia, arthralgia and convulsions. Peripheral neuropathy may necessitate stopping treatment.

Paromomycin, an aminoglycoside, is not absorbed from the gut; it is similar to neomycin.

Pentamidine is a synthetic aromatic amidine; it must be administered parenterally or by inhalation as it is unreliably absorbed from the gastrointestinal tract; it does not enter the CSF. Given systemically it frequently causes nephrotoxicity, which is reversible; acute hypotension and syncope are common especially after rapid i.v. injection. Pancreatic damage may cause hypoglycaemia due to insulin release.

Sodium stibogluconate (Pentostam) is an organic pentavalent antimony compound; it may cause anorexia, vomiting, coughing and substernal pain. Used in mucocutaneous leishmaniasis, it may lead to severe inflammation around pharyngeal or tracheal lesions which may require corticosteroid administration to control. Meglumine antimoniate is similar.

Suramin forms stable complexes with plasma protein and is detectable in urine for up to 3 months after the last injection; it does not cross the blood-brain barrier. It may cause tiredness, anorexia, malaise, polyuria, thirst and tenderness of the palms and soles.

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Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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