What is Delamanid used for?

Delamanid is a relatively new and groundbreaking drug in the fight against tuberculosis (TB), specifically multidrug-resistant tuberculosis (MDR-TB). Marketed under the trade name Deltyba, Delamanid is a product of intensive research and development by Otsuka Pharmaceutical Co., Ltd., a Japanese pharmaceutical company renowned for its commitment to global health challenges. As a nitro-dihydro-imidazooxazole derivative, Delamanid represents a different class of anti-TB drugs compared to traditional treatments. Its primary indication is for the treatment of MDR-TB in adults and children over six years old, particularly in instances where other first-line and second-line treatments have failed or are not suitable.

Delamanid was granted conditional approval by the European Medicines Agency (EMA) in 2014 and subsequently received approval in several other regions, including Japan and South Korea. It has also been included in the World Health Organization's (WHO) Essential Medicines List, marking it as a crucial component in the fight against TB globally. Recent research continues to explore its efficacy, optimal usage regimens, and potential in combination therapies to enhance TB treatment outcomes.

Delamanid Mechanism of Action

The mechanism of action of Delamanid is both unique and innovative. Unlike traditional TB medications that target bacterial cell walls or protein synthesis, Delamanid works by inhibiting the synthesis of methoxy-mycolic and keto-mycolic acids, which are essential components of the mycobacterial cell wall. By inhibiting these enzymes, Delamanid disrupts the bacterial cell wall synthesis, leading to cell death.

Moreover, Delamanid's mechanism includes a secondary action where it potentially generates nitric oxide, which exhibits potent anti-mycobacterial properties. This dual mechanism not only makes Delamanid highly effective against MDR-TB but also minimizes the potential for the development of drug resistance, a significant concern with existing TB treatments.

How to Use Delamanid

Delamanid is administered orally in tablet form, usually taken twice daily with food to enhance absorption and reduce gastrointestinal side effects. The recommended dose for adults is 100 mg twice daily, and for children, dosing depends on body weight. Treatment duration with Delamanid can vary but typically extends for up to 24 weeks as part of combination therapy with other anti-TB drugs.

The onset of action with Delamanid is not immediate; it is a part of a prolonged treatment regimen aiming to ensure complete eradication of the mycobacterium. Patients are advised to adhere strictly to the prescribed regimen and not to miss doses to avoid the risk of developing drug-resistant strains of TB.

What is Delamanid Side Effects

Like all medications, Delamanid comes with a profile of potential side effects. The most commonly reported side effects include nausea, vomiting, dizziness, and headache. More severe side effects can occur but are relatively rare. These can include QT prolongation, a condition affecting the heart's electrical activity, which may predispose individuals to irregular heartbeats. Consequently, monitoring of the heart's function through regular electrocardiograms (ECGs) during treatment is recommended.

Contraindications for Delamanid include patients with known hypersensitivity to the drug or any of its components. It is also advised to use Delamanid cautiously in patients with a history of heart conditions, particularly those predisposed to QT prolongation. Regular monitoring and consultations with healthcare providers are crucial to manage any emerging side effects effectively.

What Other Drugs Will Affect Delamanid

Delamanid's effectiveness can be influenced by interactions with other drugs. Co-administration with certain medications can either reduce its efficacy or increase the risk of adverse effects. For instance, drugs that also prolong the QT interval, such as certain antiarrhythmics, antipsychotics, and some fluoroquinolone antibiotics, should be avoided or used cautiously in combination with Delamanid. The potential for additive effects on QT prolongation necessitates careful consideration and monitoring.

Other medications that induce or inhibit liver enzymes, particularly those in the cytochrome P450 family, may alter the metabolism of Delamanid. For example, strong inducers of cytochrome P450 enzymes, such as rifampicin, can decrease Delamanid plasma levels, potentially reducing its efficacy. Conversely, strong inhibitors of these enzymes may increase Delamanid levels, heightening the risk of side effects.

Patients are advised to inform their healthcare providers of all medications they are taking, including over-the-counter drugs and supplements, to prevent harmful interactions. Additionally, ongoing research continues to refine the understanding of drug-drug interactions involving Delamanid, which may lead to more tailored and effective treatment regimens in the future.

In conclusion, Delamanid represents a significant advancement in the treatment of MDR-TB, offering hope where traditional therapies have failed. Understanding its mechanism of action, proper administration, potential side effects, and interactions with other drugs is crucial for healthcare providers and patients alike to maximize its benefits while minimizing risks. As research progresses, Delamanid’s role in TB treatment may continue to expand, contributing to global efforts to combat this persistent and deadly disease.