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In Meyler's Side Effects of Drugs (Sixteenth Edition), 2016
Pharmacokinetics

Diethylcarbamazine is extensively metabolized, the half-life being 6–12 hours; the remainder enters the urine within 48 hours. Over the initial period the dosage should be increased slowly to avoid or reduce allergic responses as a result of destruction of parasites and liberation of antigen, and then maintained at 3 mg/kg tds for 34 weeks. Not all of its adverse effects are necessarily due to destruction of the parasite; weakness, lethargy, anorexia, and nausea can be due to the drug itself.

Thomas B. Nutman, in The Travel and Tropical Medicine Manual (Fifth Edition), 2017
Treatment

DEC is the drug of choice for treatment of TPE, the dose typically being 6?mg/kg per day for 14 days. Symptoms usually resolve between days 4 and 7 of therapy. Characteristically, respiratory symptoms rapidly resolve after treatment with DEC. Despite dramatic initial improvement after conventional treatment with DEC, symptoms recur in approximately 20% of patients 12-24 months after treatment, and a majority of patients continue to have subtle clinical, radiographic, and functional abnormalities. Repeat treatment may be necessary to prevent pulmonary fibrosis, a serious sequela of TPE if left untreated.

Approaches to Design and Synthesis of Antiparasitic Drugs

Satyavan Sharma, Nitya Anand, in Pharmacochemistry Library, 1997
4.1.2 Diethylcarbamazine (DEC, 3)

Diethylcarbamazine has been found to be active against adult ascarids in cats and dogs. However a combination of DEC (3 mg/kg) and styrylpyridinium chloride (5 mg/kg) gave protection against hookworms, ascarids and heartworms in dogs. DEC has also been used as a prophylactic agent against canine heartworm disease at a dose of 5.5 mg/kg given daily during the mosquito season plus an additional two months [56].

DEC has no action on the microfilaria or adult worms of L. carinii in vitro, but exhibits lethal action on the filariids in vivo. The drug kills > 90% of the microfilariae circulating in the blood in cotton rats, Mongolian jirds and Mastomys natalensis infected with L. carinii at an intraperitoneal dose of 6 mg/kg given for 5 days [59,60]. However, DEC has little or no action against the microfilariae of Dipetalonema perstans, Dipetalonema viteae and Dirofilaria repens in jirds and dogs [7,16]. The drug has been found to be highly effective against microfilariae of Onchocerca cervicalis, O. gutturosa and O. gibsoni in horses and cattle at a dose of 20 mg/kg given for 3-5 days [62]. The pre-adult developing stages of D.immitis in dogs may be killed at a dose of 55 mg/kg of DEC [61].

The action of DEC on adult filarial worms is species dependent. The drug shows only poor or no activity on the macrofilariae of L.carinii and D. viteae. in rodents and Dirofilaria immitis and D.repens in dogs. The adult worms of O. volvulus are also not susceptible to DEC. However, DEC has been found to kill the adult worms of Brugia pahangi, B.malayi, W.bancrofti, L. loa, Dipetalonema streptocerca and Setaria digitata in different animals [7,62].
Tissue Nematodes (Trichinellosis, Dracunculiasis, Filariasis, Loiasis, and Onchocerciasis)

James W. Kazura, in Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases (Eighth Edition), 2015
Therapy

Diethylcarbamazine at a dose of 8 to 10?mg/kg/day for 21 days should be given to persons who do not have microfilaremia. Repeated treatment courses with diethylcarbamazine may be necessary in 40% to 50% of patients. Calabar swelling, pruritus, and eye worms may be precipitated by treatment. Side effects can be minimized by concurrent administration of antihistamines or corticosteroids. In persons with high-level microfilaremia (>2500/mL), there is a significant risk for renal and central nervous system complications due to the rapid destruction of large numbers of microfilariae. Options include withholding anthelmintic drugs, cytapheresis to remove microfilariae before administration of diethylcarbamazine, and administration of a single dose of ivermectin.
Neglected Diseases: Extensive Space for Modern Drug Discovery

Stefano Sainas, ... Marco L. Lolli, in Annual Reports in Medicinal Chemistry, 2018
4.4 Diethylcarbamazine Patch Test

Diethylcarbamazine was the drug of choice for onchocerciasis therapy for 30 years. However, treatment with diethylcarbamazine provokes side effects in patients infected with O. volvulus that have been named the Mazzotti reaction. These reactions, which occur within a few hours after an oral dose, include, dermal edema, lymphadenopathy, itching, fever, maculopapular eruptions, but also more severe manifestations such as meningism, arthropathy, tachycardia, hypotension, severe prostration, and even death.94 The mechanism of action is thought one of the inflammatory reactions, particularly involving eosinophils, associated with the exposure and killing of the microfilariae.