To treat toxoplasmosis, a combination of three drugs—amounting to more than ten pills a day—is usually recommended:
Pyrimethamine (Daraprim): A large dose (between 100 mg and 200 mg) of this antimalarial drug is taken at first, followed by a lower dose. It is taken by mouth in pill form.
Leucovorin: This medication contains folate, the active form of the B complex vitamin. Because pyrimethamine can decrease folic acid levels in the body, which can reduce the formation of red and white blood cells, leucovorin is necessary to protect against anemia and other toxicities.
Sulfadiazine: This drug—an antibiotic—is taken by mouth four times a day.
High doses of these treatments are continued for four to six weeks. Thereafter, lower doses are are taken as "maintenance therapy" to prevent the toxoplasmosis for coming back. Maintenance therapy can be discontinued if you have completed the initial six weeks of treatment and no longer have any symptoms of toxoplasmosis—provided that your CD4 cell count is above 200 for at least six months while taking anti-HIV medicines.
Some patients are allergic to sulfadiazine and cannot tolerate it. In turn, an alternative to sulfadiazine may be necessary. The U.S. Department of Health and Human Services recommends clindamycin for this purpose.
Corticosteroids, such as dexamethasone, are sometimes used to help control inflammation of the brain and the symptoms associated with toxoplasmosis. However, these need to be used carefully, given that corticosteroids can have a negative effect on the immune system.
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