Heartworm

Heartworm Uses, Dosage, Side Effects, Food Interaction and all others data.

Ivermectin selectively binds and with high affinity to glutamate-gated chloride ion channels, which occur in invertebrate nerve and muscle cells leading to an increase in the permeability of cell membranes to chloride ions with hyperpolarization of the nerve or muscle cell and, ultimately, death of the parasite.

Ivermectin is a semisynthetic, anthelminitic agent. It is an avermectin which a group of pentacyclic sixteen-membered lactone (i.e. a macrocyclic lactone disaccharide) derived from the soil bacterium Streptomyces avermitilis. Avermectins are potent anti-parasitic agents. Ivermectin is the most common avermectin. It is a broad spectrum antiparasitic drug for oral administration. It is sometimes used to treat human onchocerciasis (river blindness). It is the mixture of 22,23-dihydro-avermectin B1a (at least 90%) and 22,23-dihydro-avermectin B1b (less than 10%).

Heartworm
Uses
Dosage
Side Effect
Precautions
Interactions
Uses during Pregnancy
Uses during Breastfeeding
Accute Overdose
Food Interaction
Half Life
Volume of Distribution
Clearance
Interaction With other Medicine
Contradiction
Storage

Trade Name	Heartworm
Generic	Ivermectin + pyrantel pamoate + praziquantel chewable tablet
Type	For animal use only
Therapeutic Class
Manufacturer
Available Country	United States
Last Updated:	September 19, 2023 at 7:00 am

Uses

Ivermectin is used for the treatment of the following infections:

Strongyloidiasis of the intestinal tract. Ivermectin is used for the treatment of intestinal (i.e., nondisseminated) strongyloidiasis due to the nematode parasite Strongyloides stercoralis.

This indication is based on clinical studies of both comparative and open-label designs, in which 64-100% of infected patients were cured following a single 200-mcg/kg dose of ivermectin.

Onchocerciasis: Ivermectin is used for the treatment of onchocerciasis due to the nematode parasite Onchocerca volvulus.

This indication is based on randomized, double-blind, placebo-controlled and comparative studies conducted in 1427 patients in onchocerciasis-endemic areas of West Africa. The comparative studies used diethylcarbamazine citrate (DEC-C).

NOTE: Ivermectin has no activity against adult Onchocerca volvulus parasites. The adult parasites reside in subcutaneous nodules which are infrequently palpable. Surgical excision of these nodules (nodulectomy) may be considered in the management of patients with onchocerciasis, since this procedure will eliminate the microfilariae-producing adult parasites.

This medication is used to treat intestinal worm infections such as pinworm, roundworm, and hookworm. Pyrantel belongs to a class of drugs known as anthelmintics. It works by making the worms unable to move (paralyzed) so that the body can remove them naturally in the stool.

Heartworm is also used to associated treatment for these conditions: Acne Rosacea, Ascaris lumbricoides infection, Cutaneous larva migrans, Demodicidosis, Gnathostomiasis, Mansonella ozzardi infection, Mansonella streptocerca infection, Oesophagostomiasis, Onchocerciasis, Pediculosis Capitis, Scabies, Trichuriasis, Wuchereria bancroftii infection

How Heartworm works

Ivermectin binds selectively and with high affinity to glutamate-gated chloride ion channels in invertebrate muscle and nerve cells of the microfilaria. This binding causes an increase in the permeability of the cell membrane to chloride ions and results in hyperpolarization of the cell, leading to paralysis and death of the parasite. Ivermectin also is believed to act as an agonist of the neurotransmitter gamma-aminobutyric acid (GABA), thereby disrupting GABA-mediated central nervous system (CNS) neurosynaptic transmission. Ivermectin may also impair normal intrauterine development of O. volvulus microfilariae and may inhibit their release from the uteri of gravid female worms.

Dosage

Heartworm dosage

Oral

Filariasis:

Adult: Dosing regimen depends on the causative agent. Mansonella streptocerca 150 mcg/kg as a single dose; Mansonella ozzardi 200 mcg/kg as a single dose.
Child: ≥15 kg: Dosing regimen depends on the causative agent. Mansonella streptocerca 150 mcg/kg as a single dose; Mansonella ozzardi 200 mcg/kg as a single dose.

Scabies:

Adult: Sarcoptes scabiei 200 mcg/kg as a single dose, repeat dose in 2 wk.
Child: ≥15 kg: Sarcoptes scabiei 200 mcg/kg as a single dose, repeat dose in 2 wk.

Onchocerciasis:

Adult:150 mcg/kg as a single dose; retreatment may be given every 6-12 mth until adult worms die.
Child: >5 yr and ≥15kg: 150 mcg/kg as a single dose every 6-12 mth until adult worms die.

Ascariasis:

Adult: Ascaris lumbricoides 150-200 mcg/kg as a single dose.
Child: ≥15 kg: Ascaris lumbricoides 150-200 mcg/kg as a single dose.

Strongyloidiasis:

Adult: 200 mcg/kg as a single dose for 1-2 days.
Child: >15 kg: 200 mcg/kg as a single dose for 1-2 days.

Gnathostomiasis:

Adult: Gnathostoma spinigerum: 200 mcg/kg once daily for 2 days.
Child: ≥15 kg: Gnathostoma spinigerum: 200 mcg/kg once daily for 2 days.

Pyrantel Pamoate is given orally at anytime without regard to ingestion of food or beverages. A single dose of 11 mg/kg body weight, to a maximum of 1 gm, should be given to treat infestations caused by the parasites mentioned above. In the case of Pinworm, it is often wise to repeat the dose after an interval of 2 weeks.

Should be taken on an empty stomach.

Side Effects

Diarrhoea, nausea, vomiting, dizziness, pruritus, urticaria, rash, arthralgia, fever, myalgia, asthenia, postural hypotension, tachycardia, oedema, lymphadenopathy, sore throat, cough, headache, somnolence, transient eosinophilia, raised liver enzyme values.

Pyrantel Pamoate is well tolerated in recommended dosage. When given in large dosage, Pyrantel Pamoate may cause gastrointestinal upset such as anorexia, nausea, vomiting and diarrhoea. Other side effects that may occur in rare occasions are headache, dizziness and rash.

Toxicity

LD₅₀ = 29.5 mg/kg (Mouse, oral). LD₅₀ = 10 mg/kg (Rat, oral). Adverse effects include muscle or joint pain, dizziness, fever, headache, skin rash, fast heartbeat.

Precaution

Concurrent Loa loa infection, impaired blood-brain barrier function due to infection.

Since Pyrantel Pamoate and Piperazine appear to be mutually antagonistic, Pyrantel Pamoate should not be given together with Piperazine. Pyrantel Pamoate should be kept out of the reach of children.

Interaction

Bioavailability may be increased by alcohol, levamisole.

Volume of Distribution

The volume of distribution is 3 to 3.5 L/kg and it does not cross the blood-brain barrier.

Elimination Route

Moderately well absorbed. Improved absorption with high fat meal.

Half Life

16 hours (also reported at 22-28 hours)

Elimination Route

Ivermectin is metabolized in the liver, and ivermectin and/or its metabolites are excreted almost exclusively in the feces over an estimated 12 days, with less than 1% of the administered dose excreted in the urine.

Pregnancy & Breastfeeding use

Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Pregnancy: Since Pyrantel Pamoate has not been studied in pregnant women, use of Pyrantel Pamoate in such patients is normally contraindicated. Pyrantel Pamoate is not recommended for children below 1 year of age.

Contraindication

Hypersensitivity. Pregnancy and lactation. Children <15 kg body weight.

Known hypersensitivity to pyrantel or any ingredient in the formulation.

Special Warning

Pediatric Use: Safety and efficacy not established in children <2 years of age;a use in this age group only when potential benefits justify possible risks.Hepatic Impairment: Use with caution in patients with preexisting liver dysfunction.