Ivermectin Albendazole

Trichuris trichiura (whipworm) Mebendazole or albendazole Ivermectin... 

Albendazole is combined with either diethylcarbamazine or ivermectin in programs directed toward controlling LF. By annual dosing with combination therapy for 4-6 years, the goal is to maintain the microfilaremia at such low levels that transmission cannot occur for a period that corresponds to the duration of fecundity of adult worms. Albendazole is given with diethylcarbamazine to control LF in most parts of the world. To avoid serious reactions to dying microfilariae, an albendazole/ivermectin combination is recommended in locations where filaiiasis coexists with either onchocerciasis or loiasis. 

Trichuriasis Single-dose albendazole and mebendazole have limited efficacy in the treatment of trichuriasis. The combination of albendazole + ivermectin improves efficacy, but a mebendazole + ivermectin... 

Veraldi S, Francia C, La Vela V, Nazzaro G, Barbareschi M. Telogen effluvium after oral albendazole. Clin Exp Dermatol 2012 37 562-73. Sinha P, Garg A, Prakash O, Desai NG. Drug-induced psychosis associated with albendazole-ivermectin combination therapy. Gen Hosp... 

The drug of choice for strongyloidiasis is oral ivermectin 200 mcg/kg per day for 2 days, while albendazole 400 mg twice... 

Cutaneous larva migrans (creeping eruption) Ancylostoma braziliense and others Thiabendazole, Albendazole, or Ivermectin-... 

Ascaris lumbricoides (roundworm) Albendazole or pyrantel pamoate or mebendazole Ivermectin, piperazine... 

Strongyloides stercoralis (threadworm) Ivermectin Albendazole or thiabendazole... 

Antihistamines may be given for the first few days of therapy to limit allergic reactions, and corticosteroids should be started and doses of diethylcarbamazine lowered or interrupted if severe reactions occur. Cures may require several courses of treatment. For patients with high L loa worm burdens (more than 2500 circulating parasites/mL), strategies to decrease risks of severe toxicity include apheresis, if available, to remove microfilariae before treatment with diethylcarbamazine or therapy with albendazole, which is slower acting and better tolerated, before therapy with diethylcarbamazine or ivermectin. 

Thiabendazole is an alternative to ivermectin or albendazole for the treatment of strongyloidiasis and cutaneous larva migrans. 

An example of the application of this procedure for testing the equivalence of the albendazole or ivermectin MRLs for which differences exist between the United States and JECFA is presented in Table 12.5. Differences between US and JECFA MRLs for albendazole are due to use of different safety factors and to the JECFA consideration of good veterinary practice. That is, JECFA considered practical conditions of use of the drug and set MRLs consistent with that use accordingly, the entire ADI is likely not to be consumed. On the other hand, the United States always uses the entire ADI in setting MRLs for edible tissues. 

The intake estimates for albendazole and ivermectin predict that use of the US MRLs will not result in residues above the ADI established by JECFA, and, conversely, that use of the JECFA MRLs will not result in dietary exposure to residues above the US ADI (51). In most cases, only small amounts of the ADI would be consumed. Based on these estimates, the US and JECFA MRLs for each drug would be considered equivalent for trade purposes. 

Detection in liquid chromatography is mostly performed by fluorescence and/or ultraviolet absorption. In a few instances, electrochemical detection has also been employed (357, 368). For compounds that exhibit inherent intense fluorescence such as albendazole and metabolites (319, 320, 338, 355), closantel (344), and thiabendazole and metabolites (378), fluorometric detection is the preferred detection mode since it allows higher sensitivity. Compounds that do not fluoresce such as eprinomectin, moxidectin, and ivermectin, are usually converted to fluorescent derivatives prior to their injection into the liquid chromatographic analytical column. The derivatization procedure commonly applied for this group of compounds includes reaction with trifluoroacetic anhydride in presence of A-methylimidazole as a base catalyst in acetonitrile (346, 347, 351, 352, 366, 369, 372-374). The formation of the fluorophore is achieved in 30 s at 25 C and results in a very stable derivative of ivermectin and moxidectin (353) but a relatively unstable derivative of eprinomectin (365). However, the derivatized extracts are not pure enough, so that their injection dramatically shortens the life of the liquid chromatographic column unless a silica solid-phase extraction cleanup is finally applied. 

Flookworm Albendazole, mebendazole Ivermectin, pyrantel pamoate, thiabendazole... 

Shenoy RK, Dalia S, John A et al. (1999) Treatment of the mi-crofilaraemia of asymptomatic brugian filariasis with single doses of ivermectin, diethylcarbamazine or albendazole, in various combinations. Ann Trop Med Parasitol 93 643-651... 

Encephalopathy is an adverse event related to the treatment of L. loa with diethylcarbamazine or ivermectin, and it has also been related to albendazole (11). 

As antihehninthic drugs go, ivermectin can be considered a reasonably safe drug, and it is generally better tolerated than diethylcarbamazine. Clinical experience has often shown relatively little toxicity, although mild adverse effects, presumably due to the kilting of the microfilariae, involve at least one-third of patients some work has suggested that neutrophil activation may play a role in the development of these reactions (1). It has also been well tolerated in combinations, for example when given with albendazole in order to kill adult worms (which cannot be achieved with ivermectin alone) or with diethylcarbamazine for bancroftian filariasis (SEDA-20, 281). 

Early-stage elephantiasis caused by bancroftian filariasis in a 27-year-old traveller was treated with a single-dose oral combination of ivermectin 24 mg plus albendazole 400 mg, followed by albendazole 800 mg for 21 days (14). To avoid a severe Mazzotti-like reaction, he was given oral glucocorticoids and antihistamines for 3 days. He had a transient rash, pruritus, and mild hypotension on the days after the initial treatment, but otherwise remained well and the swelling subsided. Within 1 month he was free of symptoms. At the last follow-up examination, 3 years after treatment, there was no clinical or laboratory evidence of relapse. The authors thought that this type of treatment should be evaluated on a wider scale, given the minimal adverse events and apparent therapeutic efficacy. 

A 39-year-old Afro-Caribbean man with stage IVB T cell Ijmphoma due to HTLV-1 infection had invasive Strongyloides hyperinfection that did not respond to oral ivermectin plus albendazole because of concurrent ileus. He was treated with two 6 mg doses of a veterinary formulation of ivermectin subcutaneously. There were no adverse effects, apart from pain at the injection site. 

---