CANACIDE DRENCH

Indications

• Ascariasis
• Hookworm infection
• Strongyloidiasis
• Immunomodulation in colorectal cancer
• Autoimmune diseases

Dosage

Children: Refer to the BNF for Children for specific paediatric dosing recommendations.

Adults: Refer to the BNF for specific adult dosing recommendations.

Mechanism of action

Levamisole acts by binding to nicotinic acetylcholine receptors on the muscle cells of helminths, leading to paralysis and expulsion of the parasites. It is also thought to enhance T-cell function and boost the immune system, particularly in the context of cancer therapy.

Pharmacodynamics

Levamisole exhibits its anthelmintic effects through neuromuscular paralysis of the parasites, which prevents them from attaching to the intestinal wall and allows for their elimination. Its immunomodulatory effects are attributed to its ability to enhance T-cell proliferation and stimulate interferon production, thus improving the host's immune response.

Pharmacokinetics

Levamisole is well absorbed after oral administration, with peak plasma concentrations occurring within 1 to 2 hours. It undergoes extensive hepatic metabolism, primarily through cytochrome P450 enzymes, and has a half-life of approximately 3 to 5 hours. The metabolites are primarily excreted via the urine. Food intake does not significantly affect its absorption.

Contra-indications

• Hypersensitivity to levamisole or any of its components
• Severe immunosuppression
• History of agranulocytosis

Adverse effects

• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Rash
• Agranulocytosis
• Hepatotoxicity
• CNS effects such as dizziness and headache

Interactions

• Increased risk of agranulocytosis when used with other myelosuppressive agents
• Possible interaction with warfarin, increasing anticoagulant effect
• Caution with concurrent use of drugs that affect the liver

Precautions

• Use with caution in patients with liver impairment
• Monitor blood counts during therapy due to risk of agranulocytosis
• Consider potential drug interactions before initiating therapy

Pregnancy

Levamisole is classified as category C. Use is not recommended unless the potential benefit outweighs the potential risk to the fetus.

Breast-feeding

It is not known whether levamisole is excreted in human milk. Caution should be exercised when administering to nursing mothers.

Storage

Store at room temperature, away from light and moisture. Keep out of reach of children.

Formulations

• Tablets
• Oral suspension

Indications

• Liver fluke infections (Fasciola hepatica, Fasciola gigantica)
• Other trematode infections

Dosage

Children: Refer to the BNF for Children for specific dosing guidelines in the paediatric population.

Adults: Refer to the BNF for specific dosing recommendations as they may vary depending on the indication and patient condition.

Mechanism of action

Oxyclozanide exerts its anthelmintic effects by disrupting the energy metabolism of the helminths. It interferes with the oxidative phosphorylation process in the mitochondria of the parasites, leading to a depletion of ATP and subsequent paralysis and death of the worms.

Pharmacodynamics

Oxyclozanide has a selective action against specific stages of the liver fluke, causing immobilization and eventual death of the parasite. Its activity is enhanced in the presence of bile acids, which facilitate its uptake by the parasites. The drug exhibits a broad spectrum of activity against trematodes.

Pharmacokinetics

Oxyclozanide is absorbed from the gastrointestinal tract and undergoes hepatic metabolism. It is eliminated primarily through the feces, with a minor fraction excreted in urine. The pharmacokinetic profile shows a relatively short half-life, necessitating multiple doses for continued efficacy against fluke infections.

Pregnancy

No evidence of risk in humans. However, safety during pregnancy has not been established.

Breast-feeding

It is unknown whether oxyclozanide is excreted in human breast milk. Caution is advised.

Storage

Store in a cool, dry place, away from light. Keep out of reach of children.