Cosmec Super

Indications

• Onchocerciasis (river blindness)
• Strongyloidiasis
• Scabies (especially hyperkeratotic or crusted scabies)
• Lymphatic filariasis
• Other helminth infections

Dosage

Children: Child 6 months–17 years: 100 mg for 1 dose;

Adults: Adult: Initially 1 mg/kg daily on the first day, then increased to 6 mg/kg daily in divided doses, gradually increased over 3 days. Maximum 9 mg/kg per day. For scabies, 100 mg for 1 dose; if reinfection occurs, a second dose may be given after 2 weeks.

Mechanism of action

Ivermectin binds selectively to glutamate-gated chloride channels, leading to increased permeability of the cell membrane to chloride ions. This results in hyperpolarization of the nerve or muscle cells in the parasites, causing paralysis and death. It also interacts with other chloride channels, which may contribute to its antiparasitic effects.

Pharmacodynamics

Ivermectin exhibits broad-spectrum activity against a variety of parasites, including nematodes and arthropods. Its effectiveness is attributed to its ability to paralyze and kill parasites, thus facilitating their expulsion from the host. The drug has a long half-life, allowing for effective dosing regimens, and it is generally well-tolerated in patients.

Pharmacokinetics

Ivermectin is rapidly absorbed following oral administration, with peak plasma concentrations occurring within 4 to 6 hours. It is extensively distributed throughout the body, including the central nervous system. The drug undergoes hepatic metabolism, primarily via cytochrome P450, and is eliminated with a half-life of approximately 18 hours. Excretion occurs mainly in the feces, with a smaller proportion eliminated in urine.

Contra-indications

• Blood disorders
• Epilepsy
• Sjögren’s syndrome

Adverse effects

• Diarrhoea
• Dizziness
• Headache
• Influenza-like illness
• Insomnia
• Myalgia
• Nausea
• Rash
• Seizure
• Taste alteration
• Vomiting
• Skin reactions
• Abnormal sensation in eye
• Anaemia
• Appetite decrease
• Asthenia
• Asthma exacerbated
• Chest discomfort
• Confusion
• Conjunctival haemorrhage
• Constipation
• Gastrointestinal discomfort
• Headache
• Hepatitis
• Hypotension
• Joint disorders
• Leukopenia
• Myalgia
• Nausea
• Oedema
• Pain
• Psychiatric disorder
• Severe cutaneous adverse reactions
• Stupor
• Tachycardia
• Tremor
• Urinary incontinence
• Vertigo

Interactions

• Coumarins: Unknown (increases anticoagulant effect)
• Levamisole: Unknown (increases exposure)

Precautions

• Use with caution in hepatic impairment
• Avoid sun exposure when using topical formulations

Pregnancy

Embryotoxic in animal studies, avoid if possible.

Breast-feeding

Manufacturer advises avoid-limited information available; ensure infant does not come in contact with treated areas.

Storage

Store in a cool, dry place away from direct sunlight.

Formulations

• Tablets
• Topical formulation

Indications

• Nematode infections
• Trematode infections
• Parasitic infections in livestock

Dosage

Children: Refer to specific product guidelines or BNF for detailed dosing information.

Adults: Refer to specific product guidelines or BNF for detailed dosing information.

Mechanism of action

Closantel acts by inhibiting the oxidative phosphorylation process in the mitochondria of helminths. This disruption in energy production leads to paralysis and death of the parasites, making it effective against infections caused by nematodes and trematodes.

Pharmacodynamics

Closantel exhibits a high affinity for the mitochondrial complexes involved in oxidative phosphorylation. The drug's action on helminths results in reduced ATP production, which is critical for their survival and reproduction. Its selectivity for parasitic cells over host cells minimizes toxicity in treated animals.

Pharmacokinetics

Closantel is well absorbed following oral administration, with a significant volume of distribution indicating extensive tissue binding. The drug undergoes metabolism in the liver, with subsequent excretion primarily via the feces. Its half-life allows for effective dosing intervals, maximizing its anthelmintic efficacy.

Pregnancy

Safety in pregnancy has not been established. Use only if clearly needed.

Breast-feeding

Caution is advised. The effects on the nursing infant are unknown.

Storage

Store in a cool, dry place, away from direct sunlight.

Indications

• Mild to moderate dehydration
• Severe dehydration
• Diarrhea-related dehydration
• Vomiting-related dehydration
• Heat-related illnesses
• Post-operative fluid replacement

Dosage

Children: In children, the oral rehydration solution is typically administered at a rate of 75

Adults: The specific dosage for rehydration will vary based on the severity of dehydration. In mild cases, oral rehydration solutions can be administered at a rate of 50-100 mL/kg over 2-4 hours. For moderate to severe dehydration, intravenous fluids may be indicated, and specific protocols should be followed based on clinical guidelines.

Mechanism of action

Dehydration itself does not have a mechanism of action as it is a physiological state rather than a pharmacological agent. However, the treatment for dehydration typically involves the administration of fluids and electrolytes, either orally or intravenously, to restore hydration status. The rehydration process helps to restore normal blood volume and electrolyte balance, facilitating cellular functions and overall metabolic processes.

Pharmacodynamics

The pharmacodynamics of rehydration solutions involve the restoration of body fluid levels and the correction of electrolyte imbalances. Oral rehydration solutions (ORS) contain a balanced ratio of salts and sugars, which enhance the absorption of water in the intestines. This process helps to re-establish osmotic balance, improve hydration, and support physiological functions. In severe cases, intravenous fluids may be required to rapidly replenish lost fluids and electrolytes.

Pharmacokinetics

The pharmacokinetics of rehydration fluids depend on the type of fluid administered. Oral rehydration solutions are absorbed primarily in the small intestine, with the absorption rate influenced by the osmolarity and composition of the solution. Intravenous fluids are distributed directly into the bloodstream, with effects seen almost immediately. The elimination of excess fluids occurs through renal excretion, which helps maintain homeostasis.

Contra-indications

• Hypersensitivity to the active substance or any of the excipients
• Severe dehydration
• Acute kidney injury

Adverse effects

• Electrolyte imbalance
• Hypotension
• Dizziness
• Dry mouth
• Thirst
• Skin rash
• Nausea
• Vomiting

Interactions

• Caution with concomitant use of diuretics
• May interact with other medications affecting electrolyte levels
• Potential interaction with medications that affect kidney function

Precautions

• Use with caution in patients with renal impairment
• Monitor electrolyte levels during therapy
• Ensure adequate hydration during treatment

Pregnancy

Use only if clearly needed and prescribed by a healthcare professional. Risk-benefit should be considered.

Breast-feeding

Consult healthcare provider before use. Monitor infant for any adverse effects.

Storage

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

Formulations

• Oral solution
• Oral powder
• Intravenous solution