Iva Snow Plus

Indications

• Fascioliasis (liver fluke infection) in cattle
• Fascioliasis in sheep

Dosage

Children: Refer to the BNF for Children for appropriate dosing in younger animals.

Adults: Refer to the BNF for specific dosing guidelines which depend on the condition being treated and animal weight.

Mechanism of action

Clorsulon acts by inhibiting the enzyme phosphofructokinase, which is a key regulator in the glycolytic pathway. This inhibition leads to a decrease in ATP production in the parasites, ultimately resulting in their death due to energy depletion.

Pharmacodynamics

Clorsulon is effective against adult Fasciola hepatica and Fasciola gigantica. The drug's selectivity for parasitic cells over mammalian cells is due to its targeting of the unique metabolic pathways present in the parasites. The time to onset of action can vary depending on the severity of the infection and the specific parasite involved.

Pharmacokinetics

Clorsulon is administered orally and has a moderate absorption profile. It is distributed throughout the body, with a significant volume of distribution. The drug undergoes hepatic metabolism and is excreted primarily via the urine and feces. The half-life and clearance rates can vary based on the species and individual animal factors.

Pregnancy

There are no adequate and well-controlled studies in pregnant women. The use of clorsulon during pregnancy should be considered only if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

It is not known whether clorsulon is excreted in human milk. Caution should be exercised when clorsulon is administered to a breastfeeding woman.

Storage

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

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