Nilvasol DS Suspension

Indications

• Nematode infections
• Ascariasis
• Hookworm infections
• Strongyloidiasis
• Immunosuppression in certain cancer treatments

Dosage

Children: Refer to the BNF for Children for pediatric dosing information.

Adults: Refer to the BNF for specific dosing recommendations based on the condition being treated.

Mechanism of action

The mechanism of action of levamisole as an antiparasitic agent involves agonistic activity towards the L-subtype nicotinic acetylcholine receptors in nematode muscles, reducing the males' ability to control reproductive muscles and limiting copulation. As an immunomodulator, levamisole enhances immune function by stimulating T-cell activation and proliferation, increasing antibody formation, and potentiating the functions of monocytes, macrophages, and neutrophils.

Pharmacodynamics

Levamisole acts as an anthelmintic by targeting nematode nicotinic acetylcholine receptors, leading to paralysis of the worms. As an immunomodulator, it behaves as an immunostimulant, increasing natural killer (NK) cells and activated T-cells, particularly when used adjuvantly with fluorouracil in cancer treatment. Its ability to enhance immune responses makes it valuable in clinical settings where immune function is compromised.

Pharmacokinetics

Levamisole is well absorbed following oral administration, with peak plasma concentrations typically occurring within 1 to 2 hours. It undergoes extensive hepatic metabolism, and its metabolites are primarily excreted via the kidneys. The half-life of levamisole varies, but it is generally around 5 to 7 hours in healthy individuals. Due to its immunomodulatory properties, the pharmacokinetics can be influenced by the patient's immune status and concomitant medications.

Adverse effects

• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Rash
• Neutropenia
• Hepatotoxicity

Interactions

• Albendazole may have decreased exposure when used with levamisole
• Ivermectin may have increased exposure when used with levamisole

Precautions

• Use with caution in patients with a history of blood dyscrasias
• Monitor for signs of infection due to potential immunosuppressive effects
• Careful consideration should be given when prescribing to patients with liver impairment

Pregnancy

Levamisole should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus, as safety in pregnancy has not been established.

Breast-feeding

Levamisole is excreted in human milk; therefore, a decision should be made whether to discontinue breastfeeding or to discontinue the drug, taking into account the importance of the drug to the mother.

Storage

Store at room temperature, away from light and moisture.

Formulations

• Tablets
• Oral solution

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.

Mechanism of action

The mechanism of action of levamisole as an antiparasitic agent appears to be tied to its agnositic activity towards the L-subtype nicotinic acetylcholine receptors in nematode muscles. This agonistic action reduces the capacity of the males to control their reproductive muscles and limits their ability to copulate. The mechanism of action of Levamisole as an anticancer drug in combination with fluorouracil is unknown. The effects of levamisole on the immune system are complex. The drug appears to restore depressed immune function rather than to stimulate response to above-normal levels. Levamisole can stimulate formation of antibodies to various antigens, enhance T-cell responses by stimulating T-cell activation and proliferation, potentiate monocyte and macrophage functions including phagocytosis and chemotaxis, and increase neutrophil mobility, adherence, and chemotaxis.

Pharmacodynamics

Levamisole is a synthetic imidazothiazole derivative that has been widely used in treatment of worm infestations in both humans and animals. As an anthelmintic, it probably works by targeting the nematode nicotinergic acetylcholine receptor. As an immunomodulator, it appears that Levamisole is an immunostimulant which has been shown to increase NK cells and activated T-cells in patients receiving this adjuvantly along with 5FU for Stage III colon cancer.