WORMIZAN PLUS SOLUTION

Indications

• Ascariasis
• Hookworm infections
• Strongyloidiasis
• Chronic lymphocytic leukaemia
• Colorectal cancer
• Autoimmune disorders such as rheumatoid arthritis

Dosage

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

Adults: Refer to specific clinical guidelines or BNF for recommended dosing.

Mechanism of action

Levamisole acts as a nicotinic acetylcholine receptor agonist in helminths, leading to paralysis and death of the parasites. It also modulates immune responses by enhancing T-cell function and promoting the activity of macrophages, thereby increasing the host's ability to fight infections and neoplastic cells.

Pharmacodynamics

Levamisole exhibits a biphasic pharmacological profile, displaying both anthelmintic and immunomodulatory properties. In the context of parasites, it causes muscle contraction and paralysis by overstimulating nicotinic receptors. Its immune-modulating effects involve the enhancement of T-helper cell activity, which can be beneficial in certain malignancies and autoimmune conditions.

Pharmacokinetics

Levamisole is rapidly absorbed after oral administration, with peak plasma concentrations occurring within 1-2 hours. It is extensively metabolized in the liver, primarily via cytochrome P450 enzymes. The half-life is approximately 3-6 hours, with the majority of metabolites excreted in the urine. Factors such as liver function can significantly affect its pharmacokinetics.

Contra-indications

• Hypersensitivity to levamisole or any of its components
• Severe renal impairment
• History of agranulocytosis or other blood dyscrasias

Adverse effects

• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Dizziness
• Rash
• Agranulocytosis
• Hepatotoxicity

Interactions

• May enhance the effects of warfarin and other anticoagulants
• Should not be used concurrently with immunosuppressive drugs due to increased risk of infection
• May interact with other anthelmintics or anti-parasitic drugs

Precautions

• Monitor blood counts regularly due to the risk of agranulocytosis
• Use with caution in patients with liver disease
• Consider potential interactions with other medications
• Assess for signs of infection or bleeding

Pregnancy

Levamisole is not recommended during pregnancy due to insufficient safety data.

Breast-feeding

Caution is advised, as levamisole may pass into breast milk; consult with a healthcare provider.

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.