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Ivermectin

A Review of its Antifilarial Activity, Pharmacokinetic Properties and Clinical Efficacy in Onchocerciasis

Summary

Synopsis

Ivermectin, a derivative of avermectin B, is an orally effective microfilaricidal agent. It is the current drug of choice for treating patients infected with the nematode Onchocerca volvulus, which is a major cause of blindness in inhabitants of some tropical areas. Ivermectin is administered orally as a single dose of 150 βg/kg given annually. Skin and ocular microfilarial counts are dramatically reduced after the first dose, with some evidence for a resulting decrease in transmission of infection by the blackfly vector. With the exception of rare serious reactions such as severe systemic postural hypotension, ivermectin is generally well tolerated. The drug has the clear advantages of ease of administration and better tolerability compared with diethylcarbamazine and suramin, agents previously used to treat onchocerciasis.

Thus, ivermectin is suitable for inclusion in mass treatment programmes and is the best therapeutic option presently available to combat onchocerciasis. As such it provides hope for many thousands of people at risk of becoming blind, and represents a major contribution to tropical medicine.

Pharmacological Properties

Since O. volvulus is difficult to maintain under laboratory conditions, the in vitro and in vivo micro- and macrofilaricidal activity of ivermectin has also been investigated in other filarial species of nematode. Ivermectin concentrations of 10 to 50 /ug/L had no significant effect on O. volvulus microfilariae in vitro Higher concentrations (5 to 30 mg/L) killed microfilariae with 100% mortality achieved at 30 mg/L. In vitro, low concentrations of ivermectin (3.14 × 10−8 to 1 × 10−7 mol/L) inhibited motility of O. gutturosa macrofilariae to a limited extent; immobilisation was achieved at a concentration of 1.25 × 10−5 mol/L.

In humans, a single oral 100 to 200 Mg/kg dose markedly reduced numbers of skin and ocular tissue O. volvulus microfilariae and decreased microfilariae motility. After ivermectin treatment, most remaining viable microfilariae are found in the subcuticular skin layer; in untreated patients microfilariae are found predominantly in the upper lmm of skin.

The mechanism of action of ivermectin is not fully understood but a number of possibilities have been proposed including a direct toxic effect (possibly mediated by potentiation of the inhibitory neurotransmitter GABA) and/or inhibition of intrauterine microfllarial development and release from female adult worms.

In healthy subjects peak plasma ivermectin concentrations of about 50 μg/L are recorded approximately 4 hours after the administration of a 12mg dose in either tablet or capsule formulation. There is evidence that absorption is greater if the drug is administered in an oral aqueous ethanol solution. Little is known regarding the distribution and elimination of ivermectin although 2 metabolites have been identified in humans. The following pharmacokinetic variables have been reported in healthy subjects: elimination half-life (28 hours), volume of distribution (46.9L), plasma protein binding (93%) and oral clearance (1.2 L/h).

Clinical Efficacy

Large scale community trials in tens of thousands of patients with onchocerciasis, including children older than 5 years, have demonstrated that ivermectin is effective and suitable for mass treatment. Skin microfilariae counts decreased by 85 to 95% when measured 2 months after single dose treatment with oral ivermectin 150 μg/kg; such reductions are clinically significant in patients with heavy infestation.

Dose-finding and comparative trials indicate that parasite counts decrease rapidly within 2 to 8 days of a 100 to 200 μg/kg dose, and remain suppressed for several months. Although levels rise gradually toward baseline thereafter, at 12 months skin microfilariae counts are only one-tenth of pretreatment values.

Reductions in ocular parasite counts (in the cornea and anterior chamber) tend to follow a course parallel to that in skin, although the rate of decrease is slower. At 4 months ocular levels had diminished by 80% in a large community trial. However, the finding that after several months ocular microfilariae counts rose to about 30% of pretreatment levels led some investigators to advocate a 6-monthly, rather than a once yearly, treatment programme.

Ivermectin as a single dose is at least as effective as diethylcarbamazine administered in a complicated multiple dose regimen, and is considerably better tolerated. Although both drugs produce similar patterns of microfilarial elimination from skin and eyes, ivermectin causes a more sustained suppression of microfilariae counts.

By reducing the prevalence of microfilariae amongst a mass population, ivermectin therapy also influences the rate of disease transmission. In one large trial the reduction in availability of microfilariae for transmission was estimated to be 68 to 78%, consistent with a decrease in vector infection of 65 to 85% as evidenced by entomological results. These effects are reflected in reductions in overall microfilarial load in both treated and untreated patients in mass treatment programmes and, in 1 trial, a decrease in the annual rate of new infections in children.

Tolerability

Almost all of the adverse effects which occur during ivermectin treatment are a result of the patient’s immune response to dead microfilariae, and usually appear within 3 days of the dose. The most common of these include myalgia, rash, node tenderness, swelling of nodes, joints, limbs or face, itching, fever and chills. These are usually of mild to moderate severity and generally respond to analgesics or antihistamines. The severity of the response is directly related to the initial degree of O. volvulus infestation.

The incidence of adverse effects among patients administered ivermectin is difficult to quantify because of variability in reporting methods. Although small samples have reported incidence rates of as high as 35%, this is probably not representative. In a mass treatment programme involving >50 000 subjects, 9% had an adverse effect after the first dose, and the rate was 15% amongst more than 7400 Ghanaian patients in a separate trial.

Ivermectin does not cause severe ocular complications in patients with onchocerciasis. No changes in visual acuity or appearance of punctate opacities have occurred with ivermectin, and in this respect it is superior to diethylcarbamazine. Similarly, ivermectin is much less likely to cause the potentially fatal Mazzotti reaction associated with diethylcarbamazine, although there have been reports of severe postural hypotension (occurring in 37 of about 14000 patients in 1 large trial) and other rare but serious reactions in patients receiving ivermectin.

Dosage and Administration

Ivermectin is administered as a single oral dose, usually 150 A*g/kg. Annual re-treatment (using the same initial dosage) is required. There is some evidence from clinical trials that ivermectin may be more effective in patients with heavy ocular involvement when given 6-monthly rather than yearly.

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References

  • Albiez EJ, Walter G, Kaiser A, Ranque P, Newland HS, et al. Histological examination of onchocercomata after therapy with ivermectin. Tropical Medicine and Parasitology 39: 93–99, 1988a

    PubMed  CAS  Google Scholar 

  • Albiez EJ, Newland HS, White AT, Kaiser A, Greene BM, et al. Chemotherapy of onchocerciasis with high doses of diethyl-carbamazine or a single dose of ivermectin: microfilaria levels and side effects. Tropical Medicine and Parasitology 39: 19–24, 1988b

    PubMed  CAS  Google Scholar 

  • Ali BH. The effect of ivermectin on some haematological indices in rabbits: influence of vitamin K treatment. Clinical and Experimental Pharmacology and Physiology 17: 735–738, 1990

    PubMed  Article  CAS  Google Scholar 

  • Awadzi K, Dadzie KY, Kläger S, Gilles HM. The chemotherapy of onchocerciasis. XIII. Studies with ivermectin in onchocerciasis patients in northern Ghana, a region with long lasting vector control. Tropical Medicine and Parasitology 40: 361–366, 1989

    CAS  Google Scholar 

  • Awadzi K, Dadzie KY, Schulz-Key H, Gilles HM, Fulford AJ, et al. The chemotherapy of onchocerciasis. XI. A double-blind comparative study of ivermectin, diethylcarbamazine and placebo in human onchocerciasis in northern Ghana. Annals of Tropical Medicine and Parasitology 80: 433–442, 1986

    CAS  Google Scholar 

  • Aziz MA, Diallo S, Diop IM, Lariviëre M, Porta M. Efficacy and tolerance of ivermectin in human onchocerciasis. Lancet 1: 171–173, 1982

    Article  Google Scholar 

  • Bianco AE, Nwachukwu MA, Townson S, Doenhoff MJ, Muller RL. Evaluation of drugs against onchocerca microfilariae in an inbred mouse model. Tropical Medicine and Parasitology 37: 39–45, 1986

    PubMed  CAS  Google Scholar 

  • Bryan RT, Stokes SL, Spencer HC. Expatriates treated with ivermectin. Lancet 337: 304, 1991

    PubMed  Article  CAS  Google Scholar 

  • Caumes E, Datry A, Paris L, Gaxotte P, Danis M, et al. Efficacy of ivermectin in the treatment of cutaneous larva migrans. Presented at the 31st International Congress of Antimicrobial Agents and Chemotherapy, Chicago, 1991

  • Chavasse DC, Davies JB. In vitro effects of ivermectin on Onchocerca volvulus microfilariae assessed by observation and by inoculation into Similium damnosum sensu lato Transactions of the Royal Society of Tropical Medicine and Hygiene 84: 707–708, 1990

    PubMed  Article  CAS  Google Scholar 

  • Chiou R, Stubbs RJ, Bayne WF. Determination of ivermectin in human plasma and milk by high-performance liquid chromatography with fluorescence detection. Journal of Chromatography 416: 196–202, 1987

    PubMed  Article  CAS  Google Scholar 

  • Cupp EW, Bernardo MJ, Kiszewski AE, Collins RC, Taylor HR, et al. The effects of ivermectin on transmission of Onchocerca volvulus Science 231: 740–742, 1986

    PubMed  Article  CAS  Google Scholar 

  • Cupp EW, Ochoa O, Collins RC, Ramberg FR, Zea G. The effect of multiple ivermectin treatments on infection of Simulium ochraceum with Onchocerca volvulus. American Journal of Tropical Medicine and Hygiene 40: 501–506, 1989

    PubMed  CAS  Google Scholar 

  • Dadzie KY, Bird AC, Awadzi K, Schulz-Key H, Gilles HM, et al. Ocular findings in a double-blind study of ivermectin versus diethylcarbamazine versus placebo in the treatment of onchocerciasis. British Journal of Ophthalmology 71: 78–85, 1987

    PubMed  Article  CAS  Google Scholar 

  • Dadzie KY, Awadzi K, Bird AC, Schulz-Key H. Ophthalmological results from a placebo controlled comparative 3-dose ivermectin study in the treatment of onchocerciasis. Tropical Medicine and Parasitology 40: 355–360, 1989

    PubMed  CAS  Google Scholar 

  • Dadzie KY, Remme J, Alley ES, de Sole G. Changes in ocular onchocerciasis four and twelve months after community-based treatment with ivermectin in a holoendemic onchocerciasis focus. Transactions of the Royal Society of Tropical Medicine and Hygiene 84: 103–108, 1990

    PubMed  Article  CAS  Google Scholar 

  • Datry A, Mayorga R, Lyagouki M, Hilmarsdottir I, Gaxotte P, et.al. Treatment of Strongyloides stercoralis infection with ivermectin versus albendazole: results of a 44 case study. Presented at the 31st International Congress of Antimicrobial Agents and Chemotherapy, Chicago, 1991

  • Davidson RN, Godfrey-Faussett P, Bryceson ADM. Adverse reactions in expatriates treated with ivermectin. Lancet 336: 1005, 1990

    PubMed  Article  CAS  Google Scholar 

  • de Sole G, Awadzi K, Remme J, Dadzie KY, Ba O, et al. A community trial of ivermectin in the onchocerciasis focus of Asubende, Ghana. II. Adverse reactions. Tropical Medicine and Parasitology 40: 375–382, 1989

    PubMed  Google Scholar 

  • de Sole G, Dadzie KY, Giese J, Remme J. Lack of adverse reactions in ivermectin treatment of onchocerciasis. Lancet 335: 1106–1107, 1990

    PubMed  Article  Google Scholar 

  • Devaney E, Howells RE. The microfilaricidal activity of ivermectin in vitro and in vivo. Tropenmedizin und Parasitologie 35: 47–49,1984

    PubMed  CAS  Google Scholar 

  • Diallo S, Aziz MA, Larivière M, Diallo JS, Diop-Mar I, et al. A double-blind comparison of the efficacy and safety of ivermectin and diethylcarbamazine in a placebo controlled study of Senegalese patients with onchocerciasis. Transactions of the Royal Society of Tropical Medicine and Hygiene 80: 927–934, 1986

    PubMed  Article  CAS  Google Scholar 

  • Diallo S, Aziz MA, Ndir O, Badiane S, Bah IB, et al. Dose-ranging study of ivermectin in treatment of filariasis due to Wuchereria bancrofti. Lancet 1: 1030–1031, 1987

    PubMed  Article  CAS  Google Scholar 

  • Dickinson CM. Improved high-performance liquid Chromatographic method for quantitation of ivermectin in whole blood, serum or muscle tissue. Journal of Chromatography 528: 250–257, 1990

    PubMed  Article  CAS  Google Scholar 

  • Duke BOL. Human onchocerciasis —an overview of the disease. Acta Leidensia 59: 9–24, 1990

    PubMed  CAS  Google Scholar 

  • Duke BOL, Soula G, Zea-Flores G, Bratthauer GL, Doumbo O. Migration and death of skin-dwelling Onchocerca volvulus microfilariae after treatment with ivermectin. Tropical Medicine and Parasitology 42: 25–30, 1991

    PubMed  CAS  Google Scholar 

  • Duke BOL, Zea-Flores G, Castro J, Cupp EW, Munoz B. Effects of multiple monthly doses of ivermectin on adult Onchocerca volvulus American Journal of Tropical Medicine and Hygiene 43: 657–664, 1990

    PubMed  CAS  Google Scholar 

  • Duke BOL, Zea-Flores G, Gannon RT. On the reproductive activity of the female Onchocerca volvulus. Tropical Medicine and Parasitology 41: 387–402, 1990

    PubMed  CAS  Google Scholar 

  • Dukuly ZD, Pacqué M, Nara A, Taylor HR, Williams PN, et al. A prospective study in high risk subjects of electrocardiographic changes with ivermectin. Tropical Medicine and Parasitology 41: 73–74, 1990

    PubMed  CAS  Google Scholar 

  • Edwards G, Breckenridge AM. Clinical pharmacokinetics of anthelmintic drugs. Clinical Pharmacokinetics 15: 67–93, 1988

    PubMed  CAS  Google Scholar 

  • Edwards G, Dingsdale A, Helsby N, Orme ML’E, Breckenridge AM. The relative systemic availability of ivermectin after administration as capsule, tablet, and oral solution. European Journal of Clinical Pharmacology 35: 681–684, 1988

    PubMed  Article  CAS  Google Scholar 

  • Ette El, Thomas WOA, Achumba JI. Ivermectin: a long-acting microfilaricidal agent. DICP, Annals of Pharmacotherapy 24: 426–433, 1990

    CAS  Google Scholar 

  • Fink DW, Porras AG. Pharmacokinetics of ivermectin in animals and man. In Campbell WC (Ed.) Ivermectin and abamectin. Springer-Verlag, New York, pp. 113–130, 1989

    Chapter  Google Scholar 

  • Freedman DO, Zierdt WS, Lujan A, Nutman TB. The efficacy of ivermectin in the chemotherapy of gastrointestinal helminthiasis in humans. Journal of Infectious Diseases 159: 1151–1153, 1989

    PubMed  Article  CAS  Google Scholar 

  • Greene BM, Dukuly ZD, Munoz B, White AT, Pacqué M, et al. A comparison of 6-, 12-, and 24-monthly dosing with ivermectin for treatment of onchocerciasis. Journal of Infectious Diseases 163: 376–380, 1991

    PubMed  Article  CAS  Google Scholar 

  • Greene BM, Taylor HR, Cupp EW, Murphy RP, White AT, et al. Comparison of ivermectin and diethylcarbamazine in the treatment of onchocerciasis. New England Journal of Medicine 313: 133–138, 1985

    PubMed  Article  CAS  Google Scholar 

  • Guderian RH, Anselmi M, Sempertegui R, Cooper PJ. Adverse reactions to ivermectin in reactive onchodermatitis. Lancet 337: 188, 1991

    PubMed  Article  CAS  Google Scholar 

  • Helling G, Awissi D, Adjamgba C, Heuschkel C, Kläger S, et al. Ivermectin: a safe drug in the treatment of onchocerciasis in a phase-III-study in Togo. Tropical Medicine and Parasitology 38: 348, 1987

    Google Scholar 

  • Heuschkel C, Schulz-Key H, Banla M, Görgen H, Kläger S, et al. Onchozerkosetherapie: eine Langzeitstudie mit Ivermectin in Togo. Mitteilungen der Osterreichischen Gesellschoft für Tropenmedizin und Parasitologie 11: 81–88, 1989

    Google Scholar 

  • Homeida MMA, Bagi IA, Galib HW, Sheikh HE, Yusif MA, et al. Prolongation of prothrombin time with ivermectin. Lancet 1: 1346–1347, 1988

    PubMed  Article  CAS  Google Scholar 

  • Jürgens S, Schulz-Key H. Effect of ivermectin on the vertical distribution of Onchocerca volvulus microfilariae in the skin. Tropical Medicine and Parasitology 41: 165–168, 1990

    PubMed  Google Scholar 

  • Klotz U, Ogbuokiri JE, Okonkwo PO. Ivermectin binds avidly to plasma proteins. European Journal of Clinical Pharmacology 39: 607–608, 1990

    PubMed  Article  CAS  Google Scholar 

  • Kumaraswami V, Ottesen EA, Vijayasekaran V, Devi SU, Swaminathan M, et al. Ivermectin for the treatment of Wuchereria bancrofti filanasis. Efficacy and adverse reactions. Journal of the American Medical Association 259: 3150–3153, 1988

    Article  CAS  Google Scholar 

  • Larivière M, Beauvais B, Aziz M, Garin YJ-F, Abeloos J, et al. A study in the Ivory Coast (1985–1987) of the efficacy and tolerance of ivermectin (Mectizan®) in human onchocerciasis. I. A comparative double-blind study of 220 patients with onchocerciasis treated with a single oral dose of 100, 150 or 200 mcg/kg. Bulletin de la Société du Pathologie Exotique et de ses Filiales 82: 35–47, 1989a

    Google Scholar 

  • Larivière M, Beauvais B, Aziz M, Garin YJ-F, Abeloos J, et al. A study in the Ivory Coast (1985-1987) of the efficacy and tolerance of ivermectin (Mectizan®) in human onchocerciasis. II. Evaluation in the light of mass campaigns on the effect of yearly or half-yearly administration of single oral doses of 100, 150 or 200 mgc/kg. Bulletin de la Société du Pathologie Exotique et de ses Filiales 82: 48–57, 1989b

    Google Scholar 

  • Larivière M, Beauvais B, Aziz M, Garin YJ-F, Peignot C, et al. A study in the Ivory Coast (1985-1987) of the efficacy and tolerance of ivermectin (Mectizan) in human onchocerciasis. III. The tolerance and efficacy of a single oral dose of 150 mcg/ kg in children. Bulletin de la Société du Pathologie Exotique et de ses Filiales 82: 58–64, 1989c

    Google Scholar 

  • Larivière M, Vingtain P, Aziz M, Beauvais B, Weimann D, et al. Double-blind study of ivermectin and diethylcarbamazine in African onchocerciasis patients with ocular involvement. Lancet 1: 174–177, 1985

    Article  Google Scholar 

  • Matsumoto K, Yamazaki J, Kasuya M, Fukuda H. The actions of ivermectin on cultured chick spinal cord neurons. Neuroscience Letters 69: 279–284, 1986

    PubMed  Article  CAS  Google Scholar 

  • Mossinger J, Schulz-Key H, Dietz K. Emergence of Onchocerca volvulus microfilariae from skin snips before and after treatment of patients with ivermectin. Tropical Medicine and Parasitology 39: 313–316, 1988

    PubMed  CAS  Google Scholar 

  • Naquira C, Jimenez G, Guerra JG, Bernai R, Nalin DR, et al. Ivermectin for human strongyloidiasis and other intestinal helminths. American Journal of Tropical Medicine and Hygiene 40: 304–309, 1989

    PubMed  CAS  Google Scholar 

  • Newland HS, White AT, Green BM, D’Anna SA, Keyvan-Larijani E, et al. Effect of single-dose ivermectin therapy on human Onchocerca volvulus infection with onchocercal ocular involvement. British Journal of Ophthalmology 72: 561–569, 1988

    PubMed  Article  CAS  Google Scholar 

  • Ottesen EA, Vijayasekaran V, Kumaraswami V, Pillai SVP, Sadanandam A, et al. A controlled trial of ivermectin and diethylcarbamazine in lymphatic filariasis. New England Journal of Medicine 322: 1113–1117, 1990

    PubMed  Article  CAS  Google Scholar 

  • Pacqué M, Muñoz B, Greene BM, White AT, Dukuly Z, et al. Safety of and compliance with community-based ivermectin therapy. Lancet 335: 1377–1380, 1990a

    PubMed  Article  Google Scholar 

  • Pacqué M, Muñoz B, Poetschke G, Foose J, Greene BM. Pregnancy outcome after inadvertent ivermectin treatment during community-based distribution. Lancet 336: 1486–1489, 1990b

    PubMed  Article  Google Scholar 

  • Pacqué MC, Muñoz B, White AT, Williams PN, Greene BM. Ivermectin and prothrombin time. Lancet 1: 1140, 1989

    Google Scholar 

  • Plorde JJ. Filariasis. In Braunwald et al. (Eds) Harrison’s principles of internal medicine. I. 11th edition, pp. 808–809, McGraw-Hill Book Company, New York, 1987

    Google Scholar 

  • Pong S-S, Wang CC, Fritz LC. Studies on the mechanism of action of avermectin B1a: stimulation of release of 7-aminobu- tyric acid from brain synaptosomes. Journal of Neurochemistry 34: 351–358, 1980

    PubMed  Article  CAS  Google Scholar 

  • Porras AG, Chiou R, Kubovetz W, Hall-Gregg M, Stubbs RJ, et al. Dose proportionality of the anthelmintic ivermectin in man. Pharmaceutical Research 4 (Suppl.): S95, 1987

  • Remme J, Baker RHA, de Sole G, Dadzie KY, Walsh JF, et al. A community trial of ivermectin in the onchocerciasis focus of Asubende, Ghana. I. Effect on the microfilarial reservoir and the transmission of Onchocerca volvulus. Tropical Medicine and Parasitology 40: 367–374, 1989

    CAS  Google Scholar 

  • Richard-Lenoble D, Kombila M, Rupp E, Pappayliou E, Gaxotte P, et al. Ivermectin in loiasis and concomitant O. volvulus and M. perstans infections. American Journal of Tropical Medicine and Hygiene 36: 480–483, 1988

    Google Scholar 

  • Richards Jr FO, Zea Flores R, Duke BOL. Dynamics of microfilariae of Onchocerca volvulus over the first 72 hours after treatment with ivermectin. Tropical Medicine and Parasitology 40: 299–303, 1989a

    PubMed  Google Scholar 

  • Richards Jr FO, McNeeley MB, Bryan RT, Eberhard ML, McNeely MF, et al. Ivermectin and prothrombin time. Lancet 1: 1139–1140, 1989b

    Article  Google Scholar 

  • Rothova A, van der Lelij A, Stilma JS, Wilson WR, Barbe RF. Side-effects of ivermectin in treatment of onchocerciasis. Lancet 1: 1439–1441, 1989

    PubMed  Article  CAS  Google Scholar 

  • Rothova A, van der Lelij A, Stilma JS, Klaassen-Broekema N, Wilson WR, et al. Ocular involvement in patients with onchocerciasis after repeated treatment with ivermectin. American Journal of Ophthalmology 110: 6–16, 1990

    PubMed  CAS  Google Scholar 

  • Roux J, Perolat Ph, Cartel J-L, Boutin J-P, Sechan Y, et al. Ivermectin study for the treatment of Bancroftian filariasis of French Polynesia. Bulletin de la Société de Pathologie Exotique et de ses Filiales 82: 72–81, 1989

    PubMed  CAS  Google Scholar 

  • Satti MZ, VandeWaa EA, Bennett JL, Williams JF, Conder GA, et al. Comparative effects of anthelmintics on motility in vitro of Onchocerca gutturosa, Brugia pahangi and Acanthocheilonema viteae. Tropical Medicine and Parasitology 39: 480–483, 1988

    PubMed  CAS  Google Scholar 

  • Schulz-Key H. Observations on the reproductive biology of Onchocerca volvulus. Acta Leidensia 59: 27–43, 1990

    PubMed  CAS  Google Scholar 

  • Schulz-Key H. The collagenase technique: how to isolate and examine adult Onchocerca volvulus for the evaluation of drug effects. Tropical Medicine and Parasitology 39: 423–440, 1988

    PubMed  Google Scholar 

  • Semba RD, Murphy RP, Newland HS, Awadzi K, Greene BM, et al. Longitudinal study of lesions of the posterior segment in onchocerciasis. Ophthalmology 97: 1334–1341, 1990

    PubMed  CAS  Google Scholar 

  • Soboslay PT, Newland HS, White AT, Erttmann KD, Albiez EJ, et al. Ivermectin effect on microfilariae of Onchocerca volvulus after a single oral dose in humans. Tropical Medicine and Parasitology 38: 8–10, 1987

    PubMed  CAS  Google Scholar 

  • Taylor HR, Murphy RP, Newland HS, White AT, D’Anna SA, et al. Treatment of onchocerciasis. The ocular effects of ivermectin and diethylcarbamazine. Archives of Ophthalmology 104: 863–870, 1986

    CAS  Google Scholar 

  • Taylor HR, Semba RD, Newland HS, Keyvan-Larijani E, White A, et al. Ivermectin treatment of patients with severe ocular onchocerciasis. American Journal of Tropical Medicine and Hygiene 40(5): 494–500, 1989

    PubMed  CAS  Google Scholar 

  • Taylor HR, Pacqué M, Muñoz B, Greene BM. Impact of mass treatment of onchocerciasis with ivermectin on the transmission of infection. Science 250: 116–118, 1990

    PubMed  Article  CAS  Google Scholar 

  • Townsend LB, Wise DS. Filariasis: river blindness, elephantiasis and other filarial infections. Pharmacy International 5: 70–74, 1984

    Google Scholar 

  • Townson S. The development of a laboratory model for onchocerciasis using Onchocerca gutturosa: in vitro culture, collagenase effects, drug studies and cryopreservation. Tropical Medicine and Parasitology 39: 475–479, 1988

    PubMed  Google Scholar 

  • Townson S, Connelly C, Dobinson A, Muller R. Drug activity against Onchocerca gutturosa males in vitro: a model for chemotherapeutic research on onchocerciasis. Journal of Helminthology 61: 271–281, 1987

    PubMed  Article  CAS  Google Scholar 

  • Townson S, Dobinson A, Connelly C, Muller R. Chemotherapy of Onchocerca lienalis microfilariae in mice: a model for the evaluation of novel compounds for the treatment of onchocerciasis. Journal of Helminthology 62: 181–194, 1988

    PubMed  Article  CAS  Google Scholar 

  • Townson S, Dobinson AR, Townsend J, Siemienska J, Zea-Flores G. The effects of ivermectin used in combination with other known anti-parasitic drugs on adult Onchocerca gutturosa and O. volvulus in vitro. Transactions of the Royal Society of Tropical Medicine and Hygiene 84: 411–416, 1990

    PubMed  Article  CAS  Google Scholar 

  • Townson S, Shay KE, Dobinson AR, Connelly C, Comley JCW, et al. Onchocerca gutturosa and O. volvulus: studies on the viability and drug responses of cryopreserved adult worms in vitro Transactions of the Royal Society of Tropical Medicine and Hygiene 83: 664–669, 1989

    PubMed  Article  CAS  Google Scholar 

  • Townson S, Tagboto SK. The effects of ivermectin on the viability of Onchocerca lienalis microfilariae in vitro and on their subsequent development in the blackfly vector, Simulium ornatum. Tropical Medicine and Parasitology 42: 31–37, 1991

    PubMed  CAS  Google Scholar 

  • Trpis M, Childs JE, Fryauff DJ, Greene BM, Williams PN, et al. Effect of mass treatment of a human population with ivermectin on transmission of Onchocerca volvulus by Simulium Yahense in Liberia, West Africa. American Journal of Tropical Medicine and Hygiene 42: 148–156, 1990

    PubMed  CAS  Google Scholar 

  • Wann KT. The electrophysiology of the somatic muscle cells of Ascaris suum and Ascaridia galli Parasitology 94: 555–566, 1987

    PubMed  Article  Google Scholar 

  • Whitworth JAG, Maude GH, Luty AJF. Expatriates treated with ivermectin. Lancet 337: 625–626, 1991

    PubMed  Article  CAS  Google Scholar 

  • Whitworth JAG, Morgan D, Maude GH, Downham MD, Taylor DW. A community trial of ivermectin for onchocerciasis in Sierra Leone: clinical and parasitology responses to the initial dose. Transactions of the Royal Society of Tropical Medicine and Hygiene 85: 92–96, 1991

    PubMed  Article  CAS  Google Scholar 

  • Whitworth JAG, Morgan D, Maude GH, Taylor DW. Community-based treatment with ivermectin. Lancet 2: 97–98, 1988

    PubMed  Article  CAS  Google Scholar 

  • WHO Expert Committee on Onchocerciasis. Third Report WHO Technical report services 752, 1987

  • Yamazaki J, Matsumoto K, Ono H, Fukuda H. Macrolide compounds, ivermectin and milbemycin D, stimulate chloride channels sensitive to GABAergic drugs in cultured chick spinal neurons. Comparative Biochemistry and Physiology 93C: 97–104, 1989

    CAS  Google Scholar 

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Various sections of the manuscript reviewed by: A.M. Breckenridge, The University of Liverpool, Liverpool, England; K.Y. Dadzie, Onchocerciasis Control Programme in West Africa, World Health Organization, African Region, Ouagadougou, Burkina Faso; S. Diallo, Faculté de Médecine et de Pharmacie, Service de Parasitologie, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal; B. Duke, River Blindness Foundation, Houston, Texas, USA; G. Edwards, Department of Pharmacology and Therapeutics, The University of Liverpool, Liverpool, England; H. Fukuda, Department of Pharmacology, College of Pharmacy, Nihon University, Chiba, Japan; T. Itoh, Department of Clinical Pharmacology, Faculty of Medicine, Tottori University, Yonago, Japan; K. Matsumoto, Department of Pharmacology, College of Pharmacy, Nihon University, Chiba, Japan; H. Neu, Department of Medicine, Division of Infectious Diseases, College of Physicians and Surgeons of Columbia University, New York, New York, USA; H. Newland, Department of Ophthalmology, Flinders Medical Centre, Bedford Park, South Australia, Australia; E.A. Ottesen, Clinical Parasitology Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA; H. Schulz- Key, Eberhard-Karls-Universität Tübingen, Universitätsklinikum, Institut für Tropemedizin, Tübingen, Federal Republic of Germany; H.R. Taylor, Department of Ophthalmology, Melbourne University, East Melbourne, Victoria, Australia; J. Whitworth, Tropical Health Epidemiology Unit, Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, London, England.

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Goa, K.L., McTavish, D. & Clissold, S.P. Ivermectin. Drugs 42, 640–658 (1991). https://doi.org/10.2165/00003495-199142040-00007

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Keywords

  • Ivermectin
  • Suramin
  • Onchocerciasis
  • Ivermectin Treatment
  • Diethylcarbamazine