Ivermectin

Development and Validation of a Stability-Indicating Reversed-Phase HPLC Method for Assay and Estimation of Related Substances of Ivermectin in an Oral Paste

Ivermectin is a potent semi-synthetic antiparasitic drug used in veterinary medicine. A reversed-phase high performance liquid chromatography (HPLC) method has been developed and validated for the identification and assay of Ivermectin, including the identification and estimation of its related impurities in an oral paste. Analytes were separated using a gradient elution at a flow rate of 1.5 mL/min on a Zorbax Extend-C18 column (150 mm × 4.6 mm i.d., 3.5-μm particle size) maintained at 30 °C. The mobile phase was composed of water as mobile-phase A and acetonitrile/methanol (85/15, v/v) as mobile-phase B. Ultraviolet detection at 245 nm was employed to monitor the analytes. Limit of quantitation (LOQ) and limit of detection (LOD) of the method are 0.6 and 0.2 μg/mL, respectively. The validation results demonstrated excellent linearity of the method in the range of 0.1-150% of the analytical concentration (0.6 mg/mL) of the method. The stability-indicating capability of the method has been demonstrated by adequately separating the degradation products from the stress degraded samples of the oral paste as per method validation requirements prescribed in the current International Council for Harmonisation guidelines.

Development and Validation of a Reversed-Phase High-Performance Liquid Chromatography (RP-HPLC) Method for Identification, Assay and Estimation of Related Substances of Ivermectin in Bulk Drug Batches of Ivermectin Drug Substance

A reversed-phase high-performance liquid chromatography (RP-HPLC) method has been developed and validated for the identification and assay of Ivermectin, including the identification and estimation of its process-related impurities and degradation products in bulk drug substance of Ivermectin. Analytes were separated on a HALO C18 column (100 mm × 4.6 mm I.D., 2.7 μm particle size) maintained at 40 °C (column temperature) with gradient elution. All analytes of interests were adequately separated within 25 min. All degradation products, process-related impurities and assay were monitored by ultraviolet detection at 254 nm. The new HPLC method described here successfully separated an isomer peak of the active pharmaceutical ingredient (API) from the major API peak. This newly separated isomer peak is around 1.2 to 1.5% (peak area) in typical API samples, and coelutes with the major API peak by all current HPLC methods. Quantitation limit of the HPLC method is 0.1% of target analytical concentration (~1.0 μg/mL). This method has been demonstrated to be accurate, robust, significantly higher degree of selectivity compared to the HPLC methods of Ivermectin drug substance reported in the literature and in the compendial HPLC methods prescribed in the current USA and European Pharmacopeia.

A milbemycin compound isolated from Streptomyces Sp. FJS31-2 with cytotoxicity and reversal of cisplatin resistance activity in A549/DDP cells

Streptomyces Sp FJS31-2 is a strain isolated from special habitat soils in the early stage of our laboratory for producing a new type of halogenated type II polyketide antibiotic with good anti-MRSA activity. In this experiment, a variety of chromatographic and spectroscopic methods was used to isolate and identify a milbemycin compound VM48130 from the ethyl acetate extract of the fermentation products. To investigate its bioactivity, Cell Counting Kit-8 (CCK-8) assay was used to test the cytotoxic activity of the compound against a variety of cancer cells (human liver cancer cell line MHCC97H and SK-Hep1, human nasopharyngeal carcinoma cell line CNE1, mouse melanoma cell line B16, human colon cancer cell line LOVO, human lung adenocarcinoma cell line A549) and normal cells (human bronchial epithelial cell line 16HBE, human normal liver cell line L02, human nasopharyngeal epithelial cell line NP69). The results showed that the compound had significant cytotoxic activity against the above cancer cells, and the IC₅₀ values were 21.96 ± 1.45, 22.18 ± 0.55, 19.42 ± 0.71, 18.61 ± 1.68, 18.62 ± 0.67, 18.52 ± 0.64 μM, respectively. Furthermore, the CCK-8 method was used to evaluate the compound's reversal of cisplatin resistance in multidrug resistant cisplatin-resistant human lung adenocarcinoma (A549/DDP) cells. The results indicated that when the compound concentration was 0.5 μM, the reversal fold (RF) reached 6.25 and showed a dose-dependent effect. At 5 μM, the RF reached 8.35, which was approximately equivalent to the reversal effect of the positive drug verapamil at the same concentration. The expression of MDR1, MRP1, LRP, MAST1 resistance genes and the corresponding proteins were analyzed by quantitative RT-PCR and Western blot assay, and found that the compound could significantly down-regulate the expression of these genes and proteins. These results indicated that VM48130 had the potential of being a lead compound for the treatment or adjuvant treatment of cancer.

Effects of ivermectin treatment during prepubertal and pubertal period on sexual parameters and sexual behavior in adulthood in rats

Pediculosis is a parasitic disease that is considered a serious global public health problem. It is caused by the ectoparasite that is popularly known as lice, mainly affecting children in early childhood. The most commonly used treatment to combat this parasitosis is the macrocyclic lactone ivermectin (IVM). However, the use of IVM is contraindicated in children who are younger than 5 years old or who weigh <15 kg because some types of drugs that are used during certain periods of brain maturation can lead to behavioral disorders. The present study evaluated the effects of IVM treatment during the prepubertal and pubertal period on sexual behavior in adulthood in male rats. Genital grooming, preputial separation, sexual behavior, sexual motivation, relative organ weight, the gonadosomatic index, and histopathology were evaluated. Oral dose of 0.2 mg/kg (therapeutic dose) of a commercial IVM formulation was administered. IVM affected genital grooming but did not influence preputial separation in prepubertal rats. Prepubertal IVM administration did not impair sexual behavior in adult rats, with the exception of the time of residence with female rats in the sexual motivation test. It did not affect relative organ weights, with the exception of the relative weight of the full seminal vesicle. It did not alter the gonadosomatic index, and no histopathological alterations were observed in different organs. These results indicate that administration of a therapeutic dose of IVM during the prepubertal and pubertal period does not alter parameters of sexual development or sexual behavior in adult male rats.

Ivermectin acute administration impaired the spermatogenesis and spermiogenesis of adult rats

Ivermectin (IVM) is an antiparasitic agent widely used in agricultural, domestic animals and in human clinical practice. In the present study, the temporal effects of therapeutic doses of IVM in the morphometric and histological assessment of testis were studied to verify if IVM acute administration impaired the spermatogenesis and spermiogenesis of adult rats, if these effects are reversible. The testosterone levels and the plasmatic IVM levels were assessed. The results show: 1) IVM acute exposure, mainly in the higher dose, reduced the testicular volume, the tubular diameter and the germinal epithelium height; 2) no interferences on Leydig cells frequency; 3) histological studies show that tubular sections containing several histological changes indicative of spermatogenesis interruption, such as disorganization of germinal epithelium, vacuolar degeneration of the germ cells and sloughing of cells into the tubular lumen; 4) no differences in testosterone levels; 5) The IVM plasmatic levels were significantly reduced at 72h after the 0.2mg/kg. It was concluded that acute IVM impaired the spermatogenesis and spermiogenesis of rats. Probably these effects were not consequence of IVM at the Leydig cells because no effects were observed at this level. Finally, our results suggest that some testicular effects are reversible and correlated with the plasmatic levels of IVM.

[Non-antibiotic anti-infectious treatments in urology]

OBJECTIVE

To define the terms of use of pesticides, antifungal, antiviral and antiseptic treatments in urology.

MATERIALS AND METHODS

A literature search was conducted on MEDLINE for all these treatments used in urology. The molecules were classified by family. Modes of action, indications in urology and adverse effects have been detailed. Authorisation files were consulted and then complemented by a literature analysis.

RESULTS

Although parasitic or viral diseases are uncommon in urology, their specific treatment deserves a thorough knowledge of pesticide and antiviral molecules. Antifungal treatments are regularly used in urology with special features to know to improve the efficacy/safety ratio. Antiseptics are used daily in urology and a better understanding of these molecules allows better use.

CONCLUSION

Beyond antibiotics, antiviral, antiparasitic and antifungal deserve a thorough knowledge. Antiseptic although used daily have features little known.

The effect of a single dose of oral ivermectin on pruritus in the homeless

BACKGROUND

Homeless people commonly present with ectoparasite-based pruritus. We evaluated the efficacy of a single dose of ivermectin to reduce the pruritus prevalence in a homeless population.

METHODS

We conducted a randomized, double-blind, placebo-controlled trial from January 2006 to April 2006 in two homeless shelters in the city of Marseille, France. Homeless people complaining of pruritus were randomized to receive either ivermectin (24 mg) or placebo. Follow-up visits were planned at day 14 and day 28 after the inclusion to assess the outcome of pruritus.

RESULTS

Forty-two subjects with pruritus were randomized to the ivermectin group and 40 to the placebo group. On day 14, pruritus was reported by significantly more subjects in the placebo group than those in the ivermectin group for both the per-protocol (PP) population (91.42% versus 68.57%, P = 0.014) and the intention-to-treat (ITT) population (92.5% versus 73.80%, P = 0.038). No significant effect was observed at day 28. Ivermectin was the only independent factor associated with the absence of pruritus at day 14 in both PP population [OR: 4.60 (95% CI:1.13; 18.73), P = 0.033] and ITT population [OR: 4.38 (95% CI: 1.07; 17.77), P = 0.039].

CONCLUSIONS

A single dose of oral ivermectin has a transient beneficial effect on the reduction of the prevalence of pruritus in the homeless population. More studies are required to assess the efficacy of multiple repeated treatments with ivermectin to reduce scabies and body lice endemic among homeless people with pruritus and the impact of such treatment on this population.

Use of ivermectin to treat an institutional outbreak of scabies in a low-resource setting

In a limited-resource hospital in Lima, Peru, 23 (63.9%) of 36 healthcare workers developed pruritus and/or skin lesions after contact with a patient with classic scabies. Of these 23, a total of 5 healthcare workers had scabies confirmed by microscopy. Oral ivermectin was used to control the outbreak effectively.

Scabies

Scabies is a neglected parasitic disease that is a major public health problem in many resource-poor regions. It causes substantial morbidity from secondary infections and post-infective complications such as acute post-streptococcal glomerulonephritis. Disease control requires treatment of the affected individual and all people they have been in contact with, but is often hampered by inappropriate or delayed diagnosis, poor treatment compliance, and improper use of topical compounds such as permethrin, lindane, or benzyl benzoate. In addition to concerns over toxicity with such compounds, parasite resistance seems to be increasing. Oral ivermectin is an alternative that has been used successfully in community control programmes. Plant derivatives such as turmeric, neem, and tea tree oil are also promising future treatments. The disease is strongly associated with poverty and overcrowding, and the associated stigma can ostracise affected individuals. Treatment of scabies in poor countries needs to integrate drug treatment programmes with efforts to improve the socioeconomic conditions and education programmes to reduce stigma. We expect the future to bring more sensitive and specific clinical and laboratory-based diagnostic methods, as well as new therapeutic strategies.

Epidemiology and morbidity of scabies and pediculosis capitis in resource-poor communities in Brazil

BACKGROUND

Pediculosis capitis and scabies are common parasitic skin diseases, especially in resource-poor communities, but data on epidemiology and morbidity are scanty.

OBJECTIVES

To assess the prevalence, seasonal variation and morbidity of pediculosis capitis and scabies in poor neighbourhoods in north-east Brazil.

METHODS

The study comprised cross-sectional surveys of a representative population of an urban slum (n = 1460) in Fortaleza, the capital of Ceará State (Brazil) and a fishing community 60 km south of the city (n = 605). Study participants were examined for the presence of scabies and pediculosis capitis. In a longitudinal study in the slum, variation of prevalence in different seasons of the year was assessed.

RESULTS

Prevalence of pediculosis capitis was 43.4% in the slum and 28.1% in the fishing community. Children aged 10-14 years and females were most frequently affected. Scabies was present in 8.8% of the population in the slum and in 3.8% of the population in the fishing community. There was no consistent pattern of age distribution. Superinfection was common in patients with scabies, and cervical lymphadenopathy in patients with pediculosis capitis. Multivariate analysis showed that age < or = 15 years, being of female sex and living in the urban slum were independent factors contributing to the simultaneous coinfestation with pediculosis capitis and scabies. The longitudinal data from the urban slum showed a characteristic seasonal variation of pediculosis capitis, but no fluctuation of scabies.

CONCLUSIONS

Pediculosis capitis and scabies are hyperendemic in the study areas and are associated with considerable morbidity. There is an urgent need to develop control measures for these parasitic skin diseases in resource-poor communities. This is the first community-based study describing in detail the epidemiology and morbidity of scabies and head lice infestation in Brazil.

Antiparasitic therapy in children

Treatment of parasitic infections in children presents many challenges for the clinician. Although parasitic infections are ubiquitous on a worldwide basis, with an estimated 1 billion persons infected with intestinal helminthes alone, physicians in the United States and other developed countries are often unfamiliar with the management of these diseases. Children are traveling internationally in larger numbers than ever before, however, and emigration from developing countries to the United States and other Western countries is increasing, so clinicians in these countries are confronted more frequently with parasitic diseases from the tropics. This article describes current approaches to antiparasitic therapy. Drugs used in the treatment of more than one type of parasite are presented once in detail, with reference to the detailed description in subsequent sections.

[Ivermectin]

Ivermectin is a semi-synthetic derivative of a macrocyclic lactone. It causes paralysis in many nematodes and arthropodes because of its effect on ion-channels in cell membranes. Ivermectin was first used in veterinary medicine. In man, it was shown to be microfilaricid against Onchocerca volvulus. Most of the adverse reactions following treatment were mild, without the systemic and ocular side effects usually complicating diethylcarbamazine therapy. In endemic areas after repeated administration of ivermectin, a dramatic reduction in dermal microfilarial load was observed, resulting in a decrease in transmission. There was a significant decrease in the prevalence of anterior segment lesions in the eyes and acute onchocercal skin disease. Moreover, ivermectin also exhibited microfilaricidal activity against Wuchereria bancrofti and Brugia malayi. Annual mass treatment with a single dose of diethylcarbamazine alone, or associated with ivermectin, was initiated in endemic areas for lymphatic filariasis. The preliminary results showed a decrease in the reservoir of microfilariae and rate of transmission, a reduction in the frequency of clinical lymphatic abnormalities due to bancroftan filariasis. In Loa loa infections ivermectin decreases microfilaremia, but serious adverse events such as encephalopathy can be induced in patients with high rate of microfilaremia. Ivermectin appears to be the drug of choice in Strongyloides stercoralis infections, a single dose is highly effective with less frequent side effects than thiabendazole. Oral ivermectin is an alternative to topical scabicides, it appears as effective as local treatment for common scabies, but there are few comparative studies. The best indications for ivermectin in this ectoparasitic infection could be the outbreak in institutions and crusty scabies, but in association with topical treatment. The precise position of this agent in the treatment of scabies remains to be specified. Ivermectin is also affective in the treatment of ascariasis and cutaneous larva migrans. It could also be a promising treatment for head lice.

Ectoparasites--the underestimated realm

CONTEXT

Ectoparasitoses (infestations with parasites that live on or in the skin) can cause considerable morbidity. Whereas pediculosis and scabies are ubiquitous, cutaneous larva migrans and tungiasis (sand-flea disease) occur mainly in hot climates. The prevalence of ectoparasitoses in the general population is usually low, but can be high in vulnerable groups. Scientific knowledge on how to deal best with parasitic skin diseases in different settings is scanty, and evidence-based measures for control are not available. For head lice and scabies the situation is daunting, because resistance of Pediculus humanus capitis and Sarcoptes scabiei to insecticides is spreading and unpredictable.

STARTING POINT

J Hunter and S Barker reported different patterns of resistance in schoolchildren in Brisbane, Australia: full resistance to malathion, permethrin, and pyrethrum in two schools, whereas head lice were susceptible to malathion and, to a lesser extent, to pyrethrums in three other schools (Parasitol Res 2003; 90: 476-78). K Yoon and colleagues found different resistance patterns in the USA and Ecuador (Arch Dermatol 2003; 139: 994-1000). Head lice from Florida were less susceptible to permethrin than those from Texas, and parasites from Ecuador were susceptible to both insecticides tested. WHERE NEXT? The occurrence of resistant pediculosis and scabies is expected to increase numerically and geographically. Clinicoepidemiological studies are urgently needed to identify the factors which govern the emergence and spread of strains of P humanus capitis and S scabiei that are resistant to insecticide or acaricide. Oral treatment with ivermectin could substitute for topically applied compounds, particularly in resource-poor communities where polyparasitism is common. A better understanding of local epidemiology is required to develop control measures. This knowledge has to be applied in combination with environmental sanitation, health education, and culturally acceptable interventions that are affordable by the underprivileged.

Controlling scabies in institutional settings: a review of medications, treatment models, and implementation

Scabies is a global problem and a significant source of morbidity in nursing home residents and workers because of its highly contagious nature. It is also a problem in hospitals that care for the elderly, the debilitated, and the immunocompromised. New outbreaks continue to occur, despite controlling the recurrent epidemics. Scabies manifests as papules, pustules, burrows, nodules, and occasionally urticarial papules and plaques. Most of the patients with scabies experience severe pruritus. A subset of patients have crusted or Norwegian scabies. These patients, who are usually debilitated or immunocompromised, do not experience the urge to scratch, and therefore do not scratch their own skin. Diagnosis of scabies is based on patient history, physical examination, and demonstration of mites, eggs, or scybala (black or brown football-shaped masses of feces of scabies) on microscopic examination. Scabies can be treated with topical or oral therapies. Topical treatments include 5% permethrin cream, 1% lindane (gamma benzene hexachloride) lotion, 6% precipitated sulfur in petrolatum, crotamiton, malathion, allethrin spray, and benzyl benzoate. Ivermectin, the only oral treatment, is not approved for scabies in the US. Most authorities advocate using a scabicide several times, specifically once a week over a period of 2-3 weeks. In an outbreak of scabies in a nursing home, residents, staff, and frequent visitors should all be treated even if they are not symptomatic. Ivermectin is useful in treating patients with Norwegian or crusted scabies, or who are debilitated. Ivermectin has no serious reported adverse effects. Model treatment plans to stop scabies epidemics have been developed. These plans coordinate treatment of all persons exposed (including ivermectin for debilitated patients), isolation of infected patients, disinfection of objects that patients have come into contact with, and education and reassurance of the medical staff. Failure to coordinate notification, education, treatment, and disinfection leads to failure to control scabies epidemics. Control of epidemics of institutional scabies requires attention to treatment effects and logistics. Treatment is low risk, but cumbersome because many individuals need be treated. It is advisable to restrict, where possible, the number of staff members that deal with scabies patients to limit the spread of the scabies. Prolonged surveillance is required for the eradication of institutional scabies. While the foregoing plans require coordination of all involved personnel and sustained efforts, they are necessary to halt the spread of scabies to patients and staff, to enhance their morale, and to prevent deterioration of labor and public relations.

Scabies and pediculosis

Although scabies and pediculosis are difficult and widespread problems, there are many effective treatments available. Dermatologists play a major role in educating the public in prevention and diagnosis. Although patients are more aware and well informed of the infections because of the Internet and other sources, practitioners are often the most important source of information and treatment in helping to eradicate this worldwide problem.