Moxidectin
Indications
Moxidectin is used for:
Onchocerciasis
Adult Dose
Onchocerciasis
Indicated for treatment of onchocerciasis (river blindness) due to Onchocerca volvulus
8 mg (four 2-mg tablets) PO as a single dose administered with or without food
Child Dose
Onchocerciasis
Indicated for treatment of onchocerciasis (river blindness) due to O volvulus in patients aged ?12 years
<12 years: Safety and efficacy not established
>12 years
8 mg (four 2-mg tablets) PO as a single dose administered with or without food
Renal Dose
Renal impairment
Mild-to-moderate (CrCl 30-89 mL/min): No dosage adjustment necessary
Severe (CrCl 15-29 mL/min) or end-stage renal disease: Safety is unknown
Administration
Administer with or without food as a single dose
Contra Indications
Precautions
Patients may develop symptomatic orthostatic hypotension with inability to stand without support after lying down for 5 minutes; patients experiencing dizziness or lightheadedness after administration should lie down until symptoms resolve
Patients with onchocerciasis who are also infected with Loa loa may develop a serious or even fatal encephalopathy following treatment; moxidectin has not been studied in patients co-infected with Loa loa; prior to treatment, patients who warrant treatment and have had exposure to Loa loa-endemic areas are recommended to undergo diagnostic screening for loiasis
Patients with hyper-reactive onchodermatitis (sowda) may be more likely than others to experience severe edema and worsening of onchodermatitis following moxidectin; manage with symptomatic treatment in patients who have experienced edema and worsening onchodermatitis
Pregnancy-Lactation
Pregnancy
Limited available data on use in pregnant women are insufficient to establish whether there is a moxidectin-associated risk for major birth defects and miscarriage
Animal data
Daily parental oral administration of dietary moxidectin to rats prior to mating, and through mating, gestation, and lactation, was associated with decreased survival and body weights for first-generation offspring, without maternal toxicity, at moxidectin doses less than 2 times the recommended human dose based on body surface area comparison
Lactation
Moxidectin was detected in the milk of lactating women following a single moxidectin dose
There are no data on the effects of moxidectin on the breastfed infant or milk production
Consider the benefits of breastfeeding along with the mother’s clinical need for moxidectin and any potential adverse effects on the breastfed child from moxidectin or from the underlying maternal condition
Interactions
Adverse Effects
Side effects of Moxidectin :
>10%
Eosinophilia (74%)
Pruritus (65%)
Musculoskeletal pain (64%)
Headache (58%)
Lymphocytopenia (48%)
Tachycardia (39%)
Rash (37%)
Orthostatic tachycardia (34%)
Abdominal pain (31%)
Hypotension (30%)
Pyrexia/chills (27%)
Leukocytosis (25%)
Influenza like illness (23%)
Grade 3 lymphocytopenia (<0.5 x 10^9/L) (23%)
Orthostatic hypotension (22%)
Neutropenia (20%)
Nonorthostatic tachycardia (18%)
Severe eosinophilia (>5 x 10^9) (18%)
Cough (17%)
Diarrhea/gastroenteritis/enteritis (15%)
Lymph node pain (13%)
Dizziness (12%)
Hyponatremia (12%)
Peripheral swelling (11%)
Mechanism of Action
The mechanism of action against O. volvulus is not known
Moxidectin is active against the microfilariae of O. volvulus
Studies suggest that moxidectin is not effective for killing the adult worms; however, it inhibits intrauterine embryogenesis and release of microfilariae from the adult worms