Adult patients with onchocerciasis caused by an infection with Onchocerca volvulus who are 12 years of age or older receive treatment with the anti-helminthic medication moxectin.

Moxidectin Uses:

• Onchocerciasis:
  • It is approved for the treatment of onchocerciasis caused by an infection with Onchocerca volvulus in individuals aged 12 and older.
  • Limitations of use: It is important to note that the drug does not kill adult O. volvulus. Patients should be followed and evaluated subsequently. The safety and efficacy of repeated administration of the drug have not been studied.

Moxidectin dose in adults:

Moxidectin Dose in the treatment of Onchocerciasis:

• Moxidectin is a medicine used to treat a disease called Onchocerciasis (also known as river blindness).
• The recommended dose for treating this disease is a single 8 mg pill taken by mouth.

Moxidectin dose in children:

Moxidectin Dose in the treatment of Onchocerciasis:

• For children who are 12 years old or older, and for teenagers, the recommended dose of Moxidectin to treat Onchocerciasis is one 8 mg pill taken by mouth one time.

Pregnancy Risk Category: C

• In some studies, with animals, Moxidectin caused unwanted side effects when it comes to reproduction.
• Because of this, during human tests, women who could become pregnant were asked to use long-lasting birth control methods.
• This precaution is probably because Moxidectin stays in the body for a long time.

Use during breastfeeding:

• Moxidectin can be found in breast milk.
• In a study with 12 women, it was found that babies got about 8.73% of the medicine dose their mothers took.
• It's generally okay for moms to breastfeed if the baby gets less than 10% of the medicine dose, but if it's over 25%, breastfeeding isn't advised.
• These 12 women were given a single dose of Moxidectin and then decided to stop breastfeeding for the study.
• Tests showed that moxidectin was more in the breast milk than in the mother's blood, especially at the start.
• Even after 28 days, some moxidectin was still in the milk.
• Only about 0.701% of the dose the mothers took was found in the milk.
• So, when deciding to breastfeed while on this medicine, consider the risks and benefits for both the baby and the mother.

Moxidectin Dose in Kidney disease:

• If your kidney clears more than or equal to 30 mL of fluid per minute (CrCl ≥30 mL/minute), you don't need to change the dose of the medicine.
• If your kidney clears less than 30 mL of fluid per minute (CrCl <30 mL/minute) or if you have severe kidney disease, the drug company hasn’t given guidelines on how to adjust the dose because it hasn't been studied in these conditions.

Moxidectin Dose in Liver disease:

There are no dosage adjustments provided in the manufacturer’s labeling (it has not been studied).

Common Side Effects of Moxidectin:

• Dermatologic:
  • Pruritus
  • Skin Rash
• Cardiovascular:
  • Postural Orthostatic Tachycardia
  • Hypotension
  • Peripheral Edema
  • Tachycardia
  • Orthostatic Hypotension
• Endocrine & Metabolic:
  • Hyponatremia
• Gastrointestinal:
  • Abdominal Pain
  • Diarrhea
  • Enteritis
  • Gastroenteritis
• Hematologic & Oncologic:
  • Eosinophilia
  • Lymphocytopenia
  • Leukocytosis
  • Neutropenia
• Central Nervous System:
  • Headache
  • Chills
  • Lymph Node Pain
  • Dizziness
•  
• Neuromuscular & Skeletal:
  • Musculoskeletal Pain
• Respiratory:
  • Flu-Like Symptoms
  • Cough
• Miscellaneous:
  • Fever

Less Common Side Effects of Moxidectin:

• Cardiovascular:
  • Symptomatic orthostatic hypotension
• Endocrine & metabolic:
  • Increased gamma-glutamyl transferase
• Hepatic:
  • Hyperbilirubinemia
  • Raised serum alanine aminotransferase
  • Raised serum aspartate aminotransferase
• Hematologic & oncologic:
  • Eosinopenia
•  
• Ophthalmic:
  • Eye pain
  • Eye pruritus
  • Visual impairment
  • Allergic conjunctivitis
  • Eyelid edema
  • Conjunctival hyperemia
  • Ocular hyperemia
  • Increased lacrimation

Frequency of side effects not defined:

• Dermatologic:
  • Mazzotti reaction

Contraindications to Moxidectin:

The manufacturer hasn't listed any specific reasons or conditions where you shouldn't use this medicine.

Warnings and precautions

Mazzoti reaction:

• Taking Moxidectin can sometimes cause skin, eye, or body reactions known as the Mazzoti reaction.
• This is because the medicine kills tiny worms (microfilariae) and the body reacts to it.
• These reactions usually start and go away within the first week after taking the medicine.
• People with more of these tiny worms in their body might have a higher chance of this reaction.
• If the reaction is very severe, there isn't a specific treatment, but things like keeping hydrated, getting steroids, or treating low blood pressure can help.
• For milder reactions, allergy medicines (antihistamines) or aspirin might be used.

Orthostatic hypotension

• Taking the medicine might cause a drop in blood pressure when you stand up, especially on the first or second day after taking it.
• This drop in blood pressure usually doesn't last long, and lying down can help manage it.

Loiasis:

• Before giving Moxidectin, it's a good idea to check if the patient has been exposed to areas where the Loa loa worm is common.
• This is because treating someone with Moxidectin who also has this worm can lead to severe brain problems, which can sometimes be deadly.

Monitoring parameters:

Skin Microfilarial Counts

• This means checking the number of tiny worms in the skin.

Screening for Loiasis

• Before treatment, check if patients have been to areas where the Loa loa worm is cmmon.

Mazzotti Reaction

• After taking the medicine, some people can have reactions called Mazzotti reactions.

Signs of Mazzotti Reaction:

• A drop in blood pressure when standing up.
• Other symptoms like skin rashes or eye problems.

How to administer Moxidectin?

• You can take the medicine with or without food.

Mechanism of action of Moxidectin:

• Moxidectin is a type of medicine that fights worms in the body.
• It works against the baby worms (microfilariae) of a worm called O. volvulus.
• But it doesn't work well against the grown-up worms.
• In studies with other similar worms, moxidectin seems to attach to specific parts of the worms, like channels for certain chemicals and transporters.
• This makes the worms' cells more open and lets certain ions go in, which causes their muscles to stop working and they can't move.
• It also makes all stages of the worms move less, stops them from releasing certain proteins that affect the immune system, and makes it harder for both male and female worms to have babies.

Distribution:

• Moxidectin spreads out in the body, and its volume is about 2,421 L with some variation.

Protein Binding:

• We don't know how much of it attaches to proteins in the blood.

Metabolism:

• The body doesn't change it much.

How Long It Lasts:

• It takes about 23.3 days (or 559 hours) for half of the drug to leave the body.

Time to Peak:

• It reaches its highest level in the blood about 4 hours after taking it.

How It Leaves the Body:

• About 2% of the medicine leaves the body through poop without any changes.

Moxidectin International Brand Names:

• Cydectin
• Moxidecton
• Moxidec
• Equimoxin

Moxidectin Brand Names in Pakistan:

Not Available.