PATHOGEN PROFILE PEER REVIEWED

Trichuris vulpis

Chris Adolph, DVM, MS, DACVM (Parasitology) Zoetis Animal Health Tulsa, Oklahoma

A single dose oxime of febantel has Dose: 50 mg/kg PO once a day for 3 Dose: 0.5 mg/kg PO once a month6 consecutive days1-4 good efficacy is available in several against adult A broad-spectrum combination and stand-alone formulations whipworms, safely used in multiple for monthly administration. A single dose species, fenbendazole is labeled for dogs removes >90% of adult worms present in while a single 6 weeks of age and in pregnant bitches. the GI tract,7 with subsequent monthly dose of In the absence of ongoing monthly doses removing worms that have milbemycin anthelmintic therapy (see Milbemycin developed from reexposure. oxime), retreatment is recommended oxime can 30 and 60 days after the first treatment A heartworm test should be performed, remove >90% because of the long prepatent period.3 with results below detectable limits before administration of milbemycin oxime. of adult worms Although there are no known contraindi- in the GI tract.7 cations, hypersensitivity reactions can occur secondary to antigen release by dead Dose: 2.5 mg/kg (topical) once a month8 and dying parasites.1 Diarrhea, vomiting, and salivation may occur infrequently in Topical moxidectin (in combination with 1 dogs and cats. imidacloprid) is labeled for the treatment and control of Trichuris vulpis infection. Febantel Like milbemycin oxime, a single dose of Dose: 25 mg/kg PO one time1,3,4 moxidectin removes >90% of adult worms (combination formulation) present in the GI tract7; however, in this formulation, levels of moxidectin remain in Febantel, a prodrug, is converted to fenben- the system until administration of the next dazole and oxfendazole after oral adminis- monthly dose, whereas other medications tration. It is not available in a single-product demonstrating efficacy aginst T vulpis are formulation but rather in combination with metabolized and eliminated more rapidly. and . A single dose of febantel has good efficacy against adult A heartworm test should be performed, with whipworms.5 This drug is contraindicated in results below detectable limits before pregnant animals. administration of moxidectin. GI = gastrointestinal

28 plumbstherapeuticsbrief.com January 2016 THERAPEUTICS SNAPSHOT Let Us Know… g MORE from page 5 Share your insight on how Pathogen Profile 8. Kyles AE, Gregory CR, Griffey SM, et al. helps you fine-tune your therapeutic skills. Immunosuppression with a combina- tion of the leflunomide analog, FK778, Send comments to [email protected] and microemulsified cyclosporine for renal transplantation in mongrel dogs. Transplantation. 2003;75(8):1128-1133. 9. Lirtzman RA, Gregory CR, Levitski RE, et al. Combined immunosuppression CHRIS ADOLPH, DVM, MS, DACVM FOIADrugSummaries/ucm054892.htm. with leflunomide and cyclosporine pre- (Parasitology), is a veterinary specialist in Accessed October 25, 2015. vents MLR-mismatched renal allograft parasitology with Zoetis Animal Health. 6. US Food and Drug Administration. rejection in a mongrel canine model. Formerly, he owned Southpark Veterinary Interceptor, NADA 140-915. http://www. Transplant Proc. 1996;28(2):945-947. Hospital in Broken Arrow, Oklahoma. Dr. fda.gov/AnimalVeterinary/Products/ 10. Colopy SA, Baker TA, Muir P. Efficacy Adolph has authored numerous peer- ApprovedAnimalDrugProducts/ of leflunomide for treatment of im- reviewed scientific papers and conducted FOIADrugSummaries/ucm054860.htm. mune-mediated polyarthritis in dogs: research in canine and feline parasitic Accessed October 22, 2015. 14 cases (2006-2008). JAVMA. 2010; diseases. For the past 10 years, he has 7. Bowman DD, Mannella C. Treating 236(3):312-318. been a popular national and international whipworms in the dog. Clin Brief. 11. Bianco D, Hardy RM. Treatment of speaker on small animal parasitology and 2011;9(6):65-68. Evans’ syndrome with human intrave- practice management topics. Dr. Adolph 8. US Food and Drug Administration. nous immunoglobulin and leflunomide earned his DVM and MS from Oklahoma Coraxis, NADA 141-417. http://www.fda. in a diabetic dog. JAAHA. 2009;45(3): State University. gov/downloads/animalveterinary/ 147-150. products/approvedanimaldrugproducts/ 12. Affolter VK, Moore PF. Canine cutane- foiadrugsummaries/ucm453544.pdf. REFERENCES ous and systemic histiocytosis: reac- 1. Plumb DC. Fenbendazole. In: Plumb DC, Accessed October 22, 2015. tive histiocytosis of dermal dendritic ed. Plumb’s Veterinary Drug Handbook. 8th cells. Am J Dermatopathol. 2000;22(1): ed. Ames, IA: Wiley-Blackwell; 2015. SUGGESTED READING 40-48. 2. Coles TB, Lynn RC. Drugs for the Elsemore DA, Geng J, Flynn L, Cruthers 13. Hanna FY. Disease modifying treatment treatment of helminth infections: L, Lucio-Forster A, Bowman DD. for feline rheumatoid arthritis. Vet Comp . In: Boothe DM, ed. Small Enzyme-linked immunosorbent assay for Orthop Traumatol. 2005;18(2):94-99. Animal Clinical Pharmacology and coproantigen detection of Trichuris vulpis 14. Chan V, Charles BG, Tett SE. Rapid de- Therapeutics. 2nd ed. St. Louis, MO: in dogs. J Vet Diagn Invest. 2014;26(3):404- termination of the active leflunomide Saunders Elsevier; 2012:451-468. 411. metabolite A77 1726 in human plasma 3. Peregrine AS. Whipworms in small Epe C. Intestinal nematodes: biology and by high-performance liquid chromatog- animals. The Merck Veterinary Manual control. Vet Clin North Am Small Anim raphy. J Chromatogr B Analyt Technol website. http://www.merckvetmanual. Pract. 2009;39(6): 1091-1107. Biomed Life Sci. 2004;803(2):331-335. com/mvm/digestive_system/ Venco L, Valenti V, Genchi M, Grandi G. 15. van Roon EN, Jansen TL, van de Laar gastrointestinal_parasites_of_small_ A dog with pseudo-Addison disease MA, et al. Therapeutic drug monitoring animals/whipworms_in_small_animals. associated with Trichuris vulpis of A77 1726, the active metabolite of html?qt=trichuris vulpis&alt=sh. Updated infection. J Parasitol Res. 2011; doi: leflunomide: serum concentrations pre- September 2014. Accessed June 28, 2015. 10.1155/2011/682039. dict response to treatment in patients 4. Intestinal parasites—whipworms. with rheumatoid arthritis. Ann Rheum Companion Animal Parasite Council Dis. 2005;64(4):569-574. website. http://www.capcvet.org/capc- 16. Gupta R, Bhatia J, Gupta SK. Risk of hep- recommendations/whipworms. Updated atotoxicity with add-on leflunomide in March 2013. Accessed June 28, 2015. rheumatoid arthritis patients. Arzneimit- 5. US Food and Drug Administration. telforschung. 2011;61(5):312-316. Drontal Plus Taste Tabs, NADA 141-007. Content presented in this article was developed 17. van Roon EN, Jansen TL, Houtman NM, http://www.fda.gov/AnimalVeterinary/ independently of Dr. Adolph's affiliation. Spoelstra P, Brouwers JR. Leflunomide Products/ApprovedAnimalDrugProducts/ for the treatment of rheumatoid arthritis in clinical practice: incidence and severi- ty of hepatotoxicity. Drug Saf. 2004;27(5): 345-352.

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