Author: Brian Holtry

Supine and postural tachycardia with postural hypotension can occur; in one large study, such effects were found in three of 40 patients. In another there was hypotension in 13 of 69 cases, but in some series these effects have not been observed at all. A massive community study in Ghana noted hypotension in only 37 of nearly 15 000 patients treated.

Emesis, ataxia, and mydriasis are cardinal signs of ivermectin toxicity. The safety, tolerability, and pharma-cokinetics of escalating high-dose ivermectin have been studied in 68 healthy subjects in a randomized, double-blind, placebo-controlled study in the following doses: Ivermectin was generally well tolerated. Quantitative pupillometry ruled out any mydriatic effect of ivermectin.

Among the published studies some have specifically sought to define the pattern of adverse effects. In one such study, although a single dose of the drug was combined in some patients with diethylcarbamazine, the adverse effect pattern was similar to that when ivermectin was used alone. There now seem to be some circumstances in which a single low dose of ivermectin is sufficient to have a prolonged effect, for example in loaiasis a dose of 150 micrograms/kg resulted in a very much reduced level of microfilaria as much as a year later, and seemed to eliminate the infestation entirely in more than half the users. If further work confirms the validity of this approach, the adverse reactions problem may be lessened, since at these doses the few reactions experienced were limited to the skin and joints, although some calabar-like swellings were also noted.

Ofloxacin ophthalmic is one of the medications to treat bacterial infections of the eye. The main active ingredient is also used in the Ofloxacin ear drops, which proved their effectiveness over time. Both remedies are to be applied with precaution and according to the prescription.

Minocycline and doxycycline are predominantly eliminated by the liver and biliary tract (70-90%). Therefore, no change in dose is needed in patients with impaired renal function. However, it should be considered that hepatic elimination of doxycycline or minocycline might be accelerated by co-administration of agents that induce hepatic enzymes.

Itraconazole is a triazole antifungal drug. It is used orally to treat oropharyngeal and vulvovaginal candidiasis, pityriasis versicolor, dermatophytoses unresponsive to topical treatment, and systemic infections, including aspergillosis, blastomycosis, chromoblastomycosis, cocci-dioidomycosis, cryptococcosis, histoplasmosis, paracocci-dioidomycosis, and sporotrichosis.