The lack of influence of food and local alcoholic brew on the blood level of Mectizan® (ivermectin)

There is concern that extraneous factors, such as food and drink, may alter the pharmacodynamics of Mectizan® (ivermectin) in patients receiving this important anti-parasitic drug, and thus might put such individuals in danger of serious adverse events. The effects of a common local alcohol-containing beverage and a local food on plasma levels of ivermectin were studied in Sudanese volunteers after administration of the standard dose used in mass drug administration programs for onchocerciasis and filariasis. levels of ivermectin at various time points (0–48 h) after administration of ivermectin were ascertained by HPLC assay in ten volunteers given 150 μg kg−1 ivermectin together with either a local sorghum-based food (‘assida’), or a locally brewed alcoholic beverage (‘arangi’ made from sorghum grain) or in those who were fasting. Maximum mean (±SD) plasma levels of ivermectin (67 ± 49 ng ml−1) were reached within 2 h in fasting patients, and had dropped to 26 ± 20 ng ml−1 after 30 h. The coadministration of local food or alcoholic beverage did not cause an increase in ivermectin plasma levels above those observed in people who were fasting. However, at 2 h after ivermectin administration, patients given alcohol had significantly lower plasma ivermectin levels than fed patients or fasting patients. There were no significant differences among treatments for AUC0–30, Cmax, or tmax, and so the coadministration of local food or alcoholic beverage did not cause any change in pharmacokinetic parameters of ivermectin in the plasma in comparison with fasting. None of the measured levels of plasma ivermectin were greater than those reported in previous studies with this compound. findings do not support the hypothesis that acute intake of alcohol is an important factor in the development of the serious adverse reactions that can occur during the treatment of loaisis patients with ivermectin (Mectizan®).