Use of intravenous lipid emulsion to treat ivermectin toxicosis in a Border Collie

Abstract

Ivermectin toxicosis in veterinary patients can result in death without aggressive treatment, and severe toxicosis often requires mechanical ventilation and intensive supportive care. This is particularly true in dogs affected by the ATP-binding cassette polymorphism. Novel ILE treatment has been shown to be effective in human patients with lipid-soluble drug toxicoses, although the exact mechanism is unknown. In the patient in the present report, ILE was used successfully to treat ivermectin toxicosis, and results of serial measurement of serum ivermectin concentration supported the proposed lipid sink mechanism of action.

Toxicology of Avermectins and Milbemycins (Macrocylic Lactones) and the Role of P-Glycoprotein in Dogs and Cats

“…Lipid therapy has also been successfully used in a border collie that ingested up to 6 mg/kg of ivermectin paste. 74 The authors demonstrated decreasing blood levels of ivermectin and a relatively rapid improvement in clinical signs in this case with use of lipid therapy. The dog in this case report was found to not have the ABCB1-1 Δ gene mutation, which may be why the therapy appeared effective: the ability of P-gp to clear ivermectin from the CNS and the circulation was intact in this patient.…”

Lipid infusion in the management of poisoning: a report of 6 canine cases

“…It is thought that the lipid component formed in the blood acts as a sink for lipophilic drugs making them unavailable to act on their target receptors; there is evidence supporting this hypothesis (Weinberg 2012). For instance, serum ivermectin concentrations rose in a dog following two lipid infusions, suggesting movement from tissues with high lipid content into the lipid phase of blood (Clarke and others 2011). In addition, in drugs causing cardiotoxicity, lipids may reduce toxic effects by providing a source of energy to the myocardial cells in the form of free fatty acids (Van de Velde and others 1996), overcoming impediments to mitochondrial free fatty acid oxidation.…”

“…Previous cases where lipid infusion was successful involved moxidectin in a Jack Russell terrier (Crandell and Weinberg 2009) and ivermectin in a doberman (Baker 2008), and neither of these breeds are associated with the ABCB1-1Δ mutation (Gramer and others 2011). A border collie successfully treated with lipid infusion for ivermectin toxicosis was negative for the mutation (Clarke and others 2011). In the case series reported here, there were two lipid-responsive collies, a breed commonly associated with ABCB1-1Δ mutation, but genetic analysis was not available in either case.…”

Poisoning of dogs and cats by drugs intended for human use

“…The use of intravenous lipid emulsion (ILE) has become popular in recent years as an antidote in cases of lipophilic human and veterinary drug toxicosis (Crandell and Weinberg, 2009;O'Brient et al, 2010;Clarke et al, 2011;Haworth and Smart, 2012;Bates et al, 2013;Maton et al, 2013) and has been used to treat ibuprofen toxicity in a dog (Bolfer et al, 2014). The benefits of ILE therapy are thought to be related to improvements in cardiac function and a 'lipid sink' effect, which relies on the formation of a lipid compartment that traps lipophilic drugs (Fernandez et al, 2011).…”