Miltefosine

What is miltefosine?

Miltefosine (Milteforan®) is a drug used to treat leishmaniasis in dogs. Leishmaniasis is a disease in dogs caused by parasites of the genus Leishmania, and the primary method of transmission is through sand flies.

Miltefosine is often combined with the drug allopurinol to increase its effectiveness. Miltefosine is unlikely to cure a dog of leishmaniasis, but it will reduce clinical signs and infectivity associated with leishmaniasis infection.

The human product (Impavido®) may be prescribed for off-label use in pets as it is difficult to obtain Milteforan® in North America. Miltefosine may also be used off-label in ferrets.

Many drugs are commonly prescribed for off-label use in veterinary medicine. “Off label” means the drug is being used in a way that has not been reviewed or approved by the U.S. Food and Drug Administration (FDA) or Health Canada. In these instances, follow your veterinarian’s directions and cautions carefully, as they may be significantly different from those on the label.

How do I give my pet miltefosine?

• Miltefosine is given orally (by mouth).
• Milteforan® comes as an oral solution. Impavido® comes in a capsule format.
• Miltefosine may be given with or without food, but giving it with food is preferred as it may prevent vomiting and diarrhea.
• If vomiting occurs when dosed on an empty stomach, give future doses with food or a treat.
• Follow the instructions on the product label, in conjunction with your veterinarian’s directions.
• Ideally, give this medication at the same time daily.
• Do not shake the oral solution form of this medication to avoid foaming.

This medication should take effect within 1 to 2 days, but its effects will not be noted outwardly, and laboratory tests may be required to evaluate this medication’s effectiveness.

Miltefosine is considered a hazardous drug, so it is essential to avoid accidental exposure:

• Do not handle this drug if you are pregnant or nursing.
• Wear disposable gloves when handling this medication.
• If your pet vomits after receiving this drug, wear gloves while cleaning up.
• Do not allow treated dogs to lick people immediately after they take the veterinary liquid form of the medication.

What if I miss giving my pet the medication?

If you miss a dose, give it as soon as you remember, and then continue with the regular dosing schedule. However, if it is almost time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not give the pet two doses at once.

Are there any potential side effects from miltefosine?

Mlitefosine may cause the following side effects:

• Vomiting
• Diarrhea
• Anorexia (loss of appetite)

Serious adverse reactions associated with this drug may occur without warning and could, in rare cases, lead to death. If any of the following signs develop, stop giving miltefosine and contact your veterinarian immediately:

• Signs of bone marrow suppression: fever, weakness, lethargy, pale gums, rapid breathing

Drug sensitivities can develop over time, with repeated exposure. Your pet may have no reaction after the first few doses but may develop a sensitivity later. It is important to watch for signs of an allergic reaction over the entire course of the treatment and notify your veterinarian if you have any concerns.

Other side effects may occur. If you notice anything unusual, contact your veterinarian immediately. This short-acting medication should stop working within 24 hours, although effects can be longer in pets with liver or kidney disease.

Are there any risk factors for this medication?

DO NOT USE in:

• Pets that are allergic to it
• Pets that are pregnant, nursing, or breeding

USE WITH CAUTION in:

• Pets with severe liver or kidney disease
• Pets with cardiac/heart disease

Are there any drug interactions I should be aware of?

There are no documented drug interactions for this medication. Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking before starting any new treatment.

Is any monitoring needed with this medication?

• Baseline blood testing should be performed to determine kidney and liver function before starting this medication, and periodically throughout the treatment period.
• At home, monitor for any side effects such as those noted above. If any occur, stop using the medication and contact your veterinarian.
• Your veterinarian will let you know when and how they want to reassess your pet to ensure the medication is working and not causing side effects.

How do I store miltefosine?

• Ensure miltefosine is tightly stored in its original container, protected from light.
• Store this medication in a dry place at room temperature of 68°F–77°F (20°C–25°C).
• Avoid freezing.
• Discard the oral solution one month after first opening the container.
• Keep out of reach from pets and children.

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility. Be prepared to provide information about the product and your pet’s weight and symptoms.