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Brand: EQUIMAX ® ELEVATION

Company: VIRBAC


FORMULATION: «oral paste/gel» in pre-charged syringes

ACTIVE INGREDIENT(S):

  • Ivermectin: 0.14 g / syringe of 23.1 mL, equivalent to 0.6 mg/mL (=600 mcg/mL, =0.6%);
  • Praziquantel: 1 g / syringe of 23.1 mL, equivalent to 4.3 mg/mL (=4.3%)
  • Pyrantel embonate (=pamoate):  9 g / syringe of 23.1 mL, equivalent to 39 mg/mL (= 39%)

CHEMICAL CLASS of the active ingredient(s):


INDICATIONS

HORSES

PARASITES CONTROLLED* (spectrum of activity)

* Country-specific differences may apply: read the product label.


RECOMMENDED DOSE*

*Can be slightly different in some countries: read the product label!

  • 3.3 mL per 100 kg bodyweight, equivalent to 200 mcg ivermectin/kg bw, 1,43 mg/kg praziquantel/kg bw, and 12.9 mg/kg pyrantel embonate.
  • Each 23.1 ml syringe treats a horse up to 700 kg

SAFETY

  • LD50 (acute oral) in rats: ~4200 mg/kg (estimate calculated according to the WHO based on the ivermectin LD50)
  • Estimated hazard class according to the WHO: not applicable for veterinary medicines

Suspected poisoning? Read the articles on ivermectin safety, praziquantel safety and/or pyrantel safety in this site.

Withholding periods (=withdrawal times) for meat & milk (country-specific differences may apply: read the product label)

  • MEAT & OFFAL: AUS: DO NOT USE LESS THAN 28 DAYS BEFORE SLAUGHTER FOR HUMAN CONSUMPTION.
  • MILK: Do not use in animals producing milk for human consumption

WARNING !!!: Never use on humans, dogs or cats

You may be interested in the following articles in this site dealing with the general safety of veterinary products:


RESISTANCE PREVENTION

Risk of resistance? YES

  • Small strongyles (cyathostomes). Tolerance of small strongyles to macrocyclic lactones (e.g. ivermectin, moxidectin), manifested as a low but significant worm egg output after treatment (determined after fecal egg counts) is not yet widespread, but has been already reported in Europe (e.g. in the UK, Germany, Italy), the USA, and Brazil. In Australia tolerance (expressed as faster recommencing of egg shedding) has been observed. Cases of resistance to pyrantel (cross-resistance with morantel) have been also reported e.g. in Australia, Europe, the USA and Brazil).
  • Parascaris equorum: Resistance to macrocyclic lactones (e.g. ivermectin, moxidectin) has been reported, e.g. in the USA, UK and Australia. Cases of resistance to pyrantel (cross-resistance with morantel) have been reported too (e.g. in the EU, USA and Canada).

This means that if this product does not achieve the expected efficacy against the mentioned parasites, it may be due to resistance and not to incorrect use, which is usually the most frequent cause of product failure.

Alternative chemical classes/active ingredients to prevent resistance of gastrointestinal roundworms through product rotation:

There are so far no reports on resistance of horse tapeworms to praziquantel.

Learn more about resistance and how it develops.


MARKETING

Are the active ingredients of this product ORIGINAL* or GENERICS**?

  • GENERICS

*Meaning that they are still patent protected and generics are not yet available
**Meaning that they have lost patent protection and may be acquired from manufacturers of generic active ingredients other than the holder of the original patent.

COUNTRIES where this product is marketed: Australia
GENERIC BRANDS available? YES, perhaps not with this particular composition. This product itself contains generic ivermectin, praziquantel and pyrantel.

Click here to learn more about GENERIC vs. ORIGINAL drugs.


COMMENTS

EQUIMAX ELEVATION oral paste for horses is a horse wormer from VIRBAC combining ivermectin, praziquantel and pyrantel.

Ivermectin was the first macrocyclic lactone introduced in the market in the early 1980s (by MSD Agvet, later MERIAL). It was a milestone and a tremendous progress that revolutionized the control of veterinary parasites. Nowadays there are thousands of brands with generic ivermectin worldwide. It is effective against most species of roundworms that affect horses and against bots (Gasterophilus spp), but not against tapeworms.

Ivermectin and other macrocyclic lactones have about two weeks residual effect on horses because they are stored in body fat and progressively released. This, together with the time that worms need to develop inside the horse after infection (pre-patent period) allows to space the treatment intervals to 10 to 12 weeks in year-round control programs in many regions. For other active ingredients that have no residual effect such as fenbendazolemebendazole, or pyrantel the treatment interval is usually 4 to 6 weeks.

Whereas in ruminants ivermectin administered at 200 mcg/kg controls a series of external parasites as well (mites, lice, etc.), such an indication is not approved in most countries in horses: external parasites have to be controlled with ectoparasiticides (e.g. pour-ons, sprays, etc.). 

Pyrantel is a veteran tetrahydropyrimidine introduced in the 1960s (by PFIZER → ZOETIS) that is moderately used in horses, abundantly in pets, but rather scarcely in ruminants. It is a narrow-spectrum anthelmintic effective against roundworms and a few tapeworms (depending on the dose) in the gut, but not against those in other organs (e.g. the lungs, the skin, etc). It is also ineffective against gastric bots (Gasterophilus spp) or whatever external parasites. 

Praziquantel is a veteran anthelmintic introduced in the 1970s (by BAYER). It is highly effective against tapeworms (in horses mainly Anoplocephala spp) but has no efficacy whatsoever against roundworms. It is the anthelmintic most vastly used against tapeworms in horses and pets, used in hundreds of brands. It is hardly used in livestock. 

Praziquantel and pyrantel have no residual effect, i.e. they kill the parasites after administration but do not protect against reinfestation.

The logic oc combining two nematicides (i.e. roundworm killers) such as ivermectin and pyrantel is related to resistance management. Since both compounds have different mechanisms of action, it is assumed that resistance development will be prevented or at least delayed because the risk of simultaneous development of worm resistance to two different mechanisms of action is much smaller than to only one. However, this is only true if the concerned worms are still susceptible to both compounds. Otherwise, if the worms are already resistant to one of them, only one will work. It will initially do the job, but the risk of development of multiple resistance to both compounds is considerable. In addition, since pyrantel has no residual effect, a few days after administration only ivermectin will be active, meaning that the resistance-delaying effect of the combination gets lost: selection of ivermectin-resistant worms will continue undisturbed.

Praziquantel is not effective against roundworms, thus it does not contribute whatsoever to resistance prevention.

Many horse owners complain about the price of the oral pastes & gels for horses (with ivermectin or other macrocyclic lactones), compared with the much cheaper injectables for livestock with the same active ingredients, used at the same dose (200 mcg/kg). This is why off-label use of livestock ivermectin injectables in horses is very common worldwide, particularly in working horses of cattle and sheep ranches. The reason why injectables are mostly not approved for use on horses is apparently that, shortly after introduction, it was noticed that horses were more prone to develop severe clostridial infections at the injection site (due to contamination of the needles) and other undesired side effects than cattle or sheep. In addition, the pharmacokinetic behavior of ivermectin on horses is different than in ruminants. For these reasons oral pastes were developed for horses that do not show such side effects. However, in numerous countries (e.g. in Latin America) some ivermectin injectables for livestock are also approved for use on horses. 

For an overview and a list of the most used oral paste & gel brands click here.


DISCLAIMER

This article IS NOT A PRODUCT LABEL. It offers complementary information that may be useful to veterinary professionals and users that are not familiar with veterinary antiparasitics. 

Information offered in this article has been extracted from publications issued by manufacturers, government agencies (e.g. EMEA, FDA, USDA, etc.) or in the scientific literature. No guarantee is given on its accuracy, integrity, sufficiency, actuality and opportunity, and any liability is denied. Read the site's DISCLAIMER.

In case of doubt contact the manufacturer or a veterinary professional.

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