Miltefosine
**Miltefosine** is an oral **antileishmanial** agent primarily used in veterinary medicine to treat **canine leishmaniasis (CanL)**, a severe systemic disease caused by the intracellular protozoan *Leishmania infantum*. - Originally developed as an **antineoplastic** (anti-cancer) drug. - **Clinical Pearl**: While it significantly reduces the parasitic load and improves clinical signs, it rarely achieves complete parasitological cure. Remission is the primary therapeutic goal. - Efficacy is markedly improved when used in combination with **allopurinol**. - It is an orphan drug in human medicine and is not commercially available as a veterinary-labeled product in the USA, though it is widely used in endemic regions (e.g., Europe).
Mecanismo: Miltefosine is an **alkylphosphocholine** (phospholipid derivative). Its exact mechanism against *Leishmania* is multifactorial: - **Inhibits macrophage penetration**: Interacts with **glycosomes** and **glycosylphosphatidyl-inositol (GPI) anchors** that are essential for the parasite's intracellular survival. - **Enzyme inhibition**: Inhibits **phospholipase** → disrupts parasite membrane signal transduction and lipid metabolism. - **Apoptosis induction**: Triggers apoptosis-like cell death in the parasite by disrupting lipid rafts in the cell membrane. - Additionally, miltefosine exhibits mild antineoplastic, immunomodulatory, and antiviral properties.
Dosificación por especie
- Canine leishmaniasis · 2 mg/kg PO · PO · once a day · 28 days · Poured onto food, with a full or partial meal.
- Canine leishmaniasis (alternative treatment to meglumine antimoniate) · 2 mg/kg PO · PO · once daily · 28 days · Use with allopurinol (10 mg/kg PO q12h, orally for at least 6 months).
- Leishmaniosis · 2 mg/kg · PO · q24h · 28 days · It is particularly important that the full course is completed and given with allopurinol. Pour on feed to reduce digestive side effects.
Las dosis son una referencia clínica para médicos veterinarios. Confirme siempre con la información vigente del producto y el paciente individual.
Vías de administración
Contraindicaciones
- Hypersensitivity to miltefosine
- Pregnant animals
- Lactating animals
- Breeding animals
- Pregnancy
- Lactation
Efectos adversos
- Vomiting (most common)
- Diarrhea
- Inappetence
- Potential nephrotoxicity
- Potential hepatotoxicity
- Vomiting (moderate, transient)
- Diarrhoea (moderate, transient)
Monitoreo
- Baseline and periodic renal function
- Hepatic enzymes
- Adverse effects (especially vomiting)
- Patient weight
- Clinical signs of leishmaniosis
- Gastrointestinal signs (vomiting, diarrhoea)
Sobredosis
Overdoses are likely to cause severe **gastrointestinal signs** (vomiting, diarrhea, anorexia). In cases of massive overdose, there is a potential for **hepatic, renal, and retinal toxicity**. There is **no specific antidote** for miltefosine overdose; treatment should consist of prompt gastrointestinal decontamination (if recent and patient is asymptomatic) followed by aggressive supportive care (IV fluids, antiemetics, hepatoprotectants).
La referencia de fármacos de VetSheet está destinada a médicos veterinarios como apoyo a la decisión clínica; no sustituye el juicio profesional ni la información vigente del fabricante.