Decoquinate 7.6 mg/mL + Levamisole HCl 30 mg/mL + Vitamin E Succinate 10,000 iu, Oral Suspension, 1000mL
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One of the most serious diseases of horses in the Americas is equine protozoal myeloencephalitis (EPM), a condition that affects the central nervous system. EPM is a disease of the brain and/or spinal cord of the horse, which is caused by the protozoan organism Sarcocystis neurona.
This disease was first described in the 1960s; at the time it was designated as “segmental myelitis.”1 By the mid-1970s, it was determined that it was caused by a protozoan organism, and a few years later, researchers drilled down to S. neurona. In the late 1990s, another organism called Neospora hughesi was shown to also cause EPM in horses, although it is much more rarely the causative agent than S. neurona. EPM is a disease that is typically found in the Western Hemisphere and is not commonly seen in other parts of the world.
Origins, Occurrence and Symptoms of EPM
Many horses in the Western Hemisphere have been exposed to the S. neurona parasite, as most horses in the United States will evidence the antibody to S. neurona in their blood. In some areas of the country over 90 percent of horses will be seropositive to S. neurona. Fortunately, only a very small percentage of horses that are seropositive to either the S. neurona or N. hughesi parasites will ultimately develop EPM.1
Sarcocystis neurona has a two-host life cycle which includes both a definitive host and several likely intermediate hosts. In 1995, the opossum was determined to be the definitive host of this parasite. The opossum sheds the infective form of the parasite (sporocysts) in its feces. These are then ingested by the horse, usually through grazing or drinking contaminated water or feed. The parasite does go through a maturation or reproductive phase and eventually produces a form of the parasite which then migrates to the central nervous system giving rise to the clinical disease referenced as EPM.2
The clinical signs of EPM can be varied, and are often asymmetrical (presenting differently on either side of the horse). These can include:
Ataxia (incoordination), spasticity (stiff, stilted movements), abnormal gait or lameness
Incoordination and weakness, which worsens when going up or down slopes or when head is elevated
Muscle atrophy, most noticeable along the topline or in the large muscles of the hindquarters, but can sometimes involve the muscles of the face or front limbs
Paralysis of muscles of the eyes, face or mouth, evident by drooping eyes, ears or lips;
Seizures or collapse
Loss of sensation along the face, neck or body
Head tilt with poor balance; horse may assume a splay-footed stance or lean against stall walls for support2
Decoquinate + Levamisole + Vitamin E for EPM in Horses
Decoquinate is a coccidiostat used in veterinary medicine and is widely used in supplementing the rations of horses, cattle, veal calves, goats, sheep and chickens. Decoquinate is a 4-hydroxy quinolone agent that has anticoccidial activity. Decoquinate in horses acts on the sporozoite stage of the life cycle. The sporozoite apparently can still penetrate the host intestinal cell, but further development is prevented. The mechanism of action for decoquinate is to disrupt electron transport in the mitochondrial cytochrome system of coccidia.3
Decoquinate is labeled for use in cattle for the prevention of coccidiosis in either ruminating or nonruminating calves, cattle, young sheep, and goats, or broilers caused by Eimeria spp. Currently, it is the only anticoccidial medication approved for use in veal calves. Decoquinate is not effective for treating clinical coccidiosis and has no efficacy against adult coccidia. Decoquinate is not FDA-approved for use in animals producing milk for food or in laying chickens.
Levamisole HCl was originally described for treating helminth infections, but it is also widely used for modulating immune responses. It is an antinematodal parasiticide and immune stimulant that is indicated for the treatment of many nematodes in cattle, sheep, goats, swine, and poultry. In sheep and cattle, levamisole has relatively good activity against abomasal nematodes, small intestinal nematodes.3 Levamisole binds cholinergic receptors found on protozoa, such as those causing EPM.
Levamisole is used in quite a few products intended for horses. In vivo assays in horses show that levamisole (with a half-life of 1 to 4 hours) is metabolized rather quickly. The elimination of by-products in the serum associated with the metabolism of levamisole HCl, however, can take much longer. Some by-products are detectable in the plasma for longer than 70 hours.3
Levamisole is classified by the Association of Racing Commissioners (ARC) International’s Uniform Classification Guidelines as a Class 2, Penalty Class B substance.
Vitamin E is a powerful antioxidant that helps neutralize free radicals, the damaging by-products of normal cellular activity and environmental contaminants. For quite a few years, veterinarians have recommended that horses undergoing treatment for EPM and other neurologic issues be supplemented with Vitamin E to support muscle and nervous tissue.
Vitamin E is a collective term for a family of eight stereoisomers found in plants. Each of the eight forms has a different methylation group that affects its bioavailability. The stereoisomers contain two tocopherols and tocotrienols, each of which consist of four similar compounds distinguished as alpha, beta, gamma, and delta. The most bioavailable source of Vitamin E is natural d-alpha-tocophorol.4
Where to buy Decoquinate + Levamisole + Vitamin E
Decoquinate + Levamisole + Vitamin E is available in the U.S. as a compounded veterinary preparation. Studies have shown that Decoquinate combined with Levamisole reduce the clinical signs and serum SAG 1, 5, 6 antibodies in horses with Equine Protozoa Myeloencephalitis (EPM).5
DECOQUINATE 7.6 MG/ML / LEVAMISOLE 3% / VITAMIN E 10,0000 iu from NexGen Pharmaceuticals provides effective treatment in protozoan infections with easy absorption and digestion. This formulation is indicated for the treatment of EPM; it is also recommended as an addition to feed for at least 28 days during periods of coccidiosis, and for the prevention of coccidiosis. Please consult your veterinarian prior to beginning any treatment regimen.
FOR RX ONLY: A valid prescription from a licensed veterinarian is required for dispensing this medication.
1MacKay, R., Morgan, K. Equine Protozoal Myeloencephalitis. In: J. American Association of Equine Practitioners, Jan. 2020.
3Plumb’s Veterinary Drugs.
5Ellison, Lindsay. Intern J Appl Res Vet Med. Vol. 10, No. 1, 2012.