[e-drug] Source of generic ivermectin? (7)

["Wilbert Bannenberg" <wjb@wxs.nl>]

E-DRUG: Source of generic ivermectin? (7)
-----------------------------------------
[numbering continued from 2005 when the same question came up; WB]

Dear Rollo

The first question: is ivermectin the drug of choice for Strongyloides?

A comparison between ivermectin and thiabendazole for single Treatment of Strongyloides concluded [http://www.academicjournals.org/AJB/PDF/Pdf2003/NovemberPDFs2003/Adenusi%20et%20al.pdf]:
 
"Single-dose ivermectin provides efficacy comparable with standard, multiple-dose thiabendazole, with a much reduced incidence of adverse effects and consequently better patient compliance."

So we have good reasons to consider ivermectin as an essential treatment for Strongyloides infection.

Can we analyse the problem of lack of access to ivermectin further:

- Is ivermectin not registered for human use in Australia?
- Is it only available for animals?
- Is the indication Strongyloides registered for ivermectin?
- If ivermectin is registered: what is the current asking price? 

The 2006 MSH Intl Price indicator guide lists no suppliers, but shows that
CRSS (Costa Rica) bought 100 tablets for USD 52.00. 
(see
http://erc.msh.org/mainpage.cfm?file=1.0.htm&module=DMP&language=English)
[Does any e-drugger from Costa Rica know what the supplier is for these
ivermectin tablets?]

Previous E-drug messages from April 2005 suggested that:
- ivermectin is widely used as a commercial veterinary drug
- ivermectin is off patent since 1997
- few generic suppliers would be interested in producing this as MSD gives
away most ivermectin for river blindness (onchocerciasis) and lymphatic
filariasis
- Shin Poong Pharmaceuticals of South Korea was suggested of making it?
[Maybe the E-drugger who suggested this confused ivermectin with
praziquantel? The latter was their succesful generic competitor of Bayer's
praziquantel when that was still patented and expensive. Any e-drugger in
South Korea with more info?]

The website for the Mectizan donation program (http://www.mectizan.org/)
does not mention Strongyloides as a possible target.

Maybe the conclusion must be that large scale donation programs like that of
MSD do have unwanted side-effects (unavailability of the generic drug for
rare other indications)?

Maybe MSD can reconsider its policy, or drop the price for the Australian
aboriginals?

Or is there a generic producer somewhere with good quality ivermectin?

Or should we give aboriginals veterinary tablets....? 
[Imagine the headlines in Australia!]

As ivermectin is on the WHO EML, we should have access to affordable
ivermectin!

Comments welcome!

Regards

Wilbert Bannenberg
---------
Wilbert Bannenberg, E-drug moderator
Email: wjb@planet.nl

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