Ivermectin distribution in the plasma and tissues of patients infected with Onchocerca volvulus

Objective: To determine the distribution of ivermectin in plasma and tissues of onchocerciasis patients following a single oral dose of 150 mu g kg(-1). Setting. Medical Department at Soba University Hospital, Khartoum. Patients: Twenty five patients and fourteen healthy volunteers. Methods: Serial blood samples were obtained from both groups. Tissue samples were removed from various patients as full thickness skin punch biopsies or during nodulectomy. Ivermectin concentration was determined by radioimmunoassay. Results: The plasma pharmacokinetic variables for patients were maximum plasma concentration 52.0 ng ml(-1) time to achieve maximum concentration, 5.2 h.; elimination half life, 35.0 h; and the area under the plasma concentration curve versus time, 2852 ng . h ml(-1). In healthy volunteers, the plasma ivermectin distribution was similar to that in patients, and both groups showed a tendency for a second rise in plasma concentration of the drug suggestive of enterohepatic recirculation. Ivermectin was detected in tissues obtained from patients. Fat showed the highest and most persistent levels, whilst values for skin, nodular tissues, and worms were comparable. Subcutaneous fascia contained the lowest concentrations. Conclusion: Infection with O. volvulus does not affect the pharmacokinetics of ivermectin, and filarial infected tissues and parasites themselves do take up the drug. There may be prolonged retention of ivermectin because of depot formation in fat tissue.