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  Discussion on Research Summary: Reducing the adverse effects of imidocarb
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DrO

Posted on Wednesday, Mar 13, 2013 - 6:23 pm:

OK this is a little complicated but is an important paper with the rising incidence of piroplasmosis in the Americas.

Imidocarb is the only effective treatment for piroplasmosis however is quite toxic do its cholinesterase inhibitor like activity. This allows the buildup of acetylcholine at the nerve endings and overstimulates the sympathetic branch of the autonomous nervous system often referred to as the "rest and digest" system. Overstimulation can cause colic and diarrhea.

Atropine and glycopyrrolate are classified as anticholinergic drugs so emphasize the flight or fight responses of the parasympathetic system. This might counter the toxic effects of the imidocarb. However these drugs can be toxic in themselves.

Imidocarb treated horses concurrently treated with glycopyrrolate had fewer problems than those treated with atropine or no other treatment.
DrO

Equine Vet J. 2012 Dec 19.
Comparison of glycopyrrolate and atropine in ameliorating the adverse effects of imidocarb dipropionate in horses.
Donnellan CM, Page PC, Nurton JP, van den Berg JS, Guthrie AJ.

Department of Companion Animal Clinical Studies, University of Pretoria, South Africa.
Abstract

REASONS FOR PERFORMING STUDY:
Imidocarb, an effective treatment for piroplasmosis, may cause colic and diarrhoea in horses. Atropine and glycopyrrolate are anticholinergics that could reduce the adverse effects of imidocarb. However, atropine and glycopyrrolate inhibit gastrointestinal motility, potentially causing ileus and colic.

OBJECTIVES:
To compare glycopyrrolate and atropine in ameliorating the adverse effects of imidocarb dipropionate in horses and to determine the effect of combinations of these drugs on the gastrointestinal tract.

METHODS:
A blinded, randomised, crossover study was performed in 8 healthy horses. Each horse received 0.9% saline i.m and i.v. (CON), and imidocarb 2.4 mg/kg bwt i.m. with one of 3 treatments i.v.: 0.9% saline (IMI), atropine 0.02 mg/kg bwt (IMATROP) and glycopyrrolate 0.0025 mg/kg bwt (IMGLYCO). Clinical data, gastrointestinal motility via borborygmi and frequency of contractions in the duodenum, caecum and right dorsal colon assessed with transabdominal ultrasound, and faecal data were measured.

RESULTS:
After imidocarb/saline treatment colic and diarrhoea were noted in 3 and 4 horses, respectively, faecal production and defaecation were increased for 3 h and faecal water percentage for 6 h. Colic was noted after atropine treatment in 4 horses, borborygmi and frequency of right dorsal colon contractions were significantly decreased for 2 h 15 min, and faecal production was not significantly different from CON. After glycopyrrolate treatment, colic was seen in one horse, frequency of intestinal contractions and faecal data were not significantly different from CON, and borborygmi was significantly decreased from CON at 1 h 15 min.

CONCLUSIONS:
Results of this study suggest that glycopyrrolate is superior to atropine in ameliorating the adverse effects of imidocarb.

POTENTIAL RELEVANCE:
Glycopyrrolate could be administered with imidocarb in horses with piroplasmosis to reduce the adverse effects of imidocarb.
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