Potential Treatment of Ivermectin Toxicity: IV Lipid Emulsion (ILE)
Intravenous lipid emulsion (ILE) is a preparation of microscopic drops of oil that are infused into a patient’s bloodstream.
It can work as an antidote to some fat-soluble poisons.
The first time I came across this therapy was way back in 2012. At that time, it was a new idea with pending safety studies. Often, though, new ideas come and go as they turn out being impractical, ineffective, or unsafe.
Fast-forward to 2020.
Ivermectin toxicity
Veterinarians use ivermectin to treat various parasitic infections as well as in some heartworm prevention medications.
As a preventive, used in low doses, ivermectin has a good safety record. Higher doses used in the treatment of mange, or other parasitic infections, come with increased risk of side effects.
It can be potentially dangerous when used for dogs with active heartworm infection which is why your veterinarian will want to test your dog before prescribing the preventive.
Further information: The Safety and Side Effects of Ivermectin in Dogs
Dogs with MDR1 genetic mutation
White feet, do not treat.
Dr. Lorie Huston, DVM
The story is quite different in breeds with multi-drug resistance (MDR1) genetic mutation such as Collies, Sheepdogs, Australian Shepherds, and other herding breeds. In these dogs, ivermectin can lead to neurotoxicity which can be life-threatening.
There is, though, testing available now to find out whether your dog does have this mutation or not.
Irreversible toxicity?
There is no antidote to treat ivermectin toxicity. Or is there?
When I was reconsidering parasite preventives for my dog, I researched some of the newer multi-purpose or long-lasting preventives. One shot of preventive medication that lasts for six months sounds good, doesn’t it?
After our negative experience with Canine Advantix, though, I asked whether there is an antidote—what if things don’t go well? And the answer was no. Can you guess what was my final decision?
Jack’s story
Jack—let’s call him that—is an 11-months-old Pit Bull cross. He was suffering from demodectic mange, and his veterinarian prescribed ivermectin treatment. Over two weeks, Jack gradually came up to full dose.
At first, Jack seemed to have been doing well. His parent did notice some mild tremors but they would go away with activity.
With the increased dose, however, adverse effects became worse. Jack was progressively more lethargic, lost interest in food, and his tremors got worse.
At the emergency clinic
When Jack arrived to the emergency hospital, he was stable but could barely walk and suffering from tremors. Based on Jack’s history, the attending veterinarian immediately suspected ivermectin toxicity.
Jack was mostly a Pit Bull but it was possible that he had the mutation from one of the other breeds in the mix. There is a test for the MDR1 mutation but Jack’s parent declined. On top of that, Jack’s treatment came is a squeeze bottle—how big is one squeeze? It was impossible to determine how much of the medication Jack was really getting.
Lipid Emulsion (ILE) to the rescue
Based on Jack’s signs and history, ivermectin toxicity remained the suspect. Fortunately, IV lipid emulsion can be used off-label as an antidote. It can bind fat-soluble substances such as ivermectin, cholecalciferol, bromethalin, and others.
Half an hour from his treatment, Jack started looking better. However, every time the veterinarian stopped the treatment, Jack’s signs returned, and he needed further medication to control his tremors.
Jack did make it through the ordeal and survived. Lipid emulsion can be a life-saving treatment for fat-soluble toxins.
In closing
I am glad I checked on the fate of this treatment. It can save lives.
Related articles:
Dog Poisoning: Don’t Panic. Don’t Panic … Too Late—Our Call To Pet Poison Helpline
Barbiturate Poisoning in a Dog: Yogi’s Sudden Collapse
Antifreeze Poisoning in Dogs: What Happens in the Dog’s Body with Antifreeze Poisoning?
Further reading:
Ivermectin Toxicosis in a Dog
I’m always concerned when a veterinarian suggests a medication for my cats that I haven’t used before. We have a great cat community that discusses all types of treatments and side effects. I always ask my vet about the medication before it’s given to my girls.
Wow, the wonders of medicine and chemistry always open my eyes when you put them in context! Vets needs to be up to date on these treatments and know what to do in cases like Jack’s. I am just glad he is doing OK.
I’m glad that Jack is okay! Is mange treatable in dogs with MDR1 genetic mutation?
Good question; our dogs always have had black or brown feet 😉 It seems that many veterinarians use milbemycin but apparently at reduced doses as well. It’s really tricky with the MDR1 dogs.
This is great information to put out there. I’ve seen ivermectin used quite often during the time that I’ve been involved in rescue for the treatment of mange, but there has always been that fear of ‘what if’. If a rescue organization isn’t aware of the risks of ivermectin toxicity, and their veterinarian doesn’t make the risks clear, they may not even realize that there IS a potential genetic mutation that could cause issues, let alone the fact that there is a test available. The same could be said for well-meaning pet owners. Knowing that there is a potential treatment, that could save a lot of lives!
The multipurpose preventative treatments make me nervous. It just seems like compounding the risks of side effects. Especially if there’s not a treatment. I’m glad this ILE helped Jack survive.
Very interesting – will have to learn more. We’ve had a very bad outcome ourselves – left our tiny 4lb Chihuahua with neurological disorders. This is one of the main reasons I’m so geared toward holistic approaches. We’re going in to talk with our vet next week – to discuss heartworm meds, so I appreciate the timing of your post.
I have never heard of this and am going to do more reading about it. I am happy Jack survived the ordeal
Interesting post! I knew about certain breeds and Ivermectin toxicity before, but had no idea how a vet would potential treat for it. ILE sounds like a useful treatment for sure and I’m glad it helped Jack.