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Diclazuril is a triazinone antiprotozoal that is effective for treating EPM. It is FDA-approved for use in horses not intended for food. Diclazuril is also used in treating infections caused by Isospora spp., Toxoplasma gondii, and Eimeria spp. and has been used for treating coccidiosis.5 Diclazuril exerts its anti-protozoan effect by inhibiting merozoite production. In horses, the oral absorption is 1.56% with a half-life of 43-65 hours. Other studies in horses have shown that at a dose of 1 mg/kg and 0.5 mg/kg the half-life is 55, and 87 hours, respectively, with peak concentration of 0.185 and 0.1 mcg/mL, respectively.4
Levamisole is a phenylimidazothiazole originally developed as an antihelminthic; it is now widely used as an immunostimulant and antineoplastic agent.5 Levamisole is effective against abomasal nematodes, small intestinal nematodes, large intestinal nematodes, and lungworms.4,5 Adult forms of species that are usually covered by levamisole include Haemonchus spp, Trichostrongylus spp, Teladorsagia spp, Ostertagia spp, Cooperia spp, Nematodirus spp, Bunostomum spp, Oesophagostomum spp, Chabertia spp, and Dictyocaulus vivipurus.
The Association of Racing Commissioners International Uniform Classification Guidelines for Foreign Substances has designated levamisole a CLASS 2 DRUG.
In addition to anti-protozoal medications, many veterinarians recommend supplementing these with between 5,000-10,000 IU per day of Vitamin E. In animals and humans, vitamin E has been shown to augment the function of the immune system. The literature holds that vitamin E may bolster the immune system to the point where the protozoa are unable to mount a defense against the medications being administered.