Onchocerciasis (River Blindness) Medication

Updated: Jun 22, 2018
  • Author: Darvin Scott Smith, MD, MSc, DTM&H, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Medication Summary

Treatment involves microfilaricidal or macrofilaricidal agents. No known nontoxic macrofilaricidal agent is available to kill adult worms effectively.



Class Summary

These agents inhibit growth and proliferation of parasites.

Ivermectin (Mectizan, Stromectol)

Drug of choice for onchocerciasis. Derived from the soil actinomycete Streptomyces avermitilis. Metabolized in liver and excreted in feces over 12 d. Plasma half-life is 18 h. Its activity is the result of increased nerve and muscle cell permeability to chloride channels, leading to hyperpolarization and paralysis due to the drug's high affinity binding to glutamate-gated and gamma aminobutyric acid–gated chloride ion channels.


Moxidectin, a macrocyclic lactone, is an anthelmintic indicated for the treatment of onchocerciasis due to Onchocerca volvulus in patients aged 12 years and older. Plasma half-life is 20-43 days and thereby reduces and maintains low skin microfilarial density effectively. Moxidectin does not kill adult O volvulus. Follow-up evaluation is advised. Safety and efficacy of repeat administration has not been studied.

Diethylcarbamazine (Hetrazan)

Diethylcarbamazine (DEC) is never used in the treatment of onchocerciasis. DEC is rarely used for diagnostic purposes, when low test doses are given and patients are observed for the Mazzotti reaction, which, in mild cases, results in pruritus, dermal edema, maculopapular eruptions, lymphadenopathy, and fever and, in severe cases, results in meningismus, severe prostration, and/or death. The mechanism of action of DEC is secondary to direct effect on microfilariae by causing organelle damage and apoptosis.



Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Doxycycline (Bio-Tab, Doryx, Doxy, Periostat, Vibramycin, Vibra-Tabs)

May be used to reduce or eliminate the endosymbiotic bacteria Wolbachia. This disrupts production of microfilariae by the adult female worm.