Purchasing compounded Diclazuril and Levamisole for EPM. So confused. Please help!

[Ang]

So my horse was recently diagnosed with EPM and put on Rebalance and vitamin E. His condition worsened the 1st week on Rebalance then improved about 1 grade over the next few weeks. Last week when we saw my vet again, she suggested adding Diclazuril and Levamisole in addition to the Rebalance.

Since I have very limited funds she agreed that I could shop around for the best prices on compounded drugs and let her know where I want her to send the prescription. However, the compounded pharmacies either won’t talk to me at all about prices since I’m not a vet, or only give me vague information about the cost per mg of product but won’t say how many mg I would need.

I also found products like this one: https://brdvetrx.com/product/diclazuril-levamisole-vitamin-e-8-3-3-1000iu-1000ml-oral-suspension-epm/ that combine both of the drugs I want with the vitamin E, but again they refuse to give me a price. Am I supposed to pick a company at random and ask my vet to order it, hoping I randomly pick the best price? What a stupid system.

Rood and Riddle’s pharmacy gave me prices for Diclazuril paste ($2.10) and powder ($0.27) but I don’t know the dosage so don’t know how much powder I’d need. They have Levamisole paste for $4.55/tube so I assume that’s 1 tube a day but again they wouldn’t confirm. This would mean I have to get 3 separate tubes shoved down my horse’s throat every day (don’t forget he’s also on Rebalance) and he’s already getting hard to dose on just 1 a day.

If you have experience with EPM and these drugs, please help! Thank you.

[jherold]

Your vet needs to give you the dosage. No way the pharmacy can give you a price without the dose. And some compounding pharmacies don’t want to deal with the general public. My vet just ordered from Pathogenes, which is the same lab that did my mares epm testing. https://www.pathogenes.com/horse-owner-information

I wouldn’t price shop too much with compounding pharmacies. They do not all produce the same quality of drug. These Epm drugs aren’t all that expensive.

[BootsAndCoffee]

If you can obtain the dosage from your vet, most compounding pharmacies will provide quotes (Wedgewood and Professional Arts definitely will provide email quotes to owners: I used both for Leukeran Rxs for my cat).

If your vet prescribes a specific format, such as a tablet, and you request a quote for a tablet (instead of powder, suspension, capsule, etc), you will have to adjust the mg slightly — for example, 1mg can be 1.1mg — to accord with the laws surrounding compounding (basically, if x medicine exists in x form in x dose, the compounded Rx has to be different in either form or dose to be “legal.”)

[mfglickman]

I called around for compounding prices for meds for my cat and hit the same wall. What you need is dosage info (preferably a script) that you can send to them for a quote; without the info they really can’t help.

FWIW both of my horses had EPM in 2020/2021. We did 60+ days of Marquis + Vitamin E (water soluble) + either MVP Eclipse or Immubiome Spine & Nerve. I continued the E and supplements for about 6 months after treatment.

Good luck - it’s an awful disease.

[george]

Just contact Dr. Ellison at Pathogens. You want her levamisole because unlike a compound hers is stable. She is also going to be able to work with your vet to figure out what protocol your specific horse needs. These are not expensive drugs through her.

[mackieb]

Hey @Ang, how is your horse doing now? Can I ask what treatment route you ended up taking? I’m planning on ordering the diclazuril/levamisole/vitamin E suspension for my girl whose symptoms have been a 1:4000 blood test result, muscle wastage, weight loss and very mild neuro, but I’m debating if I want to also include rebalance or just do the suspension.

[bktl]

Hi, My horse was 1:4000 also. Marquis and Diclazuril helped, but did not really work. Levamisole is next. How did your mare do? Thanks

[mackieb]

I ended up having great luck with the diclazuril/levamisole/vitamin E! If I remember right, through BRD pharmacy, it cost $185 per 1000mg bottle which lasted 30 days. Finished 60 days of treatment in October of 2022 and no signs of relapse since, except for the first few days after when I forgot to add a new source of vitamin E into her diet but as soon as I did that, she was right as rain. Don’t know how we were so fortunate as I seem to read way more cases of struggling to find the right treatment than success stories like mine, it sucks that there’s not just one medication guaranteed to work for every horse. Wishing you all the best in your EPM journey!!

[bktl]

Did you use the brand name Marquis? Did it work for you? Thanks