Acemannan

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ACEMANNAN

(ase-man-in)

NON-SPECIFIC IMMUNOSTIMULANT/ ANTIVIRAL

Prescriber Highlights

  • Non-specific injectable immunostimulant that has been tried in FeLV-,FIV, or FIP-positive cats, & vaccine–induced fibrosarcomas (intralesional)
  • Use is controversial; little, if any controlled study documentation supporting efficacy in veterinary medicine
  • Adverse effects include: Possible hypersensitivity reactions, localized necrosis at injection sites; bolus IV administration can cause salivation, weakness, collapse, tachycardia, tachypnea; intralesional injection can cause prolonged pain at site; intraperitoneal injection can cause monocyte infiltrates on peritoneal surfaces, liver, & spleen with resultant abdominal pain, diarrhea and vomiting.
  • Topical products available; potentially can reduce wound healing time

Uses/Indications

Veterinary acemannan injection is labeled for use in dogs or cats as an aid in the treatment (i.e., surgery) and clinical management of fibrosarcoma. It has been tried as a treatment for FeLV, FIV, and FIP infections in cats, but clinical efficacy has not been adequately proven by controlled clinical studies.

Acemannan has been used in dogs as an intralesional injection for papillomatosis. It reportedly has been used in horses, but no specific information on this was located.

Pharmacology/Actions

Acemannan’s immunostimulant activity is thought as a result of inducing increases in TNF-alpha, interferon, and IL-1. At injection sites, increased lymphocytic infiltration and accumulation have been noted. In tissue cultures, acemannan has suppressed HIV replication.

Pharmacokinetics

No information was located. Contraindications/ Precautions/ Warnings The manufacturer lists no contraindications to using acemannan, however, it should not be used in patients who have demonstrated past severe hypersensitivity reactions to it.

Adverse Effects

While the manufacturer does not list any specific adverse effects associated with use, hypersensitivity or localized injection reactions (e.g., necrosis) are possible. Hyperactivity, lethargy, fever and hypotension have been reported with systemic use of the drug.

Bolus IV administration can cause salivation, weakness, collapse, hypotension, tachycardia and tachypnea. Intralesional injection can cause bleeding or prolonged pain at the injection site. Intraperitoneal injection can cause monocyte infiltrates on peritoneal surfaces, lung, liver, and spleen. Abdominal pain, vomiting and diarrhea have been reported with high dose, intraperitoneal injections.

Reproductive/Nursing Safety

No specific information was located on reproductive or nursing safety. The product label states, “The effects of this compound have not been studied in pregnant animals” and, also, “…the chemical nature of acemannan and the absence of significant toxicity in several animal species suggest the compound is not a teratogen.”

Overdosage/Acute Toxicity

Single IP injections of 50 mg/kg in dogs resulted in no significant signs of toxicity. Acemannan fed orally to dogs at rates of up to 1.5 g/kg/day for 90 days showed no significant effects.

Drug Interactions

None were identified.

Laboratory Considerations

None were identified.

Doses

DOGS/CATS:

For labeled indications (aid in treatment and management of fibrosarcoma):

a) Prior to use, reconstitute with 10 mL sterile diluent. Five to 10 minutes may be necessary for complete dissolution. Shake well before using. Use within 4 hours after rehydration. Administer by concurrent intraperitoneal (IP) and intralesional injections weekly for a minimum of 6 treatments. Recommended IP dose is 1 mg/kg. Recommended intralesional dose is 2 mg injected deep into each tumor mass. When used as a prelude to surgery, give concurrent IP and intralesional injections weekly. Continue until delineation, necrosis or maximum tumor enlargement due to edema and immune cellular infiltration occur. Rapid necrosis, which accompanies this response, may happen within 2 to 4 weeks. Surgical excision is recommended immediately upon delineation, necrosis or maximum tumor enlargement. (Label Information; Acemannan Immunostimulant—VPL)

Monitoring

  • Clinical efficacy
  • Adverse effects (most likely local reactions)

Client Information

  • This compound is recommended for use by veterinary professionals only
  • Clients should be made aware of the “investigational” nature of using acemannan systemically; adverse effects are possible

Chemistry

Acemannan is a water soluble, complex carbohydrate polymer that is derived from Aloe vera. It is a long-chained polydispersed beta-(1,4)-acetylated polymannose with interspersed O-acetyl groups with a mannose:acetyl ratio of approximately 1:1.

Storage/Stability

Acemannan injection should be stored at temperatures less than 35°C (95°F); protect from extremes of heat or light.

Dosage Forms/Regulatory Status

VETERINARY-LABELED PRODUCTS:

Acemannan 10 mg vial with 10 mL vial of diluent (sterile saline) in kits of two vials (one of each) or eight vials (4 of each): Acemannan Immunostimulant® (VPL); OTC Biologic. Labeled for use in dogs or cats. Note: This product is a USDA-licensed biologic and is not an FDA-approved product.

Note: There are also topical products labeled for veterinary use that contain acemannan including a wound dressing and cleansing foam. Trade name is CarraVet® (VPL).

HUMAN-LABELED PRODUCTS: No systemic products located

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