Miltefosine in canine leishmaniosis: how to use it
5-year-old crossbreed dog diagnosed with leishmaniosis with skin lesions and lymphadenomegaly, without azotaemia. The owner cannot come to the clinic daily for injections and asks about an oral treatment.
Regarding the use of miltefosine in this dog, which statement is correct?
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A. It is given orally with food for 28 days, combined with allopurinol; its main adverse effects are vomiting and diarrhoea
Correct. Miltefosine is a leishmanicidal alternative to meglumine antimoniate, with similar efficacy and no reported nephrotoxicity. Giving it with food reduces gastrointestinal effects. It is teratogenic: do not use it in pregnant bitches or breeding animals.
B. It should be used as monotherapy, because allopurinol reduces its absorption
There is no such interaction. LeishVet recommends combining the leishmanicidal drug (miltefosine or antimoniate) with allopurinol, which is continued for months as a leishmaniostatic drug.
C. It is given subcutaneously once daily for 4 weeks
That is the regimen for meglumine antimoniate, which is injectable. Miltefosine is an oral solution.
D. It eliminates the parasite, so after treatment no follow-up or allopurinol is needed
No available treatment achieves parasitological cure in dogs: it reduces parasite load and produces clinical remission, but relapses are possible. Periodic follow-up is essential.
lightbulb Key takeaway
Meglumine antimoniate (injectable) and miltefosine (oral) have comparable efficacy; choose according to the patient, renal function and what is feasible for the owner. Both are combined with allopurinol. Warn about the gastrointestinal effects of miltefosine and always give it with food.
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.