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Ivermectin

    Brands

    DEA Class; Rx

    Common Brand Names; Stromectol

    • Anthelmintics

    ivermectin topical (Rx, OTC)

    Brand and Other Names: Sklice, Soolantra
    • Classes: Acne Agents, Topical; 
    • Scabicidal Agents; 
    • Pediculicides, Topical

    Antiparasitic agent in avermectin class; similar to macrolide antibiotics but lacks antibacterial activity
    Used orally for onchocerciasis or strongyloidiasis and topically for Pediculus capitis (head lice) or rosacea
    Resistance to ivermectin has not been reported

    Indicated for the treatment of onchocerciasis due to Onchocerca volvulus infection.

    For the treatment of strongyloidiasis.
    For the treatment of pediculosis including pediculosis capitis, pediculosis corporis, and pediculosis pubis.
    For the treatment of inflammatory lesions of acne rosacea.
    For the treatment of scabies infections, including crusted (Norwegian) scabies.
    For the treatment of Bancroft’s filariasis caused by Wuchereria bancrofti.
    For the secondary treatment of cutaneous larva currens or cutaneous larva migrans.
    For the treatment of ascariasis (roundworm infection).
    For the treatment of enterobiasis (pinworm infection).
    For the treatment of trichuriasis (whipworm infection).

    Hypersensitivity to ivermectin

    • Abdominal pain
    • Asthenia
    • Hypotension
    • Mild EKG changes
    • Peripheral & facial edema
    • Transient tachycardia
    • Dizziness
    • Headache
    • Hyperthermia
    • Insomnia
    • Somnolence
    • Vertigo
    • Pruritus
    • Rash
    • Urticaria
    • Diarrhea
    • Nausea
    • Vomiting
    • Eosinophilia
    • Leukopenia
    • ALT/AST increased
    • Limbitis
    • Myalgia
    • Tremor
    • Blurred vision
    • Mild conjunctivitis
    • Punctate opacity
    • Mazzotti reaction (with onchocerciasis)
    • Edema
    • Fever
    • Lymphadenopathy
    • Ocular damage
    • Pruritus rash
    • Conjunctival hemorrhage (with onchocerciasis)
    • Hepatitis

    Strongyloidiasis: The patient should be reminded of the need for repeated stool examinations to document clearance of infection with Strongyloides stercoralis; not active against disseminated Strongyloides, only intestinal

    Onchocerciasis: The patient should be reminded that treatment does not kill the adult Onchocerca volvulus parasite, and therefore repeated follow-up and retreatment is usually required

    Long-term studies in animals have not been performed to evaluate carcinogenic potential of ivermectin

    Therapy had no adverse effects on fertility in rats in studies at repeated doses of up to 3 times maximum recommended human dose of 200 mcg/kg (on mg/m2/day basis)

    Immunocompromised patients may require repeated treatment; control of extraintestinal strongyloidiasis may require suppressive therapy (eg, once monthly)

    Pregnancy category: C

    There is information available on the presence of ivermectin in human milk in 4 lactating women after a single 150 mcg/kg oral dose of ivermectin; however, there is insufficient information from this study to determine effects of ivermectin on breastfed infant or on milk production

    Adults

    150—200 mcg/kg single dose PO for most indications; up to 400 mcg/kg PO for Bancroft’s filariasis; 4 oz/topical application.

    Geriatric

    150—200 mcg/kg single dose PO for most indications; 4 oz/topical application.

    Adolescents

    150—200 mcg/kg single dose PO for most indications; 4 oz/topical application.

    Children

    > 15 kg: 150—200 mcg/kg single dose PO for most indications; 4 oz/topical application.
    <= 15 kg: Safety and efficacy have not been established for oral dosage forms; 4 oz/topical application.

    Infants

    >= 6 months: Safety and efficacy have not been established for oral dosage forms; 4 oz/topical application.
    < 6 months: Safety and efficacy have not been established.

    Neonates

    Safety and efficacy have not been established.

    Ivermectin 

    tablet

    • 3mg

    topical lotion

    • 0.5% (Sklice)

    topical cream

    • 1% (Soolantra)