Ivermectin


Generic Medicine Info
Indications and Dosage
Oral
Strongyloidiasis
Adult: 200 mcg/kg for 1-2 days.
Child: ≥15 kg: Same as adult dose.

Oral
Onchocerciasis
Adult: 150 mcg/kg as single dose; repeat treatment every 3-12 mth until symptoms resolved.
Child: ≥15 kg: Same as adult dose.

Topical/Cutaneous
Head pediculosis
Adult: As 0.5% lotion: Apply sufficient amount into dry hair and scalp as single dose, then leave on for 10 min before rinsing.
Child: ≥6 mth Same as adult dose.

Topical/Cutaneous
Rosacea
Adult: As 1% cream: Apply onto affected area(s) once daily for up to 4 mth, repeat treatment course if needed.
Special Patient Group
Immunocompromised patient (e.g. HIV-infected): Repeated courses may be required; once mthly dosing for strongyloidiasis.
Administration
Should be taken on an empty stomach.
Special Precautions
Patient w/ onchocerciasis and loiasis. Immunocompromised patients. Childn. Pregnancy and lactation.
Adverse Reactions
Significant: Mazzotti reaction (e.g. oedema, pruritus, urticaria rash, lymphadenitis, arthralgia, synovitis, fever, sore throat, cough, headache, tachycardia, orthostatic hypotension, oedema).
Nervous: Dizziness, asthenia, fatigue, somnolence, vertigo, tremor.
GI: Diarrhoea, abdominal pain, nausea, anorexia, constipation, vomiting.
Hepatic: Increased serum ALT, AST.
Haematologic: Eosinophilia, decreased WBC, increased Hb.
Ophthalmologic: Conjunctivitis, ocular hyperemia, irritation (topical); limbitis, punctate opacity, abnormal sensation, eyelid oedema, anterior uveitis, conjunctival haemorrhage (oral).
Dermatologic: Burning sensation, irritation, itch, dry skin, contact dermatitis, erythema (topical).
Potentially Fatal: Rarely, encephalopathy.
Patient Counseling Information
Avoid contact w/ eyes and lips.
MonitoringParameters
Assess for loiasis prior to therapy. Monitor for presence of larvae in stool, 3-4 wk post-therapy; skin and eye microfilarial counts; ophthalmological conditions.
Drug Interactions
Increased serum concentration w/ P-glycoprotein inhibitors. Decreased serum concentration w/ P-glycoprotein inducers. Enhanced anticoagulant effect of vit K antagonists (e.g. warfarin). Diminished therapeutic effect of lactobacillus and estriol.
Food Interaction
Increased absorption w/ high-fat meal.
Action
Description: Ivermectin is a semisynthetic anthelmintic. It has strong affinity and selectively binds to glutamate gated Cl ion channels which results to increased permeability of cell membranes to Cl ions leading to hyperpolarisation of the nerve or muscle cell causing death of the parasite. Its mode of action in rosacea is still unknown but thought to act as an antiparasitic agent against Dermodex folliculorum mites which can trigger rosacea and has anti-inflammatory effect.
Pharmacokinetics:
Absorption: Well absorbed from the GI tract. Increased absorption w/ high-fat meal. Time to peak plasma concentration: Approx 4 hr (oral); approx 10 hr (topical).
Distribution: High concentration in the liver and adipose cell. Enters breast milk. Volume of distribution: 3.1-3.5 L/kg. Plasma protein binding: Approx 93%, mainly albumin (oral); >99% (topical).
Metabolism: Metabolised in the liver by CYP3A4 enzyme.
Excretion: Via faeces; urine (<1 %). Elimination half-life: 18 hr (oral); approx 6 days (topical).
Chemical Structure

Chemical Structure Image
Ivermectin

Source: National Center for Biotechnology Information. PubChem Database. Ivermectin, CID=6321424, https://pubchem.ncbi.nlm.nih.gov/compound/Ivermectin (accessed on Jan. 21, 2020)

Storage
Store between 20-25°C.
ATC Classification
D11AX22 - ivermectin ; Belongs to the class of other dermatologicals.
P02CF01 - ivermectin ; Belongs to the class of avermectine agents. Used as antinematodal.
References
Anon. Ivermectin (Systemic). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 15/08/2017.

Anon. Ivermectin (Topical). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 15/08/2017.

Buckingham R (ed). Ivermectin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 15/08/2017.

Joint Formulary Committee. Ivermectin. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 15/08/2017.

McEvoy GK, Snow EK, Miller J et al (eds). Ivermectin. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 15/08/2017.

Sklice Lotion (Sanofi Pasteur, Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 15/08/2017.

Stromectol Tab (Merck Sharp & Dohme Corp.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 15/08/2017.

Disclaimer: This information is independently developed by MIMS based on Ivermectin from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2021 MIMS. All rights reserved. Powered by MIMS.com
Register or sign in to continue
Asia's one-stop resource for medical news, clinical reference and education
Sign up for free
Already a member? Sign in