Ivermectin


Generic Medicine Info
Indications and Dosage
Oral
Onchocerciasis
Adult: For treatment of cases due to immature forms of Onchocerca volvulus: 150 mcg/kg as a single dose; may repeat treatment every 3-12 months until symptoms resolved.
Child: ≥15 kg: Same as adult dose.

Oral
Intestinal strongyloidiasis
Adult: 200 mcg/kg as a single dose. Alternatively, 200 mcg/kg daily may be given for 1-2 days.
Child: ≥15 kg: Same as adult dose.

Topical/Cutaneous
Head pediculosis
Adult: As 0.5% lotion: Apply sufficient amount (up to 1 tube) to completely coat dry hair and scalp thoroughly, then leave on for 10 minutes. Rinse off the scalp and hair well with warm water; use a fine-toothed comb to remove nits as needed. For single use only.
Child: ≥6 months As 0.5% lotion: Same as adult dose.

Topical/Cutaneous
Inflammatory lesions of rosacea
Adult: As 1% cream: Apply a thin layer onto the affected area(s) of the face once daily for up to 4 months; may repeat treatment course if needed. If there is no improvement after 3 months, discontinue treatment.
Special Patient Group
Intestinal strongyloidiasis:
Immunocompromised (including HIV-infected) patients: Repeated treatment courses may be necessary; control of extraintestinal strongyloidiasis may require once monthly (suppressive) therapy.
Administration
Should be taken on an empty stomach.
Contraindications
Hypersensitivity.
Special Precautions
Patient with loiasis (heavy infection of Loa loa); hyperreactive onchodermatitis (sowda). Immunocompromised (including HIV-infected) patients. No activity against adult Onchocerca volvulus parasites. Severe hepatic impairment (topical cream). Children. Pregnancy and lactation.
Adverse Reactions
Significant: Mazzotti reaction (e.g. lymphadenitis, oedema, arthralgia, synovitis, tachycardia, fever, pruritus, urticaria) and ophthalmic reaction particularly in patients undergoing treatment for onchocerciasis; transient aggravation of rosacea (topical cream).
Blood and lymphatic system disorders: Transient eosinophilia, leucopenia, anaemia.
Eye disorders: Conjunctival haemorrhage (if treated for onchocerciasis); conjunctivitis, ocular hyperaemia, eye irritation (topical lotion).
Ear and labyrinth disorders: Vertigo.
Gastrointestinal disorders: Abdominal pain, constipation, diarrhoea, nausea, vomiting.
General disorders and administration site conditions: Asthenia, fatigue.
Investigations: Increased AST, ALT, and bilirubin.
Metabolism and nutrition disorders: Anorexia.
Nervous system disorders: Dizziness, tremor, seizures.
Psychiatric disorders: Somnolence.
Respiratory, thoracic and mediastinal disorders: Worsening of bronchial asthma.
Skin and subcutaneous tissue disorders: Rash, Stevens-Johnson syndrome, toxic epidermal necrolysis (oral); dandruff (topical lotion); skin burning sensation, irritation, pruritus, dry skin (topical cream/lotion).
Vascular disorders: Orthostatic hypotension.
Potentially Fatal: Rarely, encephalopathy (especially if the patient with onchocerciasis is co-infected with Loa loa).
Patient Counseling Information
Topical: Avoid contact with eyes and lips.
Monitoring Parameters
Evaluate pregnancy status before use in patients who may become pregnant. Assess for loiasis before and after therapy (especially in patients with significant exposure to Loa loa endemic areas of West and Central Africa). Obtain skin and eye microfilarial counts; periodic ophthalmologic exams. Perform follow-up stool examination (for intestinal strongyloidiasis).
Drug Interactions
Rarely, increased INR with warfarin.
Food Interaction
Increased bioavailability with a high-fat meal.
Action
Description: Ivermectin is a semisynthetic anthelmintic derived from the avermectins. It has a strong affinity and binds selectively to glutamate-gated chloride ion channels of invertebrate nerve and muscle cells resulting in increased permeability of cell membrane to chloride ions with hyperpolarisation of the nerve or muscle cell, thereby causing the death of the parasite. The mechanism of action in the treatment of rosacea is still unknown but may be associated with the anti-inflammatory effects of ivermectin and antiparasitic action that causes the death of Demodex mites reported to contribute to skin inflammation.
Pharmacokinetics:
Absorption: Well absorbed from the gastrointestinal tract (fasted state). Increased bioavailability with a high-fat meal. Time to peak plasma concentration: Approx 4 hours (oral); approx 10 hours (topical cream).
Distribution: High concentration in the liver and adipose cell. Enters breast milk (small amounts). Volume of distribution: 3.1-3.5 L/kg. Plasma protein binding: Approx 93% mainly to albumin (oral); >99% (topical).
Metabolism: Metabolised in the liver mainly by CYP3A4 isoenzyme.
Excretion: Via faeces; urine (<1%). Elimination half-life: Approx 18 hours (oral); approx 6 days (topical cream).
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
Tab: Store below 30°C. Cream/lotion: Store between 15-30°C. Do not freeze.
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 31/03/2021.

Anon. Ivermectin (Topical). AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 03/06/2021.

Anon. Ivermectin (Topical). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 31/03/2021.

Buckingham R (ed). Ivermectin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 31/03/2021.

Ivermectin Lotion (Taro Pharmaceuticals U.S.A., Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 31/03/2021.

Joint Formulary Committee. Ivermectin. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 31/03/2021.

Merck Sharp & Dohme (NZ) Ltd. Stromectol Tablets data sheet 28 February 2019. Medsafe. http://www.medsafe.govt.nz. Accessed 31/03/2021.

Sklice Lotion 0.5% (Sanofi Pasteur Inc.). U.S. FDA. https://www.fda.gov. Accessed 03/06/2021.

Soolantra 10 mg/g Cream (Galderma [UK] Limited). MHRA. https://products.mhra.gov.uk. Accessed 31/03/2021.

Soolantra Cream (Galderma Laboratories, L.P.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 31/03/2021.

Stromectol (MSD Pharma [Singapore] Pte. Ltd.). MIMS Singapore. http://www.mims.com/singapore. Accessed 03/06/2021.

Stromectol Tablet (Merck Sharp & Dohme Corp.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 31/03/2021.

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
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