Generic Name

Ivermectin

Precaution

Concurrent Loa loa infection, impaired blood-brain barrier function due to infection. Lactation: Enters breast milk (AAP Committee states compatible with nursing)

Indication

Ascariasis, Strongyloidiasis, Filariasis, Scabies, Onchocerciasis, Gnathostomiasis

Contra Indication

Hypersensitivity. Pregnancy and lactation. Childn <15 kg body weight.

Dose

N/A

Side Effect

Diarrhoea, nausea, vomiting, dizziness, pruritus, urticaria, rash, arthralgia, fever, myalgia, asthenia, postural hypotension, tachycardia, oedema, lymphadenopathy, sore throat, cough, headache, somnolence, transient eosinophilia, raised liver enzyme values.

Pregnancy Category

Mode of Action

Ivermectin selectively binds and with high affinity to glutamate-gated chloride ion channels, which occur in invertebrate nerve and muscle cells leading to an increase in the permeability of cell membranes to chloride ions with hyperpolarization of the nerve or muscle cell and, ultimately, death of the parasite.

Interaction

Bioavailability may be increased by alcohol, levamisole.

Pregnancy Category Note

Pregnancy category: C Pregnancy There are no studies in pregnant women; epidemiologic studies during pregnancy are insufficient to inform a drug-associated risk of adverse developmental outcomes, because either the timing of administration during gestation was not accurately ascertained or the administration occurred only during the second trimester; however, systemic exposure from topical use of ivermectin is much lower than that from oral use In animal reproduction studies, ivermectin induced adverse developmental outcomes when orally administered to pregnant mice, rats and rabbits during the period of organogenesis only at or near doses that were maternally toxic to the pregnant females Lactation 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 Topical ivermectin systemic exposure is much lower than that for oral ivermectin; furthermore, amount of ivermectin present in human milk after topical application to lactating women has not been studied The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for therapy and any potential adverse effects on breastfed infant or from underlying maternal condition Lactation: Enters breast milk (AAP Committee states compatible with nursing)

Adult Dose

Strongyloidiasis of the Intestinal Tract 15-24 kg: 3 mg PO once 25-35 kg: 6 mg PO once 36-50 kg: 9 mg PO once 51-65 kg: 12 mg PO once 66-79 kg: 15 mg PO once >80 kg: 200 mcg/kg PO once River Blindness (Onchocerciasis) 15-25 kg: 3 mg PO; may repeat in 3-12 mo 26-44 kg: 6 mg PO; may repeat in 3-12 mo 45-64 kg: 9 mg PO; may repeat in 3-12 mo 65-84 kg: 12 mg PO; may repeat in 3-12 mo >85 kg: 150 mcg/kg PO; may repeat in 3-12 mo Scabies Due to Sarcoptes Scabiel 200 mcg/kg as single dose; may repeat in 14 days if necessary Gnathostoma Spinigerum Gnathostomiasis: 200 mcg/kg as single dose

Child Dose

River Blindness (Onchocerciasis) <15 kg: Safety and efficacy not established 15-25 kg: 3 mg PO; may repeat in 3-12 mo 26-44 kg: 6 mg PO; may repeat in 3-12 mo 45-64 kg: 9 mg PO; may repeat in 3-12 mo 65-84 kg: 12 mg PO; may repeat in 3-12 mo >85 kg: 150 mcg/kg PO; may repeat in 3-12 mo Strongyloidiasis of the Intestinal Tract <15 kg: Safety and efficacy not established 15-24 kg: 3 mg PO once 25-35 kg: 6 mg PO once 36-50 kg: 9 mg PO once 51-65 kg: 12 mg PO once 66-79 kg: 15 mg PO once >80 kg: 200 mcg/kg PO once Scabies Child: >15 kg: Sarcoptes scabiei 200 mcg/kg as a single dose, repeat dose in 2 wk.

Renal Dose

N/A

Administration

Oral Should be taken on an empty stomach.