ivermectin

Absorption: Some absorption follows oral administration; fat enhances absorption; little systemic absorption with topical administration.

Distribution: Small amounts enter breast milk.

Metabolism/Excretion: Metabolized by the liver by the CYP3A4 isoenzyme; parent drug and metabolites excreted mainly in feces; <1% excreted unchanged in urine.

Half-Life: Oral: 18 hr; Cream: 6.5 days.

Time/Action Profile ⬆ ⬇

(blood levels)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	4 hr	unknown
Topical	unknown	unknown	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity.

Use Cautiously in:

OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Safety and effectiveness not established in children <15 kg (oral) or <6 mo (lotion).

Adv. Reactions/Side Effects ⬆ ⬇

Derm: burning sensation (topical), dry skin (topical), pruritus, rash, urticaria

EENT: conjunctivitis (topical)

GI: abdominal pain, anorexia, constipation, diarrhea, nausea, vomiting

Neuro: COMA, confusion, disorentation, dizziness, drowsiness, fatigue, stupor, tremor, vertigo, weakness

Misc: Mazzotti reaction (onchocerciasis only), DEATH

Interactions ⬆ ⬇

Drug-drug:

May ↑ risk of bleeding with warfarin.

Route/Dosage ⬆ ⬇

Strongyloidiasis

PO (Adults and Children ≥80 kg): 200 mcg/kg as a single dose.
PO (Adults and Children 66–79 kg): 15 mg (5 tablets) as a single dose
PO (Adults and Children 51–65 kg): 12 mg (4 tablets) as a single dose.
PO (Adults and Children 36–50 kg): 9 mg (3 tablets) as a single dose.
PO (Adults and Children 25–35 kg): 6 mg (2 tablets) as a single dose.
PO (Adults and Children 15–24 kg): 3 mg (1 tablet) as a single dose.

Onchocerciasis

PO (Adults and Children ≥85 kg): 150 mcg/kg as a single dose; course may be repeated at 3–12 mo intervals.
PO (Adults and Children 65–84 kg): 12 mg (4 tablets) as a single dose; course may be repeated at 3–12 mo intervals
PO (Adults and Children 45–64 kg): 9 mg (3 tablets) as a single dose; course may be repeated at 3–12 mo intervals.
PO (Adults and Children 26–44 kg): 6 mg (2 tablets) as a single dose; course may be repeated at 3–12 mo intervals.
PO (Adults and Children 15–25 kg): 3 mg (1 tablet) as a single dose; course may be repeated at 3–12 mo intervals.

Head Lice

(Adults and Children ≥6 mo): Apply lotion (up to 1 tube) to dry hair and rub until scalp is moistened; leave on for up to 10 minutes, and then rinse off with water.

Rosacea

(Adults ): Apply cream to affected areas of face once daily.

Availability ⬆ ⬇

(Generic available)

Tablets: 3 mg
Lotion (Sklice): 0.5%^OTC
Cream (Soolantra): 1%

Assessment ⬆ ⬇

Strongyloidiasis/Onchocerciasis: Monitor repeat stool samples for clearance of infection.
Strongyloidiasis/Onchocerciasis: Monitor for signs and symptoms of Mazzotti reactions (arthralgia/synovitis, enlargement and tenderness of axillary cervical, inguinal and other lymph nodes, skin involvement including edema, papular and pustular or frank urticarial rash, fever) in patients treated for Onchocerciasis. Treatment includes oral hydration, recumbency, IV normal saline, and/or parenteral corticosteroids to treat postural hypotension, and antihistamines and/or aspirin for most mild to moderate cases.
Head Lice: Assess scalp for presence of lice and their ova (nits) prior to and 1 wk after application of ivermectin.
Rosacea: Assess facial lesions periodically during therapy.

Lab Test Considerations:

May rarely cause ↑INR when co-administered with warfarin.
- May cause ↑ ALT and ↑ AST.
- May cause ↓ leukocyte count, eosinophilia, and ↑ hemoglobin.

Implementation ⬆ ⬇

PO: Administer on an empty stomach with water.
Topical Apply sufficient amount of lotion to cover hair and scalp; up to 1 tube. Wait 10 minutes and rinse off with water; avoid contact with eyes. Tube is for single use only; discard unused portion. Wash hands after application.
Rosacea: Using a pea-size amount for each affected area of face (forehead, chin, nose, each cheek), spread as a thin layer, avoiding the eyes and lips, once daily.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take the single dose on an empty stomach with water.
Advise patient that ivermectin does not kill the adult Onchocerca parasites; repeated follow-up and retreatment is usually required.
Instruct patient to notify health care professional if scalp itching, numbness, redness, or rash occurs.
- Instruct patient to avoid getting Sklice lotion or Soolantra cream in eyes. If this occurs, eyes should be flushed thoroughly with water. Health care professional should be contacted if eye irritation persists.
- Advise patient that others residing in the home should also be checked for lice.
- Instruct patient on methods of preventing reinfestation. All clothes, including outdoor apparel and household linens, should be machine-washed using very hot water and dried for at least 20 min in a hot dryer. Dry-clean nonwashable clothes. Brushes and combs should be soaked in hot (130°F), soapy water for 5–10 min. Remind patient that brushes and combs should not be shared. Wigs and hairpieces should be shampooed. Rugs and upholstered furniture should be vacuumed. Toys should be washed in hot, soapy water. Items that cannot be washed should be sealed in a plastic bag for 2 wk.
- If patient is a child, instruct parents to notify school nurse or day care center so that classmates and playmates can be checked.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Advise a lactating woman to avoid accidental transfer of topical products to breast area to prevent infant from ingesting the drug.

Evaluation/Desired Outcomes ⬆ ⬇

Eradication of strongyloidiasis and onchocerca infections, and head lice.
Reduction in inflammatory lesions of rosacea.

US Brand Names ⬆ ⬇

Sklice, Soolantra, Stromectol

Canadian Brand Names ⬆ ⬇

Code ⬆

NDC Code

0006- Merck Sharp and Dohme Corp.
- 0006-0032- STROMECTOL
  - 0006-0032-20- 2 BLISTER PACK in 1 CARTON (0006-0032-20) > 10 TABLET in 1 BLISTER PACK

0299- Galderma Laboratories, L.P.
- 0299-3823- SOOLANTRA
  - 0299-3823-00- 2 g in 1 TUBE (0299-3823-00)

0299- Galderma Laboratories, L.P.
- 0299-3823- SOOLANTRA
  - 0299-3823-02- 1 TUBE in 1 BLISTER PACK (0299-3823-02) > 2 g in 1 TUBE

0299- Galderma Laboratories, L.P.
- 0299-3823- SOOLANTRA
  - 0299-3823-30- 1 TUBE in 1 CARTON (0299-3823-30) > 30 g in 1 TUBE

0299- Galderma Laboratories, L.P.
- 0299-3823- SOOLANTRA
  - 0299-3823-45- 1 TUBE in 1 CARTON (0299-3823-45) > 45 g in 1 TUBE

0299- Galderma Laboratories, L.P.
- 0299-3823- SOOLANTRA
  - 0299-3823-60- 1 TUBE in 1 CARTON (0299-3823-60) > 60 g in 1 TUBE

0591- Actavis Pharma, Inc.
- 0591-4052- Ivermectin
  - 0591-4052-89- 1 TUBE in 1 CARTON (0591-4052-89) > 45 g in 1 TUBE

24338- Arbor Pharmaceuticals
- 24338-183- Sklice
  - 24338-183-04- 1 TUBE in 1 CARTON (24338-183-04) > 117 g in 1 TUBE

42799- Edenbridge Pharmaceuticals, LLC
- 42799-806- Ivermectin
  - 42799-806-01- 2 BLISTER PACK in 1 CARTON (42799-806-01) > 10 TABLET in 1 BLISTER PACK

63629- Bryant Ranch Prepack
- 63629-7275- Ivermectin
  - 63629-7275-1- 2 TABLET in 1 BOTTLE (63629-7275-1)

63629- Bryant Ranch Prepack
- 63629-7275- Ivermectin
  - 63629-7275-2- 30 TABLET in 1 BOTTLE (63629-7275-2)

63629- Bryant Ranch Prepack
- 63629-7275- Ivermectin
  - 63629-7275-3- 4 TABLET in 1 BOTTLE (63629-7275-3)

63629- Bryant Ranch Prepack
- 63629-7275- Ivermectin
  - 63629-7275-4- 10 TABLET in 1 BOTTLE (63629-7275-4)

66993- Prasco Laboratories
- 66993-948- Ivermectin
  - 66993-948-48- 1 TUBE in 1 CARTON (66993-948-48) > 45 g in 1 TUBE

76413- Central Texas Community Health Centers
- 76413-155- Ivermectin
  - 76413-155-02- 2 TABLET in 1 BOTTLE (76413-155-02)

76413- Central Texas Community Health Centers
- 76413-155- Ivermectin
  - 76413-155-04- 4 TABLET in 1 BOTTLE (76413-155-04)

76413- Central Texas Community Health Centers
- 76413-155- Ivermectin
  - 76413-155-06- 6 TABLET in 1 BOTTLE (76413-155-06)

76413- Central Texas Community Health Centers
- 76413-155- Ivermectin
  - 76413-155-08- 8 TABLET in 1 BOTTLE (76413-155-08)

76413- Central Texas Community Health Centers
- 76413-155- Ivermectin
  - 76413-155-10- 10 TABLET in 1 BOTTLE (76413-155-10)

76413- Central Texas Community Health Centers
- 76413-155- Ivermectin
  - 76413-155-12- 12 TABLET in 1 BOTTLE (76413-155-12)

76413- Central Texas Community Health Centers
- 76413-155- Ivermectin
  - 76413-155-14- 14 TABLET in 1 BOTTLE (76413-155-14)

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇