ivermectin

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.

Availability ⬆ ⬇

(Generic available)

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

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.

US Brand Names ⬆ ⬇

Sklice, Soolantra, Stromectol

Action ⬆ ⬇

Binds selectively and with a high affinity to chloride channels in invertebrate nerve and muscle cells, resulting in parasite paralysis and death.
Active against Strongyloides stercoralis and the nemotode form of Onchocerca volvulus.
Mechanism in treating rosacea unknown.

Therapeutic effects:

Death of infecting parasites with resolution of symptoms of infection.
Reduction in inflammatory lesions of rosacea.

Classifications ⬆ ⬇

Therapeutic Classification: anthelmintics

Pharmacologic Classification: avermectins

Pharmacokinetics ⬆ ⬇

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.

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

(blood levels)

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

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.

Pronunciation ⬆ ⬇

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)

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Indications ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇