No

Antibiotic, Miscellaneous

Treatment of the following infections: Strongyloidiasis of the intestinal tract due the nematode parasite Strongyloides stercoralis. Onchocerciasis due to the nematode parasite Onchocerca volvulus. Ivermectin is only active against the immature form of Onchocerca volvulus, and the intestinal forms of Strongyloides stercoralis. Ivermectin has been used for other parasitic infections including Ascaris lumbricoides, bancroftian filariasis, Brugia malayi, scabies, Enterobius vermicularis, Mansonella ozzardi, Trichuris trichiura.

C

Hypersensitivity to ivermectin or any component

Data have shown that antihelmintic drugs like ivermectin may cause cutaneous and/or systemic reactions (Mazzoti reaction) of varying severity including ophthalmological reactions in patients with onchocerciasis. These reactions are probably due to allergic and inflammatory responses to the death of microfilariae. Patients with hyper-reactive onchodermatitis may be more likely than others to experience severe adverse reactions, especially edema and aggravation of the onchodermatitis. Repeated treatment may be required in immunocompromised patients (eg, HIV); control of extraintestinal strongyloidiasis may necessitate suppressive (once monthly) therapy

Percentage unknown: Transient tachycardia, peripheral and facial edema, hypotension, mild EKG changes, dizziness, headache, somnolence, vertigo, insomnia, hyperthermia, pruritus, rash, urticaria, diarrhea, nausea, abdominal pain, vomiting, leukopenia, eosinophilia, increased ALT/AST, weakness, myalgia, tremor, limbitis, punctate opacity, mild conjunctivitis, blurred vision

Mazzotti reaction (with onchocerciasis): Pruritus, edema, rash, fever, lymphadenopathy, ocular damage

Accidental intoxication with, or significant exposure to unknown quantities of veterinary formulations of ivermectin in humans, either by ingestion, inhalation, injection, or exposure to body surfaces, has resulted in the following adverse effects: rash, edema, headache, dizziness, asthenia, nausea, vomiting, and diarrhea; other adverse effects that have been reported include seizure and ataxia

Treatment is supportive; usual methods for decontamination are recommended

Ivermectin is a semisynthetic antihelminthic agent; it binds selectively and with strong affinity to glutamate-gated chloride ion channels which occur in invertebrate nerve and muscle cells. This leads to increased permeability of cell membranes to chloride ions then hyperpolarization of the nerve or muscle cell, and death of the parasite.

Peak response: 3-6 months

Absorption: Well absorbed

Distribution: Does not cross the blood-brain barrier

Half-life: 16-35 hours

Metabolism: Hepatic, >97%

Elimination: <1% excreted in urine, the remainder in feces

Oral:

Adults:

Strongyloidiasis: 200 mcg/kg as a single dose; follow-up stool examinations

Onchocerciasis: 150 mcg/kg as a single dose; retreatment may be required every 3-12 months until the adult worms die

Skin and eye microfilarial counts, periodic ophthalmologic exams

May cause dizziness, drowsiness, or insomnia

May cause leukopenia; use caution with clozapine and carbamazepine

No information available to require special precautions

No effects or complications reported

If infected with strongyloidiasis, repeated stool examinations are required to document clearance of the organisms; repeated follow-up and retreatment is usually required in the treatment of onchocerciasis

Ensure that patients take ivermectin with water

Tablet: 6 mg

de Silva N, Guyatt H, and Bundy D, "Anthelmintics. A Comparative Review of Their Clinical Pharmacology," Drugs, 1997, 53(5):769-88.

"Drugs for Parasitic Infections," Med Lett Drugs Ther, 1993, 35(911):111-22.