Pharm
Ivermectin
search
Ivermectin
, Mectizan, Stromectol
Indication
Scabies
(refractory to
Permethrin
5%)
Head Lice
Strongyloidiasis
Onchocerciasis
Mechanism
Developed initially as veterinary anti-parasitic agent
Related to
Macrolide
antibiotics
Also decreases
Nerve Impulse
transmission
Potentiates GABA-gated chloride channels
Pharmacokinetics
Peak Level: 3-6 hours after intake
Half-Life: >12 hours
Metabolized by Cyp 3A4
Crosses blood brain barrier via
P-Glycoprotein
(ABCB1 Transporter)
Preparations
Ivermectin 6 mg tablet
Dosing
Scabies
or
Head Lice
Ivermectin 200 mcg/kg PO x1 dose, repeat in 10 days
Strongyloidiasis
Ivermectin 200 mcg/kg PO for 1 dose
Onchocerciasis
Ivermectin 150 mcg/kg PO for 1 dose
Efficacy
Scabies
Studies show efficacy over
Lindane
for
Scabies
Madan (2001) J Dermatol 28:481-4 [PubMed]
Permethrin
5% appears to be more effective for
Scabies
Usha (2000) J Am Acad Dermatol 42:236-40 [PubMed]
Precautions
Safe in children >15 kg (33 pounds)
Avoid in
Lactation
Pregnancy Category: C
Adverse Effects
Reaction - Allergy to
Parasite
Death
Nausea
Fever
Headache
Arthralgia
Rash
Adverse Effects
Toxicity or
Overdose
Doses <500 mg in adults and <5mg/kg in children are typically without reaction
In 2021, patients were taking very high doses for
COVID-19
(based on little evidence of benefit)
High dose toxicity (
Seizure
s, coma, death) was at risk at these doses (e.g. 600 mg taken for several days)
Patients ingested high risk formulations (topical Ivermectin, veterinary Ivermectin)
Findings typically resolve within 6-8 hours of ingestion
Gastrointestinal Findings
Nausea
or
Vomiting
Abdominal Pain
Diarrhea
Neurologic Findings
Headache
Dizziness
Hallucination
s
Confusion
Cardiopulmonary Findings
Hypotension
Tachycardia
Skin Findings
Urticaria
Edema
Management
See
Unknown Ingestion
Activated Charcoal
Indicated in early presentation of large ingestion
Supportive Management
ABC Management
Benzodiazepine
s for
Seizure
s
Consider
Intravenous Lipid Emulsion
Reference
Tomaszewski (2021) Crit Dec Emerg Med 35(9): 32
Meinking (1995) N Engl J Med 333:26 [PubMed]
Fawcett (2003) Am Fam Physician 68(6):1089-92 [PubMed]
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