Dosing & Uses
Dosage Forms & Strengths
tablet
- 3mg
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
Dosing considerations
- In general repeat doses not necessary; perform stool examinations to verify eradication of infection
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
Dosing considerations
- Note: Does not treat adult worms (must be surgically excised)
Head Lice (Pediculosis capitis; Off-label)
200 mcg/kg PO once; may require 1-2 additional doses repeated after 7 days
Blepharitis (Demodex folliculorum; Off-label)
200 mcg/kg PO once as a single dose, THEN repeat dose once in 7 days
Filariasis Due to Mansonella Ozzardi (Off-label)
6 mg PO as single dose
Filariasis Due to Mansonella Streptocera (Off-label)
150 mcg/kg as single dose
Scabies Due to Sarcoptes Scabiel
Immunocompromised patients: 200 mcg/kg as single dose; may repeat in 14 days if necessary
Gnathostoma Spinigerum
Gnathostomiasis: 200 mcg/kg as single dose
Administration
Take on empty stomach
Monitor: Stool exams (Strongyloides)
Dosage Forms & Strengths
tablet
- 3mg
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
Dosing considerations
- Note: Does not treat adult worms (must be surgically excised)
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
Dosing considerations
- In general repeat doses not necessary; perform stool examinations to verify eradication of infection
Administration
Take on empty stomach
Monitor: Stool exams (Strongyloides)
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (5)
- erdafitinib
erdafitinib will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If coadministration unavoidable, separate administration by at least 6 hr before or after administration of P-gp substrates with narrow therapeutic index.
- lasmiditan
lasmiditan increases levels of ivermectin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
- quinidine
quinidine will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
- sotorasib
sotorasib will decrease the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.
- tepotinib
tepotinib will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling.
Monitor Closely (50)
- amiodarone
amiodarone will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- atorvastatin
atorvastatin will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- berotralstat
berotralstat will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor or titrate P-gp substrate dose if coadministered.
- bosutinib
bosutinib increases levels of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- clarithromycin
clarithromycin will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- clotrimazole
clotrimazole will decrease the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- dronedarone
dronedarone will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- elagolix
elagolix will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- eliglustat
eliglustat increases levels of ivermectin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.
- erythromycin base
erythromycin base will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- erythromycin ethylsuccinate
erythromycin ethylsuccinate will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- erythromycin lactobionate
erythromycin lactobionate will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- erythromycin stearate
erythromycin stearate will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- felodipine
felodipine will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- fosphenytoin
fosphenytoin will decrease the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- fostamatinib
fostamatinib will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Concomitant use of fostamatinib may increase concentrations of P-gp substrates. Monitor for toxicities of the P-gp substrate drug that may require dosage reduction when given concurrently with fostamatinib.
- glecaprevir/pibrentasvir
glecaprevir/pibrentasvir will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- indinavir
indinavir will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- istradefylline
istradefylline will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.
- itraconazole
itraconazole will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- ivacaftor
ivacaftor increases levels of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Ivacaftor and its M1 metabolite has the potential to inhibit P-gp; may significantly increase systemic exposure to sensitive P-gp substrates with a narrow therapeutic index.
- ketoconazole
ketoconazole will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- lapatinib
lapatinib will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- levoketoconazole
levoketoconazole will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- lomitapide
lomitapide increases levels of ivermectin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing dose when used concomitantly with lomitapide.
- lonafarnib
lonafarnib will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Lonafarnib is a weak P-gp inhibitor. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. Reduce P-gp substrate dose if needed.
- loratadine
loratadine will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- lovastatin
lovastatin will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- nefazodone
nefazodone will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- nicardipine
nicardipine will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- nifedipine
nifedipine will decrease the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- nilotinib
nilotinib will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- phenobarbital
phenobarbital will decrease the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- phenytoin
phenytoin will decrease the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- ponatinib
ponatinib increases levels of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- quercetin
quercetin will decrease the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- ranolazine
ranolazine will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- rifampin
rifampin will decrease the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- ritonavir
ritonavir will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- sarecycline
sarecycline will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.
- simvastatin
simvastatin will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- sirolimus
sirolimus will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- St John's Wort
St John's Wort will decrease the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- stiripentol
stiripentol will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.
- tacrolimus
tacrolimus will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- tolvaptan
tolvaptan will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- trazodone
trazodone will decrease the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- tucatinib
tucatinib will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.
- verapamil
verapamil will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- warfarin
ivermectin increases effects of warfarin by unspecified interaction mechanism. Use Caution/Monitor.
Minor (0)
Adverse Effects
Frequency Not Defined
Abdominal pain
Asthenia
Hypotension
Mild EKG changes
Peripheral & facial edema
Transient tachycardia
Dizziness
Headache
Hyperthermia
Insomnia
Somnolence
Vertigo
Pruritus
Rash
Urticaria
Diarrhea
Nausea
Vomiting
Eosinophilia
Leukopenia
ALT/AST increased
Limbitis
Myalgia
Tremor
Blurred vision
Mild conjunctivitis
Punctate opacity
Mazzotti reaction (with onchocerciasis)
Edema
Fever
Lymphadenopathy
Ocular damage
Pruritus rash
Conjunctival hemorrhage (with onchocerciasis)
Hepatitis
Postmarketing Reports
Neurotoxicity, including alteration of consciousness of variable severity (eg, somnolence/drowsiness, stupor, and coma), confusion, disorientation, and death
Warnings
Contraindications
Hypersensitivity to ivermectin
Cautions
Strongyloidiasis: The patient should be reminded of the need for repeated stool examinations to document clearance of infection with Strongyloides stercoralis; not active against disseminated Strongyloides, only intestinal
Onchocerciasis: The patient should be reminded that treatment does not kill the adult Onchocerca volvulus parasite, and therefore repeated follow-up and retreatment is usually required
Long-term studies in animals have not been performed to evaluate carcinogenic potential of ivermectin
Therapy had no adverse effects on fertility in rats in studies at repeated doses of up to 3 times maximum recommended human dose of 200 mcg/kg (on mg/m2/day basis)
Immunocompromised patients may require repeated treatment; control of extraintestinal strongyloidiasis may require suppressive therapy (eg, once monthly)
Mazzotti reactions
- Microfilaricidal drugs, such as diethylcarbamazine citrate (DEC-C), might cause cutaneous and/or systemic reactions of varying severity (the Mazzotti reaction) and ophthalmological reactions in patients with onchocerciasis
- These reactions are probably due to allergic and inflammatory responses to the death of microfilariae; onchocerciasis treated patients may experience these reactions in addition to clinical adverse reactions possibly related to the drug itself
- The treatment of severe Mazzotti reactions has not been subjected to controlled clinical trials; oral hydration, recumbency, intravenous normal saline, and/or parenteral corticosteroids have been used to treat postural hypotension; antihistamines and/or aspirin have been used for most mild to moderate cases
- Neurotoxicity with use of ivermectin, including alteration of consciousness of variable severity (eg, somnolence/drowsiness, stupor, and coma), confusion, disorientation, and death, reported in patients without onchocerciasis or in patients with onchocerciasis in absence of Loa loa infection; these reactions have generally resolved with supportive care and discontinuation of therapy
Loiasis
- Rarely, patients with onchocerciasis who are also heavily infected with Loa loa may develop a serious or even fatal encephalopathy either spontaneously or following treatment with an effective microfilaricide
- The following adverse experiences have been reported in these patients, pain (including neck and back pain), red-eye, conjunctival hemorrhage, dyspnea, urinary and/or fecal incontinence, difficulty in standing/walking, mental status changes, confusion, lethargy, stupor, seizures, or coma
- This syndrome has been seen very rarely following the use of ivermectin; in individuals who warrant treatment with ivermectin for any reason and have had significant exposure to Loa loa endemic areas of West or Central Africa, implement pretreatment assessment for loiasis and careful post-treatment follow-up
Drug interactions overview
- Post-marketing reports of increased INR (International Normalized Ratio) have been rarely reported when ivermectin was co-administered with warfarin
Pregnancy & Lactation
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)
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Binds glutamate-gated Cl ion channels in invertebrate nerve and muscle cells; produces paralysis, death of parasite
Absorption
Well absorbed
Peak serum time: 4 hr
Peak effect: 3-6 months (treatment of orchocerciasis); 3 months (treatment of strongyloides)
Distribution
Protein bound: 93%
Vd: 3-3.5 L/kg
Does not cross blood-brain barrier
Metabolism
Hepatic (CYP3A4, CYP2D6, CYP2E1)
Elimination
Half-life: 18 hr
Excretion: Feces; urine (<1%)
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Stromectol oral - | 3 mg tablet |  | |
| Soolantra topical - | 1 % cream |  | |
| Soolantra topical - | 1 % cream |  | |
| ivermectin topical - | 1 % cream |  | |
| Sklice topical - | 0.5 % lotion |  | |
| ivermectin oral - | 3 mg tablet |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
ivermectin topical
IVERMECTIN LOTION - TOPICAL
(EYE-ver-MEK-tin)
COMMON BRAND NAME(S): Sklice
USES: This medication is used to treat head lice, tiny insects that attach to your hair and live on the blood from your scalp. Head lice infestation causes itching and irritation of the scalp. Ivermectin works by paralyzing and killing parasites such as lice and their eggs (nits).Ivermectin lotion is not recommended for use in children younger than 6 months of age. Too much medication may be absorbed through their skin, leading to an increased risk of side effects.
HOW TO USE: If you are using the over-the-counter product to self-treat, read and follow all directions on the product package before using this medication. If you have any questions, consult your pharmacist. If your doctor has prescribed this medication, use it as directed.Apply ivermectin lotion only to dry hair and scalp. Use enough lotion (up to 1 tube) to completely coat and cover all of your hair from the roots to the ends and all of your scalp. Leave it on for a full 10 minutes, then rinse off with water. Children should have an adult apply this medication for them. After using this medication, wait 24 hours before applying shampoo to hair and scalp.Do not use this medication on your eyebrows or eyelashes. Avoid getting this medication in your eyes. If this occurs, flush your eyes with water. Do not swallow this medication. Do not use ivermectin lotion in your mouth, nose, vagina, or other areas of your body. Wash your hands after applying this medication.This medication is for a single use only. Throw away any unused lotion. You may use a fine-tooth comb or a special lice/nit comb to remove dead lice/nits.Tell your doctor if your condition lasts or gets worse.
SIDE EFFECTS: Eye redness/irritation, dry skin, or a stinging/burning feeling may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using ivermectin, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: skin conditions.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.The form of this medication taken by mouth passes into breast milk in small amounts. It is unknown if this form of ivermectin passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
OVERDOSE: This medicine may be harmful if swallowed. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: rash, swelling, headache, dizziness, vomiting, diarrhea, numbness/tingling, seizures, loss of coordination, shortness of breath.
NOTES: To prevent the spread of lice, wash in hot water or dry clean all recently used clothing, hats, bedding, and towels. Soak and wash in hot water all hair care items such as brushes, combs, and hair clips.
MISSED DOSE: Not applicable.
STORAGE: Store at room temperature. Do not freeze. This medication is for single use only. Throw away any unused lotion. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised August 2021. Copyright(c) 2022 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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