Ivermectol represents a significant advancement in antiparasitic therapy, offering broad-spectrum efficacy against a range of nematode and arthropod infestations. As a semi-synthetic derivative of avermectin B1, it operates through a unique mechanism of action that potentiates glutamate-gated chloride ion channels in invertebrate nerve and muscle cells. This comprehensive profile details the pharmacological characteristics, clinical applications, and safety considerations of this potent anthelmintic agent, providing healthcare professionals with essential information for therapeutic decision-making.

Features

• Contains ivermectin as active pharmaceutical ingredient (typically 3mg, 6mg, or 12mg tablets)
• High bioavailability with peak plasma concentrations achieved within 4 hours post-administration
• Extensive tissue distribution with particularly high concentrations in liver and adipose tissue
• Plasma half-life of approximately 18 hours, allowing for convenient dosing regimens
• Metabolized primarily in the liver via cytochrome P450 3A4 system
• Excreted almost exclusively in feces with less than 1% renal excretion
• Demonstrated efficacy against both adult and larval stages of target parasites
• Standardized manufacturing under current Good Manufacturing Practices (cGMP)

Benefits

• Provides rapid and effective clearance of parasitic infections across multiple species
• Single-dose regimen sufficient for many indications, improving patient compliance
• Broad-spectrum activity reduces need for multiple antiparasitic medications
• Well-established safety profile with extensive clinical documentation
• Cost-effective treatment option for both individual and mass drug administration programs
• Minimal impact on beneficial gut flora compared to broad-spectrum antibiotics

Common use

Ivermectol is indicated for the treatment of various parasitic infections including strongyloidiasis caused by Strongyloides stercoralis, onchocerciasis (river blindness) resulting from Onchocerca volvulus infection, and lymphatic filariasis when used in combination with other agents. It demonstrates efficacy against cutaneous larva migrans, scabies caused by Sarcoptes scabiei infestation, and certain cases of pediculosis. Off-label applications include treatment of demodicosis and selected ectoparasitic infestations. The medication has proven particularly valuable in mass drug administration programs for neglected tropical diseases in endemic regions.

Dosage and direction

Dosage is weight-based, typically administered as a single oral dose of 150-200 mcg/kg. For strongyloidiasis: 200 mcg/kg once daily for 1-2 days. For onchocerciasis: 150 mcg/kg as a single dose, repeated every 6-12 months as needed. Tablets should be taken with water on an empty stomach (1 hour before or 2 hours after food) to optimize absorption. For patients with difficulty swallowing, tablets may be crushed and mixed with a small amount of water. Dosage adjustments may be necessary for patients with hepatic impairment. Follow-up stool examinations or skin snips are recommended to confirm parasite clearance.

Precautions

Exercise caution in elderly patients due to potential age-related decreases in hepatic function. Monitor patients with asthma or severe chronic obstructive pulmonary disease as hypersensitivity reactions may exacerbate respiratory symptoms. Use with caution in patients with history of seizure disorders as central nervous system effects have been reported. Consider alternative treatments in patients with compromised blood-brain barrier due to potential neurotoxicity. Regular ophthalmological examination is recommended for patients receiving repeated treatment for onchocerciasis due to possible retinal changes.

Contraindications

Hypersensitivity to ivermectin or any component of the formulation. Contraindicated in patients with meningitis or other conditions that may increase permeability of the blood-brain barrier. Not recommended for children weighing less than 15 kg unless potential benefits outweigh risks. Avoid use in pregnant women unless clearly needed due to limited safety data. Not indicated for treatment of invasive helminth infections during lactation. Contraindicated in patients with concurrent loiasis due to risk of severe encephalopathy.

Possible side effect

Common adverse reactions (≥1% incidence) include pruritus, rash, fever, lymph node tenderness, and transient eosinophilia. Musculoskeletal pain, dizziness, and orthostatic hypotension may occur within the first 24-48 hours post-treatment. Mazzotti-type reactions (fever, urticaria, lymphadenopathy) are frequently observed in patients with onchocerciasis. Rare but serious effects include toxic epidermal necrolysis, hepatitis, and neutropenia. Ophthalmological effects including conjunctival hemorrhage, anterior uveitis, and chorioretinitis have been reported in treatment of onchocerciasis.

Drug interaction

Strong CYP3A4 inhibitors (ketoconazole, ritonavir) may increase ivermectin plasma concentrations. Inducers of CYP3A4 (rifampin, carbamazepine) may decrease efficacy. Enhanced sedative effects may occur with concurrent benzodiazepine administration. Potential additive effect with other GABA-ergic agents. Warfarin metabolism may be affected, requiring increased monitoring of INR values. Exercise caution with concomitant use of other antiparasitic agents due to potential for additive neurotoxicity.

Missed dose

If a scheduled dose is missed, administer as soon as possible. However, if it is near the time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed administration. For mass drug administration programs, implement catch-up dosing according to program-specific guidelines. Document missed doses in patient records and assess potential impact on treatment efficacy.

Overdose

Symptoms of overdose may include gastrointestinal distress, neurological effects (dizziness, sedation, tremor), respiratory depression, and pupillary dilation. Management is primarily supportive with gastric lavage considered if presentation occurs within 1-2 hours of ingestion. Activated charcoal may be administered. Monitor vital signs and provide symptomatic treatment. Hemodialysis is not effective due to high protein binding and extensive tissue distribution. Contact poison control center for specific management recommendations.

Storage

Store at controlled room temperature (20-25°C/68-77°F) in original container. Protect from light and moisture. Keep blister strips intact until time of administration. Do not freeze. Keep out of reach of children and pets. Discard any medication that has passed the expiration date printed on packaging. Do not transfer tablets to other containers as this may affect stability.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Healthcare professionals should exercise clinical judgment when prescribing Ivermectol. Always verify current prescribing information and consult official product labeling. Dosage recommendations may vary based on regional guidelines and specific product formulations. The prescriber assumes full responsibility for appropriate patient selection and monitoring.

Reviews

Clinical studies demonstrate efficacy rates of 85-95% for strongyloidiasis with single-dose therapy. Meta-analysis of onchocerciasis treatment shows microfilarial load reduction exceeding 95% at 3 months post-treatment. Systematic review of mass drug administration programs indicates significant reduction in disease transmission in endemic areas. Dermatological applications show complete resolution of scabies in 70-80% of cases with single treatment, increasing to 95% with second dose. Long-term safety data from millions of treated patients support favorable benefit-risk profile. Ongoing research continues to explore expanded applications and optimized dosing regimens.