Ivermectin (systemic)_ Drug information - UpToDate

Prévia do material em texto

Official reprint from UpToDate
www.uptodate.com © 2024 UpToDate, Inc. and/or its affiliates. All Rights Reserved.
Brand Names: US
Stromectol
Pharmacologic Category
Anthelmintic
Dosing: Adult
®
Ivermectin (systemic): Drug information
2024© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
Contributor Disclosures
For additional information see "Ivermectin (systemic): Patient drug information" and "Ivermectin
(systemic): Pediatric drug information"
For abbreviations, symbols, and age group definitions show table
Ascariasis (alternative agent) (off-label use):
Note: For patients with complications (eg, intestinal obstruction, acute
cholangitis), initiate therapy after resolution of acute symptoms (Ref).
Oral: 150 to 200 mcg/kg as a single dose (Ref).
Collapse All
Ascariasis 
Demodex folliculitis (off-label use): Oral: 200 mcg/kg once weekly for 2 doses (Ref).
Demodex folliculitis 
Gnathostomiasis, cutaneous (off-label use):
Note: Not recommended for CNS disease due to inflammatory response from
dying larvae (Ref).
Gnathostomiasis, cutaneous 
5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 1/23
https://www.uptodate.com/
https://www.uptodate.com/contents/lexi-contributors-disclosure
https://www.uptodate.com/contents/ivermectin-systemic-patient-drug-information?search=ivermectin&topicRef=83315&source=see_link
https://www.uptodate.com/contents/ivermectin-systemic-pediatric-drug-information?search=ivermectin&topicRef=83315&source=see_link
https://www.uptodate.com/contents/ivermectin-systemic-pediatric-drug-information?search=ivermectin&topicRef=83315&source=see_link
https://www.uptodate.com/contents/image?imageKey=DRUG%2F57469&topicKey=DRUG_GEN%2F83315&search=ivermectin&source=see_link
https://www.uptodate.com/contents/image?imageKey=DRUG%2F57469&topicKey=DRUG_GEN%2F83315&search=ivermectin&source=see_link
Oral: 200 mcg/kg once daily for 2 days (Ref).
Hookworm-related cutaneous larva migrans (off-label use): Oral: 200 mcg/kg once
daily for 1 or 2 days (Ref).
Hookworm-related cutaneous larva migrans 
Lice, refractory (off-label use):
Note: Reserve for patients with an insufficient response to topical therapy (Ref).
Optimal dose, dosing interval, and frequency are uncertain (Ref).
Pediculus capitis: Oral: 200 mcg/kg once weekly for 2 doses (Ref); some experts
suggest 400 mcg/kg once weekly for 2 doses (Ref).
Pediculosis pubis: Oral: 200 mcg/kg once weekly for 2 doses (Ref); some experts
suggest 250 mcg/kg once, with a repeat dose in 7 to 14 days (Ref).
Lice, refractory 
Mansonella infection (off-label use):
Note: For individuals from Loa loa–endemic areas, rule out co-infection prior to
ivermectin administration to avoid life-threatening encephalopathy (Ref).
Mansonella ozzardi: Oral: 150 mcg/kg as a single dose (Ref).
Mansonella streptocerca infection (alternative agent): Oral: 150 mcg/kg as a single
dose (Ref).
Mansonella infection 
Onchocerciasis:
Note: For individuals from Loa loa–endemic areas, rule out co-infection prior to
ivermectin administration to avoid life-threatening encephalopathy (Ref).
Oral: 150 mcg/kg once; repeat dose every 3 to 6 months until asymptomatic (Ref).
For patients outside endemic areas or in areas with low transmission,
doxycycline therapy is initiated 1 week after the initial ivermectin dose (Ref).
Onchocerciasis 
5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 2/23
Scabies (off-label use):
Note: For cohabitants or other individuals who have had prolonged skin-to-skin
contact within the previous 6 weeks, simultaneous treatment is recommended
(Ref).
Classic scabies, treatment: Oral: 200 mcg/kg once; repeat dose in 7 to 14 days (Ref).
Crusted scabies, treatment: Oral: 200 mcg/kg once daily in combination with
permethrin for 3, 5, or 7 nonconsecutive days depending on infection severity
(eg, for 3 days: give on days 1, 2, and 8; for 5 days: give on days 1, 2, 8, 9, and
15; for 7 days: give on days 1, 2, 8, 9, 15, 22, and 29) (Ref).
Scabies 
Strongyloidiasis:
Note: For individuals from Loa loa–endemic areas, rule out co-infection prior to
ivermectin administration to avoid life-threatening encephalopathy (Ref).
Uncomplicated infection:
Patients who are immunocompetent: Oral: 200 mcg/kg once daily for 1 or 2
days (Ref).
Patients who are immunocompromised: Oral: 200 mcg/kg once daily for 2
days; repeat dosing regimen in 2 weeks (Ref).
Severe, disseminated infection: Oral: 200 mcg/kg once daily until symptoms have
resolved and stool and/or sputum examination is negative for ≥2 weeks (Ref).
Some experts suggest switching to an alternative approach for patients who
are immunocompromised or critically ill with persistently positive (eg, ≥3 days)
stool examination (Ref). For patients with persistent immunosuppression after
clinical improvement, some experts use suppressive ivermectin 200 mcg/kg
once monthly for ≥6 months (Ref).
Strongyloidiasis 
Trichuriasis (whipworm) (alternative agent) (off-label use): Oral: 600 mcg/kg once
daily for 3 days in combination with albendazole (Ref).
Trichuriasis 
5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 3/23
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring
dose/frequency adjustment or avoidance. Consult drug interactions database for more
information.
Dosing: Kidney Impairment: Adult
The renal dosing recommendations are based upon the best available evidence and clinical
expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts,
PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
Altered kidney function: No dosage adjustment necessary for any degree of kidney
dysfunction (<1% excreted in the urine) (Ref).
Hemodialysis, intermittent (thrice weekly): Unlikely to be significantly dialyzed (highly
protein bound; large V ): No supplemental dose or dosage adjustment necessary (Ref).
Peritoneal dialysis: Unlikely to be significantly dialyzed (highly protein bound; large V ): No
dosage adjustment necessary (Ref).
CRRT: No dosage adjustment necessary (Ref).
PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (Ref).
Dosing: Hepatic Impairment: Adult
There are no dosage adjustments provided in manufacturer’s labeling.
Dosing: Older Adult
Refer to adult dosing.
Dosing: Pediatric
(For additional information see "Ivermectin (systemic): Pediatric drug information")
Dosage guidance:
Safety: For individuals from Loa loa-endemic areas, rule out coinfection prior to
ivermectin administration to avoid life-threatening encephalopathy (Ref).
Dosing: Description of ivermectin use in infants and children weighing <15 kg is limited
due to theoretical risk for CNS adverse events, however it has been used in this
population for a variety of indications with no reports of serious adverse events (Ref).
Following the indication-specific dosing information are weight-band dosing tables to
assist with calculation and rounding of doses.
d
d
Collapse All
Ascariasis; roundworm 
5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 4/23
https://www.uptodate.com/contents/ivermectin-systemic-pediatric-drug-information?search=ivermectin&topicRef=83315&source=see_link
Ascariasis (Ascaris lumbricoides); roundworm (alternative agent): Limited data
available: Children ≥15 kg and Adolescents: Oral: 150 to 200 mcg/kg/dose as a
single dose (Ref).
Gnathostomiasis, cutaneous: Limited data available:Children ≥15 kg and
Adolescents: Oral: 200 mcg/kg/dose once daily for 2 days (Ref).
Gnathostomiasis, cutaneous 
Hookworm-related cutaneous larva migrans: Limited data available: Children ≥15 kg
and Adolescents: Oral: 200 mcg/kg as a single dose (Ref).
Hookworm-related cutaneous larva migrans 
Lice (alternative agent): Limited data available: Note: Ivermectin is not ovicidal;
therefore, repeat doses are necessary to eradicate infestation:
Head lice: Children ≥15 kg and Adolescents: Oral: 200 to 400 mcg/kg/dose for 2
doses administered 9 to 10 days apart. Dosing at the higher end of the range
(ie, 400 mcg/kg/dose) may result in fewer treatment failures (Ref).
Pubic lice: Children ≥15 kg and Adolescents: Oral: 250 mcg/kg/dose for 2 doses
administered 7 to 14 days apart (Ref).
Lice 
Mansonella infection:
Mansonella ozzardi: Limited data available: Children ≥15 kg and Adolescents: Oral:
150 mcg/kg as a single dose (Ref).
Mansonella streptocerca : Limited data available: Children ≥15 kg and Adolescents:
Oral: 150 mcg/kg as a single dose (Ref).
Mansonella infection 
Onchocerciasis (Onchocerca volvulus); river blindness:
Onchocerciasis; river blindness 
5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 5/23
Weight-band dosing: Weight-band dosing tables are provided to assist with calculation and
rounding of doses; refer to indication-specific dosing for details.
Weight-Band Dosing to Provide
~150 mcg/kg
Patient Weight Single Oral Dose
15 to 25 kg 3 mg
26 to 44 kg 6 mg
45 to 64 kg 9 mg
65 to 84 kg 12 mg
Weight-Band Dosing to Provide
~200 mcg/kg
Patient Weight Single Oral Dose
Children ≥15 kg and Adolescents: Oral: 150 mcg/kg/dose every 3 to 6 months until
asymptomatic (Ref). Ivermectin is only effective against microfilariae; if
treatment of macrofilariae is desired, doxycycline may be initiated 1 week after
ivermectin treatment (Ref).
Scabies: Limited data available: Children ≥15 kg and Adolescents: Oral: 200
mcg/kg/dose for 2 doses administered at 7 to 14 days apart (Ref).
Scabies 
Strongyloidiasis:
Children ≥15 kg and Adolescents: Oral: 200 mcg/kg/dose once daily for 1 to 2 days.
Patients with hyperinfection and disseminated disease may need prolonged or
repeated treatment (eg, daily treatment until stool and/or sputum exams are
negative for 2 weeks) (Ref).
Strongyloidiasis 
Trichuriasis ( Trichuris trichiura); whipworm: Limited data available: Children ≥15 kg
and Adolescents: Oral: 200 mcg/kg/dose once daily for 3 days (Ref).
Trichuriasis; whipworm 
5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 6/23
Patient Weight Single Oral Dose
15 to 24 kg 3 mg
25 to 35 kg 6 mg
36 to 50 kg 9 mg
51 to 65 kg 12 mg
66 to 79 kg 15 mg
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring
dose/frequency adjustment or avoidance. Consult drug interactions database for more
information.
Dosing: Kidney Impairment: Pediatric
There are no dosage adjustments provided in the manufacturer's labeling.
Dosing: Hepatic Impairment: Pediatric
There are no dosage adjustments provided in the manufacturer's labeling.
Adverse Reactions (Significant): Considerations
CNS effects including neurotoxicity (eg, ataxia, confusion, disorientation,
encephalopathy, impaired consciousness [including coma], stupor, tremor) and
central nervous system depression with subsequent breathing difficulties, have
rarely been reported in humans, but are well known to occur in animals (Ref).
Theoretical risk for CNS effects in infants and young children due to immature
blood-brain barrier has been extrapolated from animal data and has minimized
use in patients <15 kg. Existing data in younger pediatric patients are limited, with
recent evaluations describing ivermectin use in patients <15 kg for a variety of
indications with no reports of serious adverse events (Ref).
Mechanism: CNS effects occur when ivermectin crosses the blood-brain barrier into
the spinal cord, midbrain or cerebrum and blocks important neuronal
transmission that involves glutamate or gamma-amino butyric acid (Ref). In
infants and young children, it has been proposed that ivermectin may cross
the immature blood-brain barrier, resulting in CNS toxicity (Ref). In patients
with a well-developed blood-brain barrier, the neurological adverse effects of
ivermectin are thought to occur when the ATP-binding cassette subfamily B
member 1 (ABCB1) transporter (also known as P-glycoprotein) is altered and
fails to prevent the uptake of ivermectin into the brain (Ref).
Collapse All
CNS effects 
5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 7/23
Onset: Rapid; typically occurs within hours of dosing, although has also been
described as late as 7 days after administration (Ref).
Risk factors:
• Immature blood-brain barrier (Ref)
• Body weight <15 kg as a surrogate marker for an immature blood-brain
barrier (Ref)
• Mutation in ABCB1 (P-glycoprotein) transporter (Ref)
A variety of delayed hypersensitivity reactions, ranging from skin rash to severe
cutaneous adverse reactions (SCAR), including Stevens-Johnson syndrome/toxic
epidermal necrolysis and drug reaction with eosinophilia and systemic
symptoms have been reported with ivermectin use (Ref).
Mechanism: Non–dose-related; immunologic. Delayed hypersensitivity reactions,
including rashes (often maculopapular) and SCARs are T-cell-mediated (Ref).
Onset: Delayed hypersensitivity reactions: Varied. SCARs usually occur within 1 to 8
weeks after initiation (Ref), although cases associated with ivermectin have
been reported within 3 days after receiving a single dose (Ref).
Hypersensitivity reactions (delayed) 
Ivermectin may cause an immunologic post-treatment reaction, also known as a
Mazzoti reaction, which is associated with pruritus, skin rash, fever, fatigue,
lymphadenopathy, arthralgia, tachycardia, hypotension (including orthostatic
hypotension), edema, and abdominal pain (Ref). Most cases have been reported
in association with the treatment of onchocerciasis, but cases have also been
reported in association with the treatment of other infections (eg, scabies) (Ref).
Symptoms are mostly mild and usually resolve in 4 days; however, cases of coma
and death have been reported, although these deaths are often attributed to Loa
loa-associated encephalopathy (Ref). Serious Mazzoti reactions are estimated to
occur in 19% to 81% of patients exposed to ivermectin for the treatment of filarial
parasites, which is disproportionality more than other antinematodal drugs (Ref).
Mechanism: Non–dose-related; immunologic. Ivermectin exerts a strong
microfilaricidal effect on filariae, leading to a destruction of microfilariae. In
patients with high densities of microfilariae in the skin or blood, this may
Immunologic post-treatment reaction (Mazzoti reaction) 
5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 8/23
Adverse Reactions
The following adverse drug reactions and incidences are derived from product labeling unless
otherwise specified.
≥10%: Miscellaneous: Mazzotti reaction (associated with onchocerciasis: pruritus: 28%; fever:
23%; skin edema, papular rash, pustular rash, and urticaria: ≤23%; arthralgia and
synovitis: ≤9%; lymphadenitis [axillary node: 4% to 11%, cervical node: 1% to 5%, inguinal
node: 13% to 14%, other lymph node: 2% to 3%])
1% to 10%:
Cardiovascular: Orthostatic hypotension (1%), peripheral edema (3%), tachycardia (4%)
Dermatologic: Pruritus (associatedwith strongyloidiasis: 3%)
Gastrointestinal: Diarrhea (2%), nausea (2%)
Hematologic & oncologic: Decreased white blood cell count (3%), eosinophilia (3%),
increased hemoglobin (1%)
Hepatic: Increased serum alanine aminotransferase (2%), increased serum aspartate
aminotransferase (2%)
Hypersensitivity: Facial edema (1%)
Nervous system: Dizziness (3%)
Ophthalmic: Inflammation of limbus of eyes (4% to 6%), punctate cataract (1% to 2%)
<1%:
Dermatologic: Skin rash, urticaria (associated with strongyloidiasis)
Gastrointestinal: Abdominal pain, anorexia, constipation, vomiting
induce complex inflammatory reactions resulting in local tissue damage and
degradation of host structures (Ref).
Onset: Varied; within 1 to 7 days of therapy initiation (Ref).
Risk factors:
• High densities of microfilariae (ie, the larval stages of the filarial parasites)
(Ref)
• Treatment of filarial parasites (Ref)
5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 9/23
Hematologic & oncologic: Anemia, leukopenia
Nervous system: Asthenia, drowsiness, fatigue, headache, tremor, vertigo
Neuromuscular & skeletal: Myalgia
Ophthalmic: Vision loss
Frequency not defined:
Cardiovascular: Chest discomfort
Gastrointestinal: Abdominal distention
Postmarketing:
Cardiovascular: Hypotension
Dermatologic: Stevens-Johnson syndrome (Oshikoya 2020), toxic epidermal necrolysis
(Oshikoya 2020)
Hepatic: Hepatitis (Veit 2006), increased liver enzymes, increased serum bilirubin
Hypersensitivity: Drug reaction with eosinophilia and systemic symptoms (Kerneuzet
2018)
Nervous system: Central nervous system depression (Chandler 2018), neurotoxicity
(including ataxia, confusion, disorientation, encephalopathy, impaired consciousness
[including coma], stupor) (Baudou 2020; Chandler 2018), seizure (Chandler 2018)
Ophthalmic: Abnormal sensation in eyes, anterior uveitis, chorioretinitis (including
choroiditis), conjunctival hemorrhage, conjunctivitis, diplopia (Campillo 2021), eyelid
edema, keratitis
Respiratory: Exacerbation of asthma
Contraindications
Hypersensitivity to ivermectin or any component of the formulation
Warnings/Precautions
Special populations:
• Immunocompromised patients: Repeated treatment may be required in
immunocompromised patients (eg, HIV); control of extraintestinal strongyloidiasis
may necessitate suppressive (once monthly) therapy.
Other warnings/precautions:
5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 10/23
• Appropriate use: Onchocerca volvulus: Ivermectin has no activity against adult O. volvulus
parasites. L. loa: Ivermectin is not active against adult worms.
Dosage Forms: US
Excipient information presented when available (limited, particularly for generics); consult
specific product labeling.
Tablet, Oral:
Stromectol: 3 mg
Generic: 3 mg
Generic Equivalent Available: US
Yes
Pricing: US
Tablets (Ivermectin Oral)
3 mg (per each): $4.97
Tablets (Stromectol Oral)
3 mg (per each): $5.58
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided
as reference price only. A range is provided when more than one manufacturer's AWP price is
available and uses the low and high price reported by the manufacturers to determine the
range. The pricing data should be used for benchmarking purposes only, and as such should
not be used alone to set or adjudicate any prices for reimbursement or purchasing functions
or considered to be an exact price for a single product and/or manufacturer. Medi-Span
expressly disclaims all warranties of any kind or nature, whether express or implied, and
assumes no liability with respect to accuracy of price or price range data published in its
solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or
consequential damages arising from use of price or price range data. Pricing data is updated
monthly.
Administration: Adult
Oral: Administer on an empty stomach with water (manufacturer’s labeling). Some experts
recommend administering with food to increase absorption (Ref).
Administration: Pediatric
Oral: The manufacturer recommends administration on an empty stomach with water.
However, some experts recommend administering with food to increase absorption;
5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 11/23
(For additional information: Launch drug interactions program)
administration with a high-fat meal as compared to fasted increased bioavailability ~2.5 times
in healthy volunteers (Ref).
Use: Labeled Indications
Onchocerciasis: Treatment of onchocerciasis due to the immature form of Onchocerca
volvulus.
Limitations of use: Ivermectin has no activity against adult Onchocerca volvulus parasites.
The adult parasites reside in subcutaneous nodules, which are infrequently palpable.
Surgical excision may be considered since removal of these nodules will eliminate the
microfilariae-producing adult parasites.
Strongyloidiasis: Treatment of intestinal (eg, nondisseminated) strongyloidiasis due to
Strongyloides stercoralis.
Use: Off-Label: Adult
Ascariasis; Demodex folliculitis; Gnathostomiasis, cutaneous; Hookworm-related cutaneous
larva migrans; Lice, refractory; Mansonella infection; Scabies; Trichuriasis
Medication Safety Issues
Metabolism/Transport Effects
Substrate of CYP3A4 (minor), P-glycoprotein/ABCB1 (minor); Note: Assignment of
Major/Minor substrate status based on clinically relevant drug interaction potential
Drug Interactions
Note: Interacting drugs may not be individually listed below if they are part of a group
interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a
complete list of drug interactions by individual drug name and detailed management
recommendations, use the drug interactions program by clicking on the “Launch drug
interactions program” link above.
KIDs List: Ivermectin (systemic), when used in infants <1 year of age, is identified
on the Key Potentially Inappropriate Drugs in Pediatrics (KIDs) list and should
be avoided due to risk of encephalopathy (weak recommendation; low quality
of evidence) (PPA [Meyers 2020]).
Pediatric patients: High-risk medication: 
5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 12/23
https://www.uptodate.com/drug-interactions/?search=ivermectin&topicId=83315&source=responsive_topic
Bacillus clausii: Antibiotics may diminish the therapeutic effect of Bacillus clausii.
Management: Bacillus clausii should be taken in between antibiotic doses during
concomitant therapy. Risk D: Consider therapy modification
BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk X:
Avoid combination
BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine
(Immunization). Risk C: Monitor therapy
Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine.
Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within
14 days following the use of oral or parenteral antibiotics. Risk X: Avoid combination
Fecal Microbiota (Live) (Oral): May diminish the therapeutic effect of Antibiotics. Risk X: Avoid
combination
Fecal Microbiota (Live) (Rectal): Antibiotics may diminish the therapeutic effect of Fecal
Microbiota (Live) (Rectal). Risk X: Avoid combination
Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may
diminish the therapeutic effect of Immune Checkpoint Inhibitors (Anti-PD-1,-PD-L1, and -
CTLA4 Therapies). Risk C: Monitor therapy
Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and
Estriol. Risk C: Monitor therapy
Mycophenolate: Antibiotics may decrease serum concentrations of the active metabolite(s) of
Mycophenolate. Specifically, concentrations of mycophenolic acid (MPA) may be reduced.
Risk C: Monitor therapy
Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate.
Management: Consider using an alternative product for bowel cleansing prior to a
colonoscopy in patients who have recently used or are concurrently using an antibiotic.
Risk D: Consider therapy modification
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the
live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated
typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents.
Postpone vaccination until 3 days after cessation of antibiotics and avoid starting
antibiotics within 3 days of last vaccine dose. Risk D: Consider therapy modification
Vitamin K Antagonists (eg, warfarin): Ivermectin (Systemic) may enhance the anticoagulant
effect of Vitamin K Antagonists. Risk C: Monitor therapy
5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 13/23
Food Interactions
Bioavailability appears to be increased with food, but the extent of the interaction is
uncertain. When administered following a high-fat meal, bioavailability has been shown to
increase 1.18- to 2.57-fold with a wide range of doses studied (6 to 30 mg) (Duthaler 2020;
Guzzo 2002; Miyajima 2016). Management: The manufacturer recommends to administer on
an empty stomach, although some experts recommend administering with food to increase
absorption (CDC [Workowski 2021]; Currie 2010).
Reproductive Considerations
Evaluate pregnancy status prior to use in patients who may become pregnant; patients
arriving as refugees from specific countries should not be given ivermectin for the
presumptive treatment of intestinal parasites without a reliable history of their last menstrual
period (CDC 2019a).
Pregnancy Considerations
Outcome information following maternal use of ivermectin during pregnancy is primarily
limited to inadvertent exposure during mass treatment programs (Chippaux 1993; Gyapong
2003; Ndyomugyenyi 2008; Nicolas 2020; Pacqué 1990; Westlake 2020).
The decision to use ivermectin during pregnancy should consider the specific indication (eg,
onchocerciasis or Strongyloides infection) and the risk of disease progression in the absence of
treatment (CDC 2021; CDC 2022) Although use in pregnancy is likely low risk, other agents are
currently recommended for the treatment of pediculosis pubis or scabies in pregnant
patients (CDC [Workowski 2021]).
Breastfeeding Considerations
Ivermectin is present in breast milk.
Peak ivermectin breast milk concentrations generally occurred between 4 hours (n=2) and 6
hours (n=2) after a single maternal dose; although the peak breast milk concentration
occurred at 12 hours in one patient (Ogbuokiri 1994; Rodari 2020).
The decision to use ivermectin in a patient who is breastfeeding should consider the specific
indication (eg, onchocerciasis or Strongyloides infection) and the risk of disease
progression in the absence of treatment (CDC 2021; CDC 2022). Although use is likely low
risk, other agents are currently recommended for the treatment of pediculosis pubis or
scabies in patients who are breastfeeding (CDC [Workowski 2021]). Breastfeeding
patients arriving as refugees from specific countries should not be given ivermectin for
the presumptive treatment of intestinal parasites during their first week postpartum
(CDC 2019a).
5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 14/23
Monitoring Parameters
Skin and eye microfilarial counts, periodic ophthalmologic exams; follow up stool
examinations; signs and symptoms of neurotoxicity.
Mechanism of Action
Ivermectin is a semisynthetic anthelminthic 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.
Pharmacokinetics (Adult Data Unless Noted)
Absorption: Well absorbed in the fasting state (Baraka 1996; Edwards 1988; Okonkwo 1993);
may be increased with a high-fat meal (Duthaler 2020; Guzzo 2002; Miyajima 2013).
Distribution: V :
Children 2 to 5 years: Median range: 7.46 to 8.26 L/kg (Schulz 2019).
Children 6 to 12 years: Median range: 8.58 to 10.4 L/kg (Schulz 2019).
Adults: 3.1 to 3.5 L/kg in healthy volunteers; mean 9.9 L/kg (range: 6.9 to 15.3 L/kg) in
patients with onchocerciasis; high concentration in the liver and adipose tissue; does
not readily cross the blood-brain barrier (Gonzalez Canga 2008; Okonkwo 1993).
Protein binding: ~93% primarily to albumin (Gonzalez Canga 2008).
Metabolism: Hepatic via CYP3A4 (major), CYP2D6 (minor), and CYP2E1 (minor).
Half-life elimination:
Children 2 to 5 years: Median range: 16.3 to 17.3 hours (Schulz 2019).
Children 6 to 12 years: Median range: 18.1 to 19.1 hours (Schulz 2019).
Adults: 18 hours.
Time to peak, serum: ~4 hours.
Excretion: Feces; urine (<1%).
Brand Names: International
d
For country code abbreviations ( show table)
(AE) United Arab Emirates: Imectin; (AR) Argentina: Iver p | Ivercass | Ivermectina Monserrat eclair
International Brand Names by Country 
5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 15/23
https://www.uptodate.com/contents/image?imageKey=DRUG%2F116421&topicKey=DRUG_GEN%2F83315&search=ivermectin&source=see_link
https://www.uptodate.com/contents/image?imageKey=DRUG%2F116421&topicKey=DRUG_GEN%2F83315&search=ivermectin&source=see_link
Use of UpToDate is subject to the Terms of Use.
REFERENCES
1. Addiss DG, Beach MJ, Streit TG, et al, "Randomised Placebo-Controlled Comparison of Ivermectin and
Albendazole Alone and in Combination for Wuchereria bancrofti Microfilaraemia In Haitian Children," Lancet,
1997, 350(9076):480–4. [PubMed 9274584]
2. American Academy of Pediatrics (AAP). Devore CD, Schutze GE; The Council on School Health and Commitee on
Infectious Diseases. Head Lice. Pediatrics. 2015; 135:e1355-e1365.
3. American Academy of Pediatrics (AAP). In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book:
2021 Report of the Committee on Infectious Diseases. 32nd ed. American Academy of Pediatrics; 2021.
4. Aroke D, Tchouakam DN, Awungia AT, Mapoh SY, Ngassa SN, Kadia BM. Ivermectin induced Steven-Johnsons
syndrome: case report. BMC Res Notes. 2017;10(1):179. doi:10.1186/s13104-017-2500-5 [PubMed 28482929]
| Ivertal | Securo | Vermectin; (AT) Austria: Ivergelan | Scabioral; (AU) Australia: Stromectol; (BD)
Bangladesh: A mectin | Alice | Avemac | Imec | Ivactin | Ivacure | Iverum | Ivtin | Parakil |
Stromec | Veratin | Vercov; (BE) Belgium: Ivermectin substipharm; (BG) Bulgaria: Huvemec; (BR)
Brazil: Iverliv | Ivermec | Ivermectina | Iverneo | Leverctin | Plurimec | Revectina | Uciose |
Vermectil; (CL) Chile: Kaonol; (CN) China: Hai zheng mai ke ding; (CZ) Czech Republic: Loutol; (DE)
Germany: Driponin | Iveraxiro | Ivermectin carefarm | Ivermectin Padia | Scabioral; (DO)
Dominican Republic: Ivermectina | Ivermectina calox | Ivermectina mamey | Ivexterm; (EC)
Ecuador: Amectin | Comviral | Ivermectina | Ivermin | Ivernovum novum | Ivervid | Nevimune |
Vermetil h; (EE) Estonia: Ivermectine arrow lab | Stromectol;(EG) Egypt: Ivactin | Iverzine |
Razimectin; (ES) Spain: Ivercare | Ivergalen | Ivermectina teva; (FI) Finland: Ivermectin medical
valley | Ivermectine ratiopharm | Scatol; (FR) France: Ivermectine arrow | Ivermectine biogaran |
Ivermectine cristers | Ivermectine eg | Ivermectine mylan | Ivermectine pierre fabre | Ivermectine
sandoz | Ivermectine teva | Ivermectine zentiva | Iverscal | Stromectol; (GB) United Kingdom:
Stromectol; (GR) Greece: Scaball; (HK) Hong Kong: Stromectol; (ID) Indonesia: Ivercov |
Mectinsanbe; (IN) India: Afdiver | Covidmectin | Covimac | Isco | Itin | Ivecop | Ivepack | Iver sol |
Iverbill | Ivercid | Ivercoast | Iverlin | Iverme | Ivermectol | Ivernock | Iverpil | Iversure |
Iversurge | Ivertero | Iverzen | Ivor | Ivscab | Mbez 12 | Mectin | Preco | Scavista | Tough |
Vermac | Vermact | Vermectin | Vimect | Viomectin; (IT) Italy: Iverscab | Stromectol; ( JP) Japan:
Stromectol; (KE) Kenya: Ivermectol; (KR) Korea, Republic of: Iverin; (LB) Lebanon: Ivactin | Iver p |
Ivermectine | Ivermectine biogaran | Iverzine; (LT) Lithuania: Scabioral | Stromectol; (LV) Latvia:
Stromectol; (MX) Mexico: Ivermectina | Ivexterm | Stromectol | Veridex; (MY) Malaysia: Ivermectol;
(NL) Netherlands: Ivermectine xiromed | Stromectol; (NO) Norway: Driponin | Ivermectin medical
valley | Scatol | Stromectol | Stromectol specific; (NZ) New Zealand: Stromectol; (PE) Peru: Kaonol;
(PK) Pakistan: Everlite | Felvot | Iveratan | Iverest | Ivermite | Iverterm | Mectis | Norm | Suint;
(PL) Poland: Ivermectin medical valley | Posela; (PR) Puerto Rico: Stromectol; (PT) Portugal: Mectizan
| Stromectol; (PY) Paraguay: Ivermectina dutriec | Ivermectina guayaki | Kaonol | Vivermet |
Yvermil; (QA) Qatar: Stromectol; (SE) Sweden: Ivermectin medical valley | Scatol; (SG) Singapore:
Stromectol; (SI) Slovenia: Scabioral | Stromectol; (SK) Slovakia: Ivermectin exeltis; (SL) Sierra Leone:
Mectizan; (TR) Turkey: Ziver; (TW) Taiwan: Stromectol; (UY) Uruguay: Iver 6 | Ivermectina |
Ivermectina Athena | Sanifer; (VE) Venezuela, Bolivarian Republic of: Ivergot | Ivermectina | Ivertal
| Iverwell; (VN) Viet Nam: Ivermectin nic | Pizar; (ZA) South Africa: Iladek
5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 16/23
https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/9274584/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/28482929/pubmed
5. Baraka OZ, Mahmoud BM, Marschke CK, Geary TG, Homeida MM, Williams JF. Ivermectin distribution in the
plasma and tissues of patients infected with Onchocerca volvulus. Eur J Clin Pharmacol. 1996;50(5):407-410.
doi:10.1007/s002280050131 [PubMed 8839664]
6. Baudou E, Lespine A, Durrieu G, et al. Serious ivermectin toxicity and human ABCB1 nonsense mutations. N
Engl J Med. 2020;383(8):787-789. doi:10.1056/NEJMc1917344 [PubMed 32813957]
7. Belizario VY, Amarillo ME, de Leon WU, de los Reyes AE, Bugayong MG, Macatangay BJ. A comparison of the
efficacy of single doses of albendazole, ivermectin, and diethylcarbamazine alone or in combinations against
Ascaris and Trichuris spp. Bull World Health Organ. 2003;81(1):35-42. [PubMed 12640474]
8. Bellón T. Mechanisms of severe cutaneous adverse reactions: Recent advances. Drug Saf. 2019;42(8):973-992.
doi:10.1007/s40264-019-00825-2 [PubMed 31020549]
9. Boussinesq M, Gardon J, Gardon-Wendel N, Kamgno J, Ngoumou P, Chippaux JP. Three probable cases of Loa
loa encephalopathy following ivermectin treatment for onchocerciasis. Am J Trop Med Hyg. 1998;58(4):461-469.
doi:10.4269/ajtmh.1998.58.461 [PubMed 9574793]
10. Brockow K, Przybilla B, Aberer W, et al. Guideline for the diagnosis of drug hypersensitivity reactions: S2K-
Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) and the German
Dermatological Society (DDG) in collaboration with the Association of German Allergologists (AeDA), the
German Society for Pediatric Allergology and Environmental Medicine (GPA), the German Contact Dermatitis
Research Group (DKG), the Swiss Society for Allergy and Immunology (SGAI), the Austrian Society for Allergology
and Immunology (ÖGAI), the German Academy of Allergology and Environmental Medicine (DAAU), the German
Center for Documentation of Severe Skin Reactions and the German Federal Institute for Drugs and Medical
Products (BfArM). Allergo J Int. 2015;24(3):94-105. doi:10.1007/s40629-015-0052-6 [PubMed 26120552]
11. Brooks PA, Grace RF. Ivermectin is better than benzyl benzoate for childhood scabies in developing countries. J
Paediatr Child Health. 2002;38(4):401-414. doi:10.1046/j.1440-1754.2002.00015.x [PubMed 12174005]
12. Burkhart CG, Burkhart CN. Oral Ivermectin for Phthirus pubis. J Am Acad Dermatol. 2004;51(6):1037; author
reply 1037-1038. doi:10.1016/j.jaad.2004.04.041 [PubMed 15583618]
13. Burkhart CN, Burkhart CG. Before using ivermectin therapy for scabies. Pediatr Dermatol. 1999;16(6):478-479;
discussion 480. doi:10.1046/j.1525-1470.1999.00124.x [PubMed 10632951]
14. Campillo JT, Boussinesq M, Bertout S, Faillie JL, Chesnais CB. Serious adverse reactions associated with
ivermectin: A systematic pharmacovigilance study in sub-Saharan Africa and in the rest of the World. PLoS Negl
Trop Dis. 2021;15(4):e0009354. doi:10.1371/journal.pntd.0009354 [PubMed 33878105]
15. Carme B, Ebikili B, Mbitsi A, Copin N. [Therapeutic trial with ivermectin in loiasis with medium and high
microfilaremia]. [Article in French]. Am J Trop Med Hyg. 1988;39(5):480-483. [PubMed 2043000]
16. Centers for Disease Control and Prevention (CDC). Guidelines for overseas presumptive treatment of
strongyloidiasis, schistosomiasis, and soil-transmitted helminth infections for refugees resettling to the United
States. https://www.cdc.gov/immigrantrefugeehealth/guidelines/overseas/intestinal-parasites-overseas.html.
Updated February 2019a. Accessed November 9, 2020.
17. Centers for Disease Control and Prevention (CDC). Parasites - Onchocerciasis (also known as River Blindness).
https://www.cdc.gov/parasites/onchocerciasis/health_professionals/index.html. Updated November 10, 2021.
Accessed July 25, 2022.
5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 17/23
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/8839664/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/32813957/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/12640474/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/31020549/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/9574793/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/26120552/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/12174005/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/15583618/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/10632951/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/33878105/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/2043000/pubmed
https://www.cdc.gov/immigrantrefugeehealth/guidelines/overseas/intestinal-parasites-overseas.html
https://www.cdc.gov/parasites/onchocerciasis/health_professionals/index.html
18. Centers for Disease Control and Prevention (CDC). Parasites - Strongyloides.
https://www.cdc.gov/parasites/strongyloides/health_professionals/index.html. Updated July 7, 2022. Accessed
July 13, 2022.19. Centers for Disease Control and Prevention (CDC). Parasites - Strongyloides.
https://www.cdc.gov/parasites/strongyloides/health_professionals/index.html. Updated June 16, 2023. Accessed
July 19, 2023.
20. Centers for Disease Control and Prevention (CDC). Parasites - zoonotic hookworm.
https://www.cdc.gov/parasites/zoonotichookworm/health_professionals/index.html. Updated May 26, 2020.
Accessed July 19, 2023.
21. Centers for Disease Control and Prevention (CDC). Scabies.
http://www.cdc.gov/parasites/scabies/health_professionals/meds.html. Updated October 2019b. Accessed April
15, 2022.
22. Chandler RE. Serious neurological adverse events after ivermectin-do they occur beyond the indication of
onchocerciasis? Am J Trop Med Hyg. 2018;98(2):382-388. doi:10.4269/ajtmh.17-0042 [PubMed 29210346]
23. Chippaux JP, Gardon-Wendel N, Gardon J, Ernould JC. Absence of any adverse effect of inadvertent ivermectin
treatment during pregnancy. Trans R Soc Trop Med Hyg. 1993;87(3):318. doi:10.1016/0035-9203(93)90146-h
[PubMed 8236406]
24. Chosidow O, Giraudeau B, Cottrell J, et al. Oral ivermectin versus malathion lotion for difficult-to-treat head lice.
N Engl J Med, 2010;362(10):896-905. doi:10.1056/NEJMoa0905471 [PubMed 20220184]
25. Currie BJ, McCarthy JS. Permethrin and ivermectin for scabies. N Engl J Med. 2010;362(8):717-725.
doi:10.1056/NEJMct0910329 [PubMed 20181973]
26. de Almeida Basano S, de Souza Almeida Aranha Camargo J, Fontes G, et al. Phase III clinical trial to evaluate
ivermectin in the reduction of Mansonella ozzardi infection in the Brazilian Amazon. Am J Trop Med Hyg.
2018;98(3):786-790. doi:10.4269/ajtmh.17-0698 [PubMed 29313486]
27. de Almeida Basano S, Fontes G, Medeiros JF, et al. Sustained clearance of Mansonella ozzardi infection after
treatment with ivermectin in the Brazilian Amazon. Am J Trop Med Hyg. 2014;90(6):1170-1175.
doi:10.4269/ajtmh.13-0410 [PubMed 24710613]
28. de Silva N, Guyatt H, and Bundy D, “Anthelmintics. A Comparative Review of Their Clinical Pharmacology,”
Drugs, 1997, 53(5):769-88. [PubMed 9129865]
29. Devore CD, Schutze GE, Council on School Health and Committee on Infectious Diseases, American Academy of
Pediatrics. Head lice. Pediatrics. 2015;135(5):e1355-1365. [PubMed 25917986]
30. Drugs for Parasitic Infections. In: The Medical Letter. 2013;11(143):e1-e31.
31. Duthaler U, Leisegang R, Karlsson MO, Krähenbühl S, Hammann F. The effect of food on the pharmacokinetics
of oral ivermectin. J Antimicrob Chemother. 2020;75(2):438-440. doi:10.1093/jac/dkz466 [PubMed 31691813]
32. Edwards G. Ivermectin: does P-glycoprotein play a role in neurotoxicity? Filaria J. 2003;2 Suppl 1(Suppl 1):S8.
doi:10.1186/1475-2883-2-S1-S8 [PubMed 14975065]
33. Edwards G, Dingsdale A, Helsby N, Orme ML, Breckenridge AM. The relative systemic availability of ivermectin
after administration as capsule, tablet, and oral solution. Eur J Clin Pharmacol. 1988;35(6):681-684.
doi:10.1007/BF00637608 [PubMed 3234475]
5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 18/23
https://www.cdc.gov/parasites/strongyloides/health_professionals/index.html
https://www.cdc.gov/parasites/strongyloides/health_professionals/index.html
https://www.cdc.gov/parasites/zoonotichookworm/health_professionals/index.html
http://www.cdc.gov/parasites/scabies/health_professionals/meds.html
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/29210346/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/8236406/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/20220184/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/20181973/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/29313486/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/24710613/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/9129865/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/25917986/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/31691813/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/14975065/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/3234475/pubmed
34. Eismann R, Bramsiepe I, Danz B, Wohlrab J, Marsch WC, Fiedler E. Abscessing nodular demodicosis--therapy
with ivermectin and permethrin. J Eur Acad Dermatol Venereol. 2010;24(1):79-81. [PubMed 19453783]
35. Elston DM. Demodex mites: facts and controversies. Clin Dermatol. 2010;28(5):502-504.
doi:10.1016/j.clindermatol.2010.03.006 [PubMed 20797509]
36. Expert opinion. Senior Renal Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD,
BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
37. Fischer P, Bamuhiiga J, and Büttner DW. Treatment of human Mansonella streptocerca infection with
ivermectin. Trop Med Int Health,1997;2(2):191-199. doi:10.1046/j.1365-3156.1997.d01-233.x [PubMed 9472305]
38. Fischer P, Tukesiga E, Büttner DW. Long-term suppression of Mansonella streptocerca microfilariae after
treatment with ivermectin. J Infect Dis. 1999;180(4):1403-1405. doi:10.1086/315014 [PubMed 10479183]
39. Foucault C, Ranque S, Badiaga S, Rovery C, Raoult D, Brouqui P. Oral ivermectin in the treatment of body lice. J
Infect Dis. 2006;193(3):474-476. [PubMed 16388498]
40. Frankowski BL and Bocchini JA Jr, “Head Lice,” Pediatrics, 2010, 126(2):392-403. [PubMed 20660553]
41. Gardon J, Boussinesq M, Kamgno J, Gardon-Wendel N, Demanga-Ngangue, Duke BO. Effects of standard and
high doses of ivermectin on adult worms of Onchocerca volvulus: a randomised controlled trial. Lancet.
2002;360(9328):203-210. doi:10.1016/S0140-6736(02)09456-4 [PubMed 12133654]
42. Gardon J, Gardon-Wendel N, Demanga-Ngangue, Kamgno J, Chippaux JP, Boussinesq M. Serious reactions after
mass treatment of onchocerciasis with ivermectin in an area endemic for Loa loa infection. Lancet.
1997;350(9070):18-22. doi:10.1016/S0140-6736(96)11094-1 [PubMed 9217715]
43. Goldstein AO, Goldstein BG. Pediculosis capitis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc.
http://www.uptodate.com. Accessed July 13, 2022a.
44. Goldstein AO, Goldstein BG. Pediculosis pubis and pediculosis ciliaris. Post TW, ed. UpToDate. Waltham, MA:
UpToDate Inc. http://www.uptodate.com. Accessed July 13, 2022b.
45. Goldstein BG, Goldstein AO. Scabies: management. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc.
http://www.uptodate.com. Accessed July 13, 2022c.
46. Gonzalez AA, Chadee DD, Rawlins SC. Ivermectin treatment of mansonellosis in Trinidad. West Indian Med J.
1999;48(4):231-234. [PubMed 10639847]
47. González Canga A, Sahagún Prieto AM, Diez Liébana MJ, et al, The pharmacokinetics and interactions of
ivermectin in humans--a mini-review. AAPS J. 2008;10(1):42-46. [PubMed 18446504]
48. Guzzo CA, Furtek CI, Porras AG, et al. Safety, tolerability, and pharmacokinetics of escalating high doses of
ivermectin in healthy adult subjects. J Clin Pharmacol. 2002;42(10):1122-1133.
doi:10.1177/009127002401382731 [PubMed 12362927]
49. Gyapong JO, Chinbuah MA, Gyapong M. Inadvertent exposure of pregnant women to ivermectin and
albendazole during mass drug administration for lymphatic filariasis. Trop Med Int Health. 2003;8(12):1093-
1101. doi:10.1046/j.1360-2276.2003.01142.x [PubMed 14641844]
50. Henriquez-Camacho C, Gotuzzo E, Echevarria J, et al. Ivermectin versus albendazole or thiabendazole for
Strongyloides stercoralis infection. Cochrane Database Syst Rev. 2016;2016(1):CD007745.
doi:10.1002/14651858.CD007745.pub3 [PubMed 26778150]
51. Herman JS, Chiodini PL. Gnathostomiasis, another emerging imported disease.Clin Microbiol Rev.
2009;22(3):484-92. doi:10.1128/CMR.00003-09 [PubMed 19597010]
5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 19/23
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/19453783/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/20797509/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/9472305/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/10479183/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/16388498/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/20660553/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/12133654/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/9217715/pubmed
http://www.uptodate.com/
http://www.uptodate.com/
http://www.uptodate.com/
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/10639847/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/18446504/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/12362927/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/14641844/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/26778150/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/19597010/pubmed
52. Ismail MM, Jayakody RL, Weil GJ, et al, "Long-Term Efficacy of Single-Dose Combinations of Albendazole,
Ivermectin and Diethylcarbamazine for the Treatment of Bancroftian Filariasis," Trans R Soc Trop Med Hyg,
2001, 95(3):332–5. [PubMed 11491010]
53. Ito T. Mazzotti reaction with eosinophilia after undergoing oral ivermectin for scabies. J Dermatol.
2013;40(9):776-777. doi:10.1111/1346-8138.12243 [PubMed 23855317]
54. Ivermectin tablets [prescribing information]. Parsippany, NJ: Edenbridge Pharmaceuticals, LLC; March 2022.
55. Jackson JD. Infectious folliculitis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc.
http://www.uptodate.com. Accessed July 13, 2022.
56. Jittamala P, Monteiro W, Smit MR, et al. A systematic review and an individual patient data meta-analysis of
ivermectin use in children weighing less than fifteen kilograms: Is it time to reconsider the current
contraindication? PLoS Negl Trop Dis. 2021;15(3):e0009144. doi:10.1371/journal.pntd.0009144 [PubMed
33730099]
57. Kerneuzet I, Blind E, Darrieux L, Moreau S, Safa G. Ivermectin-induced drug reaction with eosinophilia and
systemic symptoms (DRESS) syndrome. JAAD Case Rep. 2018;4(6):524-527. doi:10.1016/j.jdcr.2018.05.002
[PubMed 30023418]
58. Kraivichian K, Nuchprayoon S, Sitichalernchai P, Chaicumpa W, Yentakam S. Treatment of cutaneous
gnathostomiasis with ivermectin. Am J Trop Med Hyg. 2004;71(5):623-628. [PubMed 15569795]
59. Leder K, Weller PF. Enterobiasis (pinworm) and trichuriasis (whipworm). Post TW, ed. UpToDate. Waltham, MA:
UpToDate Inc. http://www.uptodate.com. Accessed July 13, 2022c.
60. Leder K, Weller PF. Strongyloidiasis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc.
http://www.uptodate.com. Accessed July 13, 2022b.
61. Leder K, Weller PF, Nageshwar Reddy D. Ascariasis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc.
http://www.uptodate.com. Accessed July 13, 2022a.
62. Levy M, Martin L, Bursztejn AC, et al; Groupe de Recherche de la Société Française de Dermatologie Pédiatrique.
Ivermectin safety in infants and children under 15 kg treated for scabies: A multicentric observational study. Br
J Dermatol. 2020;182(4):1003-1006. doi: 10.1111/bjd.18369 [PubMed 31344258]
63. Lima NF, Veggiani Aybar CA, Dantur Juri MJ, Ferreira MU. Mansonella ozzardi: a neglected New World filarial
nematode. Pathog Glob Health. 2016;110(3):97-107. doi:10.1080/20477724.2016.1190544 [PubMed 27376501]
64. Mackenzie CD, Geary TG, Gerlach JA. Possible pathogenic pathways in the adverse clinical events seen following
ivermectin administration to onchocerciasis patients. Filaria J. 2003;2 suppl 1(suppl 1):S5. doi:10.1186/1475-
2883-2-S1-S5 [PubMed 14975062]
65. Marti H, Haji HJ, Savioli L, et al. A comparative trial of a single-dose ivermectin versus three days of albendazole
for treatment of Strongyloides stercoralis and other soil-transmitted helminth infections in children. Am J Trop
Med Hyg. 1996;55(5):477-481. doi:10.4269/ajtmh.1996.55.477 [PubMed 8940976]
66. Matamoros G, Sánchez A, Gabrie JA, et al. Efficacy and safety of albendazole and high-dose ivermectin
coadministration in school-aged children infected with Trichuris trichiura in Honduras: a randomized
controlled trial. Clin Infect Dis. 2021;73(7):1203-1210. doi:10.1093/cid/ciab365 [PubMed 33906234]
67. Meinking TL, Taplin D, Hermida JL, et al, “The Treatment of Scabies With Ivermectin,” N Engl J Med, 1995,
333(1):26-30. [PubMed 7776990 ]
5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 20/23
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/11491010/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/23855317/pubmed
http://www.uptodate.com/
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/33730099/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/30023418/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/15569795/pubmed
http://www.uptodate.com/
http://www.uptodate.com/
http://www.uptodate.com/
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/31344258/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/27376501/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/14975062/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/8940976/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/33906234/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/7776990%20/pubmed
68. Meyers RS, Thackray J, Matson KL, et al. Key Potentially Inappropriate Drugs in Pediatrics: The KIDs List. J
Pediatr Pharmacol Ther. 2020;25(3):175-191. [PubMed 32265601]
69. Miyajima A, Hirota T, Sugioka A, et al. Effect of high-fat meal intake on the pharmacokinetic profile of
ivermectin in Japanese patients with scabies. J Dermatol. 2016;43(9):1030-1036. doi:10.1111/1346-8138.13321
[PubMed 26918286]
70. Monsel G, Caumes E. What's new in travel-associated dermatology? J Travel Med. 2015;22(4):221-224.
doi:10.1111/jtm.12224 [PubMed 26146819]
71. Murdoch ME. Onchocerciasis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com.
Accessed July 13, 2022.
72. Naquira C, Jimenez G, Guerra JG. Ivermectin for human strongyloidiasis and other intestinal helminths. Am J
Trop Med Hyg. 1989;40(3):304-309. doi:10.4269/ajtmh.1989.40.304 [PubMed 2929853]
73. National Institute for Health and Care Excellence (NICE). Drug allergy: diagnosis and management. Clinical
guideline 183. Published September 3, 2014. Accessed April 12, 2022. www.nice.org.uk/guidance/cg183.
74. Ndyomugyenyi R, Kabatereine N, Olsen A, Magnussen P. Efficacy of ivermectin and albendazole alone and in
combination for treatment of soil-transmitted helminths in pregnancy and adverse events: a randomized open
label controlled intervention trial in Masindi district, western Uganda. Am J Trop Med Hyg. 2008;79(6):856-863.[PubMed 19052293]
75. Nicolas P, Maia MF, Bassat Q, Kobylinski KC, Monteiro W, Rabinovich NR, Menéndez C, Bardají A, Chaccour C.
Safety of oral ivermectin during pregnancy: a systematic review and meta-analysis. Lancet Glob Health.
2020;8(1):e92-e100. doi:10.1016/S2214-109X(19)30453-X [PubMed 31839144]
76. Nolt D, Moore S, Yan AC, Melnick L; Committee on Infectious Diseases, Committee on Practice And Ambulatory
Medicine, Section on Dermatology. Head lice. Pediatrics. 2022;150(4):e2022059282. doi:10.1542/peds.2022-
059282 [PubMed 36156158]
77. Nontasut P, Bussaratid V, Chullawichit S, Charoensook N, Visetsuk K. Comparison of ivermectin and
albendazole treatment for gnathostomiasis. Southeast Asian J Trop Med Public Health. 2000;31(2):374-377.
[PubMed 11127342]
78. Nontasut P, Claesson BA, Dekumyoy P, Pakdee W, Chullawichit S. Double-dose ivermectin vs albendazole for the
treatment of gnathostomiasis. Southeast Asian J Trop Med Public Health. 2005;36(3):650-652. [PubMed
16124432]
79. Ogbuokiri JE, Ozumba BC, Okonkwo PO. Ivermectin levels in human breast milk. Eur J Clin Pharmacol.
1994;46(1):89-90. doi:10.1007/BF00195923 [PubMed 8005194]
80. Okonkwo PO, Ogbuokiri JE, Ofoegbu E, Klotz U. Protein binding and ivermectin estimations in patients with
onchocerciasis. Clin Pharmacol Ther. 1993;53(4):426-430. doi:10.1038/clpt.1993.46 [PubMed 8477558]
81. Oshikoya KA, Ogunyinka IA, Ogar CK, Abiola A, Ibrahim A, Oreagba IA. Severe cutaneous adverse drug
reactions manifesting as Stevens-Johnson syndrome and toxic epidermal necrolysis reported to the national
pharmacovigilance center in Nigeria: a database review from 2004 to 2017. Ther Adv Drug Saf.
2020;11:2042098620905998. doi:10.1177/2042098620905998 [PubMed 32110375]
82. Ottesen EA and Campbell WC, “Ivermectin in Human Medicine,” J Antimicrob Chemother, 1994, 34(2):195-203.
[PubMed 7814280]
5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 21/23
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/32265601/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/26918286/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/26146819/pubmed
http://www.uptodate.com/
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/2929853/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/19052293/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/31839144/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/36156158/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/11127342/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/16124432/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/8005194/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/8477558/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/32110375/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/7814280/pubmed
83. Pacqué M, Muñoz B, Poetschke G, Foose J, Greene BM, Taylor HR. Pregnancy outcome after inadvertent
ivermectin treatment during community-based distribution. Lancet. 1990;336(8729):1486-9. doi:10.1016/0140-
6736(90)93187-t [PubMed 1979100]
84. Ramirez-Avila L, Slome S, Schuster FL, et al. Eosinophilic meningitis due to Angiostrongylus and Gnathostoma
species. Clin Infect Dis. 2009;48(3):322-327. doi:10.1086/595852 [PubMed 19123863]
85. Refer to manufacturer's labeling.
86. Repetto SA, Ruybal P, Batalla E, et al. Strongyloidiasis outside endemic areas: long-term parasitological and
clinical follow-up after ivermectin treatment. Clin Infect Dis. 2018;66(10):1558-1565. doi:10.1093/cid/cix1069
[PubMed 29360939]
87. Richard-Lenoble D, Kombila M, Rupp EA, Pappayliou ES, Gaxotte P, Nguiri C, Aziz MA. Ivermectin in loiasis and
concomitant O. volvulus and M. perstans infections. Am J Trop Med Hyg. 1988;39(5):480-483. [PubMed
3195695]
88. Rodari P, Buonfrate D, Pomari E, et al. Ivermectin concentration in breastmilk of a woman with Strongyloides
stercoralis and human T-lymphotropic virus-I co-infection. Acta Trop. 2020;202:105249.
doi:10.1016/j.actatropica.2019.105249 [PubMed 31678122]
89. Romani L, Whitfield MJ. Koroiyueta J, Kama M, Wand H, et al. Mass drug administration for scabies control in a
population with endemic disease. N Engl J Med. 2015;373:2305-2313. [PubMed 26650152]
90. Salavastru CM, Chosidow O, Boffa MJ, Janier M, Tiplica GS. European guideline for the management of scabies.
J Eur Acad Dermatol Venereol. 2017;31(8):1248-1253. doi:10.1111/jdv.14351 [PubMed 28639722]
91. Salem DA, El-Shazly A, Nabih N, El-Bayoumy Y, Saleh S. Evaluation of the efficacy of oral ivermectin in
comparison with ivermectin-metronidazole combined therapy in the treatment of ocular and skin lesions of
Demodex folliculorum. Int J Infect Dis. 2013;17(5):e343-347. doi:10.1016/j.ijid.2012.11.022 [PubMed 23294870]
92. Schrijvers R, Gilissen L, Chiriac AM, Demoly P. Pathogenesis and diagnosis of delayed-type drug hypersensitivity
reactions, from bedside to bench and back. Clin Transl Allergy. 2015;5:31. doi:10.1186/s13601-015-0073-8
[PubMed 26339470]
93. Schulz JD, Coulibaly JT, Schindler C, Wimmersberger D, Keiser J. Pharmacokinetics of ascending doses of
ivermectin in Trichuris trichiura-infected children aged 2-12 years. J Antimicrob Chemother. 2019;74(6):1642-
1647. doi:10.1093/jac/dkz083 [PubMed 30859185]
94. Seegobin K, Bueno E, Maharaj S, Ashby T, Brown M, Jones L. Toxic epidermal necrolysis after ivermectin. Am J
Emerg Med. 2018;36(5):887-889. doi:10.1016/j.ajem.2017.09.021 [PubMed 28927997]
95. Segarra-Newnham M. Manifestations, diagnosis, and treatment of Strongyloides stercoralis infection. Ann
Pharmacother. 2007;41(12):1992-2001. doi:10.1345/aph.1K302 [PubMed 17940124]
96. Stromectol (ivermectin) [prescribing information]. Rahway, NJ: Merck Sharp & Dohme; May 2022.
97. Twum-Danso NA. Serious adverse events following treatment with ivermectin for onchocerciasis control: a
review of reported cases. Filaria J. 2003;2(suppl 1):S3. doi:10.1186/1475-2883-2-S1-S3 [PubMed 14975060]
98. Vanhaecke C, Perignon A, Monsel G, Regnier S, Bricaire F, Caumes E. The efficacy of single dose ivermectin in
the treatment of hookworm related cutaneous larva migrans varies depending on the clinical presentation. J
Eur Acad Dermatol Venereol. 2014;28(5):655-357. doi:10.1111/jdv.12097 [PubMed 23368818]
99. Veit O, Beck B, Steuerwald M, Hatz C. First case of ivermectin-induced severe hepatitis. Trans R Soc Trop Med
Hyg. 2006;100(8):795-797. doi:10.1016/j.trstmh.2006.02.003 [PubMed 16682062]
5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 22/23
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/1979100/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/19123863/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/29360939/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/3195695/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/31678122/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/26650152/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/28639722/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/23294870/pubmedhttps://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/26339470/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/30859185/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/28927997/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/17940124/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/14975060/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/23368818/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/16682062/pubmed
100. Weller PF. Eosinophilic meningitis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc.
http://www.uptodate.com. Accessed July 13, 2022.
101. Westlake CS, Aronoff DM. Evaluating the risks of systemic maternal ivermectin exposure during pregnancy in
human and vertebrate animals: a scoping review. Curr Drug Saf. Published August 20, 2020.
doi:10.2174/1574886315999200820125001 [PubMed 33109066]
102. Wilkins AL, Steer AC, Cranswick N, Gwee A. Question 1: Is it safe to use ivermectin in children less than five years
of age and weighing less than 15 kg? Arch Dis Child. 2018;103(5):514-519. doi:10.1136/archdischild-2017-
314505 [PubMed 29463522]
103. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021.
MMWR Recomm Rep. 2021;70(4):1-187. doi:10.15585/mmwr.rr7004a1 [PubMed 34292926]
Topic 83315 Version 194.0

5/30/24, 7:58 PM Ivermectin (systemic): Drug information - UpToDate
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/print?search=ivermectin&topicRef=8641&source=see_link 23/23
http://www.uptodate.com/
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/33109066/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/29463522/pubmed
https://www.uptodate.com/contents/ivermectin-systemic-drug-information/abstract-text/34292926/pubmed