Ivermectin Medication Guide: Dosage, Side Effects, and Treatment Uses

When using ivermectin, you’ll take a dosage based on your body weight, typically 0.15-0.2 mg/kg orally for parasitic infections such as onchocerciasis and strongyloidiasis.

It is FDA-approved for these conditions, as well as topically for head lice and rosacea.

Watch for side effects such as dizziness, diarrhoea, and allergic reactions, and be aware of potential drug interactions.

Ivermectin works by paralysing invertebrate parasites, but its mechanism is specific to avoid harming human cells.

Follow your healthcare provider’s guidance closely to optimise treatment outcomes and safety.

Keep exploring to gain a deeper understanding of this medication’s unique properties and applications.

Key Takeaways

• Ivermectin dosage ranges from 0.15-0.2 mg/kg orally, with specific regimens for strongyloidiasis, onchocerciasis, and scabies treatment.
• FDA-approved uses include treating intestinal strongyloidiasis, onchocerciasis, head lice, and inflammatory lesions of rosacea.
• Common side effects include itching, dizziness, and diarrhoea; serious effects may involve CNS toxicity, allergic reactions, and liver damage.
• Ivermectin binds to glutamate-gated chloride ion channels in invertebrate cells, causing paralysis and death of parasites.
• Regular check-ups, lab tests, and monitoring for drug interactions are crucial for optimising treatment outcomes and safety.

Dosage Information

Ivermectin dosage is based on body weight and varies by the condition being treated.

The standard dosing strategies range from 0.15-0.2 mg/kg orally, depending on the illness.

For example, strongyloidiasis is treated with a single 0.2 mg/kg dose, while onchocerciasis uses 0.15 mg/kg.

Scabies treatment involves taking 0.2 mg/kg doses spaced 1-2 weeks apart.

Age variations in dosing exist, with adjustments needed for children under 15 kg.

High-fat meals can significantly increase ivermectin absorption.

You’ll take ivermectin tablets on an empty stomach.

The number of 3 mg or 6 mg tablets depends on weight.

If you weigh 15-24 kg, a typical dose is one 3 mg tablet.

For 25-35 kg, it’s two 6 mg tablets.

Those weighing 36-50 kg take three 9 mg tablets.

For 51-65 kg, the dose is four 12 mg tablets.

For weights over 80 kg, the recommended doses are 0.2 mg/kg for strongyloidiasis and 0.15 mg/kg for onchocerciasis.

Certain conditions, like pediculosis, may use other forms, such as a 0.5% lotion or 1% cream applied topically.

Retreatment intervals range from 1-2 weeks for scabies to every 3, 6, or 12 months for onchocerciasis.

If you miss a dose, take it as soon as you remember unless it’s nearly time for the next one.

Always follow your doctor’s dosing instructions, as they may adjust amounts based on your medical situation.

Consult them if you have any questions about your personalised treatment plan.

Never take more or less than prescribed.

Onchocerciasis Treatment

To treat onchocerciasis, you’ll take oral ivermectin at a dose of 150 mcg/kg once or twice a year for 10 to 15 years, which is the current standard of care.

This long-term treatment corresponds to the lifespan of adult worms.

Ivermectin is FDA-approved for treating onchocerciasis, also known as river blindness.

Ivermectin works by killing immature worms called microfilariae, preventing symptoms like skin damage and vision loss.

It considerably reduces occurrences of blindness and skin disease, but doesn’t kill adult worms.

Your doctor may combine ivermectin with doxycycline, which targets the Wolbachia bacteria that adult worms need to survive.

Eliminating Wolbachia decreases adult worm longevity and fertility, thereby reducing microfilariae production.

If you have a Loa loa co-infection, you shouldn’t take ivermectin due to the risk of a fatal encephalitic reaction.

In this case, doxycycline may be used under close supervision.

Onchocerciasis prevention measures, such as vector control and community health initiatives, are essential in reducing transmission.

Mass drug administration programmes distribute ivermectin to over 100 million people annually in affected communities.

Surgical removal of onchocercomas, called nodulectomy, is reserved for cranial nodules or cosmetic concerns and doesn’t treat the disease itself.

Standard ophthalmic treatments manage ocular complications associated with onchocerciasis.

Research continues to explore new diagnostic methods, like using high-resolution retinal cameras and optical coherence tomography to detect microfilariae in eye tissues.

Body Weight Considerations

When taking ivermectin, it is important to follow the recommended dosage based on your body weight.

Paediatric patients may require different dosing considerations compared to adults.

For children weighing over 15 kg (33 lbs), the dose is based on body weight.

Your healthcare provider will determine the appropriate dose for you or your child based on individual weight and the specific condition being treated.

Dosing by Weight

Although ivermectin dosing guidelines primarily rely on weight-based calculations, it’s important to understand the nuances and considerations involved.

The standard dosages for specific indications, such as strongyloidiasis and onchocerciasis, are determined by mg/kg body weight.

However, dosing can also be adjusted based on weight ranges for practical purposes.

Body mass index (BMI) correlates with pharmacokinetic parameters such as terminal half-life and volume of distribution, influencing the drug’s behaviour in the body.

Here are some key points to keep in mind:

• Weight-based dosages guarantee accurate and effective treatment
• Dosing ranges simplify administration while maintaining efficacy
• Pharmacokinetic parameters remain stable across various body weights
• Fixed-dose regimens may improve access and logistics in certain settings
• Treatment protocols for specific diseases should guide dosing decisions

It’s imperative to follow the recommended dosing guidelines and make appropriate weight adjustments to optimise treatment outcomes.

Consult with a healthcare provider to determine the most suitable dosing approach based on your individual needs and the specific condition being treated.

Proper adherence to the prescribed regimen is fundamental for the successful management of the targeted disease.

Paediatric Dosing Considerations

What specific considerations come into play when dosing ivermectin for paediatric patients?

The FDA recommends against administering ivermectin to children under 33 pounds (15 kg) as the drug’s paediatric safety and effectiveness have not been established for this weight range.

In emergencies requiring treatment for those under 15 kg, consult infectious disease or microbiology specialists.

While millions of children in this group have received ivermectin in mass drug administration campaigns, dosing guidelines typically rely on height (90 cm cutoff) versus weight.

In practice, infants as young as 1-3 months have been treated for scabies with 200 μg/kg doses without neurological issues.

Neonates and infants under 15 kg do not routinely receive ivermectin without specialist input.

Children with conditions like crusted scabies may need multiple doses at 1-2 week intervals plus topical treatments.

The standard paediatric dose is 200 μg/kg for those over 15 kilograms, but this may vary based on the condition.

Ivermectin is not FDA-approved for COVID-19 treatment or prevention in any age group.

Limited data exists on renal impairment adjustments in children, while hepatic impairment warrants caution but has no specific recommendations.

Approved Uses

Ivermectin, an FDA-approved medication, treats several parasitic infections in humans, including intestinal strongyloidiasis and onchocerciasis.

It is also used topically to treat head lice infestations and inflammatory lesions associated with rosacea.

When prescribed for strongyloidiasis or onchocerciasis, you will take ivermectin orally as a single dose on an empty stomach with water.

Ivermectin’s efficacy against various parasitic infections has been well-established, but it is significant to mention that parasitic resistance can develop over time.

To minimise this risk, always take ivermectin exactly as directed by your doctor or pharmacist.

The approved forms of ivermectin for human use include:

• Oral tablets for treating intestinal strongyloidiasis and onchocerciasis
• Topical creams for treating head lice and rosacea
• Specific oral dosages for strongyloidiasis and onchocerciasis, which may include additional doses after the initial treatment

It is vital to distinguish between ivermectin products intended for human use and those formulated for animals, as they differ in their composition and dosages.

Animal products are used to prevent heartworm disease and treat internal and external parasites in pets and livestock.

When considering ivermectin for the treatment of parasitic infections, it is crucial to discuss the potential side effects and any special precautions with your healthcare provider.

This is particularly significant if you have certain immune system conditions or are pregnant or breastfeeding.

Ivermectin is a generic drug, identical to the brand-name version Stromectol, and is generally lower in cost while maintaining equivalent safety and efficacy.

Additional Uses

While ivermectin is FDA-approved for treating specific parasitic infections, it is also used off-label to treat diseases associated with Demodex mites, such as blepharitis and demodicidosis.

It has been used for over 25 years to treat parasitic infections in mammals with a good safety profile.

New evidence has linked Demodex mites to rosacea, a chronic inflammatory disease, for which ivermectin has received FDA approval.

You may find that your healthcare provider sometimes prescribes ivermectin to treat certain other roundworm infections, head or pubic lice infestations, and scabies.

Off-label applications require careful consideration of risks and benefits, as well as potential interactions with other medications.

It is important to note that the FDA has not authorised or approved ivermectin for the treatment or prevention of COVID-19 in people or animals.

Ivermectin has been investigated for various unapproved uses, but these uses are not supported by FDA approval or robust clinical evidence.

Experimental research into new uses for ivermectin is ongoing, but the FDA must approve any new uses.

Unauthorised use of ivermectin can lead to adverse effects, including overdose and interactions with other medications.

Misuse of ivermectin intended for animals has resulted in hospitalisations and adverse medical events.

Ivermectin’s anti-inflammatory activity has been demonstrated and may offer potential for treating conditions beyond parasitic infections.

The drug’s mechanism of action against Demodex mites could be explored further for new therapeutic applications.

Ivermectin’s safety profile over 25 years supports its potential use in other conditions.

Research into ivermectin’s effectiveness against other types of parasites and diseases is ongoing.

Common Side Effects

Although generally well tolerated, ivermectin can cause various side effects ranging from mild to potentially severe.

It’s important to be aware of these side effects, particularly when using the medication long-term.

Common side effects include itching, dizziness, fluid retention, rapid heartbeat, and diarrhoea.

Severe allergic reactions may involve breathing problems, a racing heart, swelling of the face or tongue, and hives.

When treating specific conditions like strongyloidiasis or intestinal infections, additional side effects such as nausea, vomiting, abdominal pain, constipation, and skin rash may occur.

In clinical trials, some of the most frequently reported side effects were:

• Peripheral oedema (swelling in the limbs)
• Tachycardia (rapid heart rate)
• Orthostatic hypotension (low blood pressure on standing)
• Facial oedema (swelling in the face)
• Headache and myalgia (muscle pain)

Post-marketing surveillance has revealed rare but serious side effects, including hypotension, worsening of bronchial asthma, toxic epidermal necrolysis, Stevens-Johnson syndrome, seizures, hepatitis, elevation of liver enzymes and bilirubin levels, and neurotoxicity.

To manage side effects, it’s important to follow the prescribed dosage and consult with a healthcare provider if any concerning symptoms arise.

Adjusting the dose or discontinuing the medication may be necessary in some cases.

Patients should also inform their healthcare provider of any pre-existing conditions or medications they’re taking to minimise the risk of adverse reactions.

Serious Side Effects

While ivermectin is generally well-tolerated, you should be aware of the potential for serious adverse effects.

Contact your doctor immediately if you experience symptoms of CNS toxicity like confusion or reduced responsiveness, signs of a severe allergic reaction such as difficulty breathing or swelling, or concerning eye problems, including vision changes or pain.

Severe skin reactions like toxic epidermal necrolysis may also occur.

It’s essential to closely monitor for these reactions and take precautions as directed by your healthcare provider.

CNS Toxicity Risks

Ivermectin, in high doses, carries risks of serious adverse effects involving the central nervous system (CNS).

Clinical manifestations of CNS toxicity can range from mild symptoms such as drowsiness and dizziness to severe CNS depression, seizures, coma, and even death.

Respiratory failure can occur in severe cases of ivermectin poisoning.

Risk factors for toxicity include: High-dose ingestions, especially of veterinary formulations.

• Concurrent use of other CNS depressants
• Certain genetic predispositions
• Previous adverse reactions to ivermectin
• Large overdoses

If CNS symptoms develop, discontinue ivermectin and provide supportive care.

Management of overdoses may involve activated charcoal for gastric decontamination.

Intravenous lipid emulsion, while used in animals, hasn’t been studied in humans.

Prompt medical attention is essential for severe CNS effects.

Suspected cases should be reported to poison control centres.

While ivermectin is generally well-tolerated at approved doses, awareness of CNS risks is important to recognise signs of toxicity.

Patients should follow dosing instructions carefully and avoid using products intended for animals.

Discussing the potential for CNS side effects with a healthcare provider can help assess individual risk factors before starting treatment.

Severe Allergic Reactions

Severe allergic reactions are a rare but serious side effect of ivermectin that requires immediate medical attention.

If you experience any symptoms of an allergic response, such as swelling of the face, lips, tongue, or throat; difficulty breathing or wheezing; severe rash or itching; rapid heartbeat; or fever, stop taking ivermectin and seek emergency medical help right away.

Call 999 or your local emergency number, as any sign of a severe allergic reaction warrants prompt treatment.

Ignoring these symptoms could be fatal.

To prevent severe allergic reactions, inform your doctor of any allergies before starting ivermectin.

If you’ve had a previous allergic response to this medication, do not take it again.

Follow dosage instructions carefully and take ivermectin under medical supervision while monitoring for signs of an allergic reaction.

Common indications include skin symptoms like hives or redness, swollen areas, respiratory difficulties, a racing heart, and general malaise.

Monitoring and Precautions

To guarantee your safety while taking ivermectin, it’s vital to monitor for potential side effects and take necessary precautions, especially if you have pre-existing health conditions or are taking other medications.

Monitoring protocols include:

• Regular check-ups and lab tests to assess your body’s response to the medication
• Report any unusual symptoms to your healthcare provider immediately
• Adhering to the prescribed dosage to avoid overdose symptoms
• Disclosing all concurrent medications, vitamins, and supplements to your doctor

Precautionary measures are important for certain conditions.

If you have an immune system disorder, are pregnant or breastfeeding, or have a history of loiasis or onchocerciasis, consult your healthcare provider before starting ivermectin.

Be vigilant for serious side effects involving the central nervous system, such as confusion, seizures, and vision problems.

Joint pain, swelling, and cardiac issues may also occur.

In case of an overdose, seek immediate medical attention.

Long-term side effects can include liver damage, persistent neurological problems, and severe skin reactions.

Oral Administration

When taken orally, ivermectin is typically administered as a single dose on an empty stomach with water.

The standard dosage for onchocerciasis is 0.15 mg/kg once every 12 months, while for strongyloidiasis, it’s 0.2 mg/kg as a single dose.

Dosages vary based on the patient’s weight, ranging from 3 mg for those weighing 15-25 kg to 15 mg for those weighing 66-79 kg.

Ivermectin is primarily metabolised in the liver, with excretion mainly via faeces over 12 days and a half-life after oral administration of approximately 18 hours.

It’s vital to follow the prescribed dosage and administration guidelines to guarantee optimal treatment efficacy and patient adherence.

After taking ivermectin, it’s important to maintain good oral hygiene to minimise the risk of side effects, such as dizziness, nausea, and vomiting.

Common mild side effects include swelling, headache, muscle pain, and fever.

However, serious side effects, such as liver damage, neurological problems, and severe eye issues, can occur.

Notify your doctor immediately if you experience any of these symptoms.

Ivermectin treats onchocerciasis by killing developing worms and strongyloidiasis by eliminating intestinal worms.

It’s also used off-label for scabies and head and pubic lice.

Internationally, it treats additional conditions like filariasis and cutaneous larva migrans.

Follow-up stool examinations are necessary after treating strongyloidiasis to confirm infection clearance.

If you miss a dose, inform your doctor.

Continue your normal diet unless instructed otherwise.

Topical Administration

Ivermectin topical formulations, available as a 0.5% lotion (Sklice) and a 1% cream (Soolantra), offer an alternative administration route for treating inflammatory lesions of rosacea and head lice.

When applying ivermectin topically, it’s crucial to use the correct topical application techniques to guarantee ideal skin absorption factors and treatment efficacy.

Follow these steps for proper application:

• Cleanse the affected area with a gentle cleanser and pat dry before applying the medication.
• Apply a pea-sized amount of ivermectin cream or lotion to each affected area of the face once daily, spreading it smoothly and evenly in a thin layer.
• Avoid contact with the eyes and lips, as the medication isn’t intended for ophthalmic or oral use.
• Wash your hands thoroughly after applying the medication to prevent accidental ingestion or transfer to other areas of the body.
• Allow the medication to absorb fully into the skin before applying other skincare products or makeup.
  – [Continuous monitoring](https://www.webmd.com/drugs/2/drug-167491/soolantra-topical/details) for any unexpected reactions is recommended while using topical ivermectin.

Topical ivermectin is generally well-tolerated, with common side effects including skin burning sensation, irritation, pruritus, and dry skin, occurring in 1% or less of patients.

Rare side effects may include erythema, contact dermatitis, and dandruff.

If you experience symptoms of an allergic reaction, such as breathing problems, a racing heart, fever, or swelling of the face and throat, discontinue use and seek medical help immediately.

Store ivermectin topical products at room temperature between 20°C and 25°C (68°F and 77°F) and keep out of reach of children.

Consult your healthcare provider for personalised guidance on using topical ivermectin for your specific condition.

Drug Interactions

Numerous medications can interact with ivermectin, altering its serum concentration and potentially impacting its efficacy or safety profile.

It’s vital to be aware of these drug interactions to guarantee optimal treatment outcomes and minimise risks.

Azithromycin, ritonavir, abametapir, darolutamide, and tafamidis can increase ivermectin serum concentrations, while cenobamate, pitolisant, venlafaxine, satralizumab, and levamisole may decrease them.

These interactions can influence the absorption, distribution, metabolism, or excretion of ivermectin.

Pharmacodynamic and pharmacokinetic interactions also play a significant role when combining ivermectin with other medications.

Doxycycline, nitazoxanide, and hydroxychloroquine sulfate have shown treatment synergy when used with ivermectin for COVID-19.

However, erythromycin and warfarin may lead to increased toxicity or reduced efficacy when co-administered with ivermectin.

Additionally, ivermectin can decrease the excretion of certain drugs, resulting in elevated serum concentrations.

Bosentan, ambrisentan, digoxin, valsartan, and selexipag are examples of medications that may accumulate in the body due to reduced elimination when taken concurrently with ivermectin.

To minimise the risk of adverse events and enhance treatment outcomes, it’s important to discuss all medications you’re taking with your healthcare provider before starting ivermectin therapy.

They can help you navigate potential drug interactions and adjust dosages or timing as needed to guarantee safe and effective use of ivermectin.

Ivermectin’s metabolism primarily involves the CYP3A4 isoenzyme, which can be affected by various medications.

Safety Profile

Safety is paramount when considering the use of ivermectin, as it can impact various patient populations differently.

Pregnancy, breastfeeding, paediatric use, geriatric use, immunocompromised status, and severe illness are key safety concerns that require careful consideration.

Risk factors for adverse reactions include liver disease and other serious medical conditions.

It is essential to discuss these safety concerns with your healthcare provider before starting ivermectin treatment.

The safety and efficacy of ivermectin have not been established for children weighing less than 15 kg.

Common side effects of ivermectin include:

• Gastrointestinal symptoms such as diarrhoea, nausea, and vomiting
• Neurological symptoms such as dizziness, drowsiness, and confusion
• Eye problems, including redness, swelling, and pain
• Skin reactions, which can be severe and involve blistering and peeling
• Systemic symptoms such as fever, weakness, and loss of appetite

Serious side effects, while rare, can occur with ivermectin use.

These include neurotoxicity, liver damage, severe allergic reactions, musculoskeletal complaints, and cardiovascular effects.

High doses or misuse of ivermectin can lead to altered mental status, seizures, and coma.

If you experience any serious side effects, seek immediate medical attention.

Overdose symptoms can be severe and potentially life-threatening.

Neurological symptoms, gastrointestinal distress, skin and eye reactions, respiratory difficulties, and musculoskeletal complaints are common signs of an ivermectin overdose.

If you suspect an overdose, contact emergency services right away.

To minimise safety risks, always use ivermectin as directed by your healthcare provider.

Follow dosage instructions carefully, and report any concerning symptoms promptly.

By understanding the safety profile of ivermectin and working closely with your medical team, you can guarantee the safest and most effective treatment possible.

Mechanism of Action

To understand how ivermectin works, let’s examine its mechanism of action.

Ivermectin selectively binds with high affinity to glutamate-gated chloride ion channels in invertebrate muscle and nerve cells.

This binding increases the cell membrane’s permeability to chloride ions, causing hyperpolarisation and leading to paralysis and death of the target parasites.

The discovery of ivermectin in the 1970s was a breakthrough in parasitic treatment.

At the molecular level, ivermectin’s interactions with glutamate-gated chloride channels are key.

It pushes these channels open, allowing an increased flow of chloride ions that hyperpolarises the cell membranes.

The drug’s specificity for invertebrates is due to the distinct structure of their glutamate-gated chloride channels compared to those of mammals.

Ivermectin also acts as an agonist of the neurotransmitter GABA, disrupting GABA-mediated central nervous system neurosynaptic transmission in the parasites.

This neurotransmitter disruption contributes to their death.

Additionally, ivermectin may impair the normal intrauterine development of parasites and inhibit their release from the uteri of gravid female worms.

The drug is primarily metabolised in the liver by CYP3A4 into various metabolites, some of which remain toxic to parasites.

Ivermectin and its metabolites are excreted almost exclusively in the faeces, with less than 1% excreted in the urine.

The elimination half-life is approximately 18 hours.

Frequently Asked Questions

Is Ivermectin Safe for Pregnant or Breastfeeding Women?

You should avoid taking ivermectin if you’re pregnant or breastfeeding.

There’s insufficient evidence supporting its safety during pregnancy, with some animal studies showing adverse effects on the foetus.

Ivermectin can pass into breast milk and may harm a nursing infant.

Consult your healthcare provider to assess the potential risks and benefits.

They’ll determine if the importance of the drug to the mother justifies the possible risks to the child.

Can Ivermectin be used to treat COVID-19?

Based on the available research, ivermectin hasn’t shown significant efficacy in treating COVID-19.

Large, well-designed studies found no meaningful benefits in outcomes such as symptom duration or hospitalisation rates when using ivermectin for COVID-19 patients compared to placebo.

Leading health organisations do not recommend prescribing or using ivermectin to treat COVID-19 due to the lack of evidence supporting its effectiveness.

You should consult your doctor about proven treatments for COVID-19.

How Long Does It Take for Ivermectin to Work?

Antiparasitic activity can persist for several months after a single dose.

You’ll notice its effectiveness within hours, with peak plasma concentrations reached about 4 hours after taking it orally.

Dermal microfilarial loads drop by 78% in just 2 days.

Ivermectin’s onset is rapid, and a single dose typically provides a 77-100% cure rate.

Supplementary doses increase this to 97-100%, stopping disease progression within 2 days.

Can Ivermectin Be Used in Children?

Ivermectin can be used in children, but its paediatric use is off-label for those under 15 kg due to limited data.

For children weighing ≥15 kg, the recommended dosage is 200 mcg/kg taken as a single dose.

Dosing strategies for preschool-aged (2-5 years) and school-aged (6-12 years) children require optimisation to achieve consistent exposure.

You should exercise caution when using ivermectin in children <5 years old or <15 kg.

Are There Any Long-Term Side Effects of Taking Ivermectin?

You may experience long-term side effects when taking ivermectin, especially with prolonged treatment duration.

These can include liver damage, neurological problems, serious eye issues, joint pain or swelling, and skin reactions.

Rare but severe effects like hepatic failure, fatal encephalopathy, and cardiac complications are also possible.

Regular monitoring, dosage adjustments, medication changes, supportive care, and emergency medical attention may be necessary to manage these long-term side effects effectively.

Conclusion

You’ve learned about ivermectin, the “wonder drug” that’s FDA-approved for parasitic infections but somehow became a controversial COVID-19 treatment.

Despite lacking solid evidence, some swear by it for everything from acne to cancer.

It’s generally safe at approved doses, but don’t be fooled by miracle cure claims or self-medicate with livestock formulations.

Consult your doctor for proper medical advice tailored to your needs.

Ivermectin is potent, so let’s stick to facts, not fiction.