How Do You Take Ivermectin for Scabies?

To effectively treat scabies with ivermectin, you’ll typically take a standard dose of 200 µg/kg, usually as two doses spaced 7-14 days apart.

Take it orally with food, ideally during or after a high-fat meal for maximum absorption.

Expect cure rates ranging from 70-100%, with a single dose yielding a 62.4% cure rate that increases to 92.8% with a second dose.

While generally safe, watch for mild side effects such as headaches, nausea, and skin irritation.

For severe crusted scabies, your doctor may recommend combination therapy with topical treatments.

Keep exploring to uncover more essential details about effectively using ivermectin for scabies.

Key Takeaways

• Take ivermectin orally, ideally with a high-fat meal, for maximum absorption.
• The standard dose is 200 µg/kg/dose, two doses spaced 7-14 days apart.
• Dosage is weight-based; for example, 3 mg for children weighing 15-24 kg.
• Ivermectin can be used in children weighing 15 kg or more.
• For severe crusted scabies, combination therapy with topical permethrin and multiple doses of ivermectin may be required

Ivermectin Dosage

Two dosage regimens are commonly used when treating typical scabies with oral ivermectin.

The standard dose is 200 µg/kg/dose, which translates to 0.2 mg/kg.

You’ll typically take two doses, spaced 7 to 14 days apart.

This double-dose approach has demonstrated higher efficacy compared to a single-dose regimen.

The dosing intervals help eliminate all stages of the parasite, as a single dose may not be sufficient.

Ivermectin is listed on the PBS for typical scabies treatment.

When treating crusted scabies, the dosage remains at 200 µg/kg/dose, but the best dosing schedule is less certain.

You may need to take three, five, or even seven doses, with appropriate spacing between doses.

In severe infections, more frequent dosing might be necessary.

It’s essential to use ivermectin with topical agents for the best results.

Safety considerations include age limitations, as the safety of ivermectin in children weighing less than 15 kg has not been established.

Similarly, its safety during pregnancy is uncertain.

While generally well tolerated, with only mild and transient adverse effects, overusing ivermectin can lead to resistance development.

This concern makes it a second-line treatment for typical scabies.

Compared to permethrin, ivermectin has similar efficacy for typical scabies.

However, ivermectin combined with topical agents is recommended for crusted scabies.

The double-dose regimen consistently outperforms a single dose in treating scabies.

Ivermectin is also effective in managing endemic scabies in communities and proves useful in treating refractory cases or when topical application is logistically challenging.

Administration Guidelines

When administering ivermectin for scabies, following the dosage guidelines based on your body weight is essential.

Take the medication with food to enhance its absorption and bioavailability.

Consult the dosage chart provided by your healthcare provider to determine the appropriate number of tablets or volume of liquid formulation to take.

The usual recommended dose for treating scabies is 0.2 mg/kg orally once, with a repeat dose in 2 weeks if needed.

Dosage by Weight

Ivermectin dosage is determined primarily by body weight for both adults and children.

Weight-based dosing ranges from 3 mg for those weighing 15-24 kg, up to 0.2 mg/kg for individuals 80 kg or more.

For onchocerciasis in those 85 kg or more, the dose is 0.15 mg/kg every 12 months.

Crusted scabies require 0.2 mg/kg on days 1, 2, 8, 9, 15, and possibly 22 and 29.

Typical scabies are treated with two 0.2 mg/kg doses given two weeks apart.

Microfilariaemia maintenance dosing is 0.15-0.2 mg/kg every 6-12 months.

Safety hasn’t been established for children under 15 kg.

Dosage adjustments may be needed, such as repeating treatment in two weeks if scabies symptoms persist.

Ivermectin can be combined with a topical scabicide.

Additional doses at 1-2 week intervals may be required for crusted scabies.

Importantly, ivermectin isn’t active against adult Onchocerca volvulus parasites.

While permethrin 5% cream or benzyl benzoate 25% lotion are first-line treatments for typical scabies, reserve ivermectin for second-line use to prevent resistance.

Multiple doses potentially increase the resistance risk.

Efficacy can be challenging to assess due to heterogeneity in the study.

Pruritus or lesions persisting don’t warrant re-treatment before 4 weeks.

Ivermectin is contraindicated for individuals with prior hypersensitivity to the medication.

Taking With Food

One key factor to contemplate when taking ivermectin for scabies is the importance of administering the drug with food.

Consuming a meal, particularly one high in fat content, can greatly enhance the bioavailability of ivermectin by up to 2.5 times compared to taking it on an empty stomach.

Ivermectin tablets should be crushed for easy administration to small children.

This food interaction is vital for optimising the effectiveness of the medication in treating scabies.

When planning your ivermectin doses, consider the following meal timing guidelines:

• Take ivermectin during or immediately after a full meal to maximise absorption
• If possible, opt for a high-fat meal to further enhance bioavailability
• Maintain consistent meal timing for each dose to guarantee steady therapeutic levels

Despite general recommendations suggesting that ivermectin be taken on an empty stomach, clinical evidence supports the benefits of taking it with food for scabies treatment.

This administration method doesn’t compromise the safety profile of the drug.

By strategically timing your ivermectin doses with meals, you can harness the food interactions to improve the efficacy of your scabies treatment plan.

Always follow your healthcare provider’s specific instructions regarding dosage and administration.

Treatment Efficacy

To effectively treat scabies, you’ll need to consider the efficacy of ivermectin.

Studies show it has high cure rates ranging from 70% to 100% for both typical and crusted scabies.

A single 200 µg/kg oral dose can provide a 62.4% cure rate, increasing to 92.8% with a second dose after 2 weeks.

In treatment comparison studies, Ivermectin’s therapeutic efficacy is statistically equivalent to topical treatments like permethrin and lindane.

It may even cure faster than lindane, with higher healing rates at day 15.

However, two doses are necessary to guarantee total eradication and mitigate resistance development.

Efficacy studies have evaluated ivermectin through clinical trials, often comparing it to topical treatments.

Randomised controlled trials demonstrate its effectiveness despite heterogeneity in study methodologies.

Observational studies and case series also support ivermectin’s efficacy.

Cochrane reviews have assessed it against topical treatments for typical and crusted scabies.

While topicals remain first-line for typical cases, with ivermectin reserved as second-line due to potential mite resistance, the oral drug is recommended with permethrin for crusted scabies.

Ivermectin is as effective as alternatives but simpler to use, improving compliance in certain settings.

Treatment efficacy is evaluated at intervals, usually 2 and 4 weeks after initial treatment.

Repeat treatments are needed since ivermectin isn’t ovicidal, and a second dose is required to eradicate all parasite stages.

Safety Considerations

Before taking ivermectin for scabies, it’s important to be aware of potential adverse effects.

While generally well-tolerated, common side effects can include joint pains, headaches, nausea, vomiting, or reduced appetite.

The safety of ivermectin in pregnant and lactating women hasn’t been established, so it should be used with caution in these populations.

Ivermectin concentrates in the liver and fatty tissues, with low levels reaching the central nervous system.

Adverse Effects

Although ivermectin is generally well-tolerated, it’s important to be aware of potential adverse effects and safety considerations before starting treatment.

Common adverse reactions include mild pruritus enhancement, transient vesicle-pustular rash, diarrhoea, nausea, dizziness, and sleepiness.

You may also experience skin irritations, such as mild itching, particularly on the hands and feet, or allergic reactions with itching and hives.

More serious adverse effects to watch out for include:

• Severe skin rashes and effects on the nervous system, such as problems with balance (ataxia) and seizures
• Low blood pressure (hypotension) and liver injury
• Coma induction in overdose cases

It’s important to be aware of potential interactions with other medications, including blood thinners, and the risk of overdose with unauthorised use or large doses.

Resistance can develop with overuse or repeated regimens.

Ivermectin is contraindicated in patients with certain conditions, such as allergic reactions to the drug.

Monitoring is required for adverse effects, especially in long-term treatments or when used in combination with other drugs.

Major organisations recommend against home use of ivermectin for COVID-19. Consult your healthcare provider if you experience any concerning symptoms.

Pregnancy and Lactation

When considering ivermectin treatment for scabies during pregnancy or lactation, it’s crucial to understand the safety considerations and potential risks.

Pregnancy is a contraindication for ivermectin due to the lack of safety data.

There’s insufficient clinical evidence to support its use in pregnant women, and the pregnancy risks aren’t well-established.

Topical scabicidal treatments are preferred during pregnancy.

If ivermectin is deemed necessary, the decision should be made after carefully evaluating the severity of scabies and weighing the potential risks.

In severe cases, the benefits of treating scabies may outweigh the potential risks to the foetus.

Lactation safety data for ivermectin is also limited.

While there’s no contraindication for its use during breastfeeding, caution is advised.

Ivermectin’s excretion in human milk and its effects on breastfed infants aren’t well-documented.

If a lactating woman is treated with ivermectin, the breastfed infant should be monitored closely for any adverse reactions.

The benefits of treating the mother should be weighed against the potential risks to the nursing infant.

In both pregnancy and lactation, the standard ivermectin dosage for scabies (0.2 mg/kg orally once, repeated in 2 weeks) may not apply, and alternative treatments should be considered.

paediatric Use

Oral ivermectin is an effective treatment option for scabies in children weighing 15 kg or more. Dosing guidelines recommend 200 micrograms/kg as a single dose, repeated after one week, to reduce the risk of treatment failure.

Four cases documented complete response after treatment with oral ivermectin in children under 15 kg.

Paediatric guidelines suggest that the 3 mg tablet formulation can be used and crushed for easier administration to younger children.

It is significant to mention that ivermectin should be taken with food to enhance its bioavailability, which goes against the typical recommendation of taking it on an empty stomach.

While ivermectin is generally well-tolerated in children, with only mild and transient side effects reported, there are some key considerations:

• Weight-based dosing adjustments are vital, and ivermectin isn’t routinely used in neonates or children under 15 kg without consulting infectious disease or clinical microbiology specialists.
• A combination of oral ivermectin and topical keratolytic and scabicidal agents is recommended for optimal treatment for crusted scabies cases.
• Close monitoring for several weeks post-treatment is critical to guarantee complete resolution of the infection, particularly in immunocompromised patients who may require repeated or extended treatment courses.

Clinical trials and case series support the efficacy and safety of oral ivermectin in paediatric scabies, with complete response rates ranging from 85-93%.

However, while CDC guidelines propose ivermectin as an alternative to topical permethrin, they also emphasise exercising caution in children weighing less than 15 kg, as the safety profile in this age group hasn’t been firmly established.

Pregnancy and Lactation

While ivermectin is generally safe and effective for treating scabies in children, its use during pregnancy and lactation requires careful consideration.

The risks associated with ivermectin during pregnancy are not well-established due to limited safety data.

It is classified as “human data suggest low risk” during pregnancy, but more research is needed to confirm its safety.

Some evidence suggests potential risks such as spontaneous abortions, stillbirths, and congenital anomalies, but the data are inconclusive due to the low number of cases.

A systematic review and meta-analysis found insufficient evidence to establish the safety of ivermectin during pregnancy.

Permethrin remains the preferred treatment for pregnant women because of its well-established safety profile.

However, if necessary, your healthcare provider may recommend ivermectin with close monitoring in the second and third trimesters.

Regarding lactation safety, ivermectin passes into breast milk in small amounts and is likely compatible with breastfeeding.

No significant adverse effects have been reported with its use during breastfeeding, but the data are limited.

Permethrin and benzyl benzoate are also suitable options for breastfeeding women.

If you are considering ivermectin while breastfeeding, consult your healthcare provider for guidance.

Treatment decisions should be made on a case-by-case basis, weighing the severity of the scabies infection against the potential risks.

Close clinical monitoring is essential, especially for pregnant women treated with ivermectin in the first and second trimesters.

Alternative treatments like permethrin should be considered first during pregnancy and lactation.

If ivermectin is deemed necessary, the standard adult dosage is 200µg/kg/dose, taken orally with food and repeated after 7 to 14 days.

Further research is needed to establish the safety and efficacy of ivermectin in pregnant and lactating women.

HIV-Infected Patients

If you’re an HIV-infected patient with scabies, you’ll want to know about ivermectin’s efficacy, dosage considerations, and how to monitor your response to treatment.

A single 200 mcg/kg oral dose of ivermectin is effective for most HIV patients with scabies, but more severe cases may require multiple doses taken 7-14 days apart.

Combination therapy with benzyl benzoate significantly improves success rates in severe crusted scabies cases.

It’s important to watch closely for any adverse reactions, which tend to be slightly more common but less severe in HIV-positive individuals compared to those without HIV.

Ivermectin Efficacy

Ivermectin demonstrates remarkable efficacy in treating scabies in HIV-infected patients, with cure rates ranging from 70% to 100% in clinical trials for both classic and crusted Norwegian scabies.

In one study, 91% of HIV-infected patients showed no evidence of scabies four weeks after the first treatment, with 8 out of 11 patients cured with a single dose.

In some cases, a second dose may be needed, administered two weeks after the initial treatment.

The severity of scabies lesions does not impact ivermectin‘s efficacy, and it can be used with or without topical agents.

Ivermectin’s safety profile is well-established, with no significant side effects reported in most patients.

• Ivermectin’s simple administration, compared to topical treatments like lindane, improves patient compliance, making it a valuable tool for controlling scabies transmission.
• While not FDA-approved for scabies treatment, ivermectin’s off-label use is supported by its effectiveness and safety in HIV-infected patients.
• The potential for ivermectin resistance in scabies mites requires ongoing monitoring and research to guarantee its continued efficacy.

Clinical trials since 1992 confirm ivermectin’s effectiveness in treating scabies, with healing rates at day 15 surpassing those of lindane.

Its use in HIV-infected patients suggests it can be employed in populations with co-infections.

Dosage Considerations

When treating scabies in HIV-infected patients, you will generally administer ivermectin as a single oral dose of 200 micrograms per kilogram.

However, dosage adjustments may be necessary based on the severity of the scabies and the patient’s immune status.

For severe or crusted scabies, you should consider combination therapy with benzyl benzoate solution.

Refractory cases in immunocompromised patients may require repeated treatment at intervals, such as every 2 weeks.

For strongyloidiasis, you may need to implement suppressive therapy with monthly dosing in HIV-infected individuals.

While these patients may experience higher frequencies of adverse reactions to ivermectin, the severity can be lower than seronegative patients.

Ivermectin is available in 3 mg oral tablets (Stromectol, generic), topical cream, and lotion.

Closely monitor those with severe immune compromise and adjust the dosing as needed.

In HIV-infected patients, combining oral ivermectin with topical benzyl benzoate proves more effective for treating crusted scabies.

Treatment outcomes will vary based on the severity of the scabies, with combination therapy being more beneficial for severe cases.

Understand that specific dosing for scabies in HIV-infected patients typically follows the 200 micrograms per kilogram guideline, similar to immunocompetent patients.

Monitoring Response

You’ll need to closely monitor the response to ivermectin treatment in HIV-infected patients with scabies.

Conduct regular treatment assessments, as these patients may require additional doses, especially if the first dose isn’t curative.

Studies show that 91% of HIV-infected patients had no evidence of scabies four weeks after the initial ivermectin treatment.

A combination of multiple ivermectin doses and topical treatments may be necessary for crusted scabies.

When monitoring HIV-infected patients with scabies, keep these points in mind:

• Disease severity can be greater, so adjust treatment based on the patient’s condition and response
• Combination therapy using oral ivermectin and topical agents is often required for effective management
• Ongoing patient monitoring for ivermectin resistance is vital, as local resistance patterns should inform treatment decisions.

Supportive care, including treating secondary infections, may also be necessary in severe cases.

By closely tracking treatment response through regular follow-up examinations and skin scrapings, you can guarantee the best outcomes for your HIV-infected patients with scabies.

Remain vigilant in patient monitoring efforts to prevent disease spread and manage potential treatment resistance.

Crusted Scabies Management

For severe cases of crusted scabies, you’ll require a more intensive treatment regimen with ivermectin.

Your doctor will prescribe a dosing schedule based on the severity of your infection, typically involving multiple doses over several weeks.

Three common treatment options are a 3-dose schedule (on days 1, 2, and 8), a 5-dose schedule (on days 1, 2, 8, 9, and 15), or a 7-dose schedule (on days 1, 2, 8, 9, 15, 22, and 29).

The dose is weight-based at 200 μg/kg/dose, rounded to 3 mg.

In addition to ivermectin, you will simultaneously use a topical permethrin 5% cream.

Apply the cream daily for the first week, then twice weekly until cured.

Do not forget to apply it to your face and scalp.

Topical keratolytics should be applied on alternate days to reduce scaling and help the permethrin penetrate more effectively.

Take your ivermectin with a meal to increase its absorption.

It is contraindicated if you are pregnant or breastfeeding.

Safety has not been established for children under 15 kg.

A healthcare provider should directly observe you taking each dose.

Be aware that resistance can develop with repeated use.

Close follow-up with your doctor is essential to ensure effective treatment, prevent recurrence, and manage complications.

You must remain isolated until your skin lesions resolve, which takes at least 8 days.

Your close contacts will also require treatment with ivermectin, even if they do not exhibit symptoms.

Misdiagnosis of crusted scabies as psoriasis or seborrhoeic dermatitis can lead to delayed treatment.

Careful monitoring is key to preventing reinfestation and managing crusted scabies in the long term.

Community Settings

In community settings with high scabies prevalence, ivermectin-based mass drug administration (MDA) is a highly effective intervention to rapidly reduce transmission and disease burden.

Health workers typically distribute 200µg/kg doses of ivermectin to all community members, except children under 15 kg and pregnant women, who receive topical permethrin instead.

Two rounds of treatment are administered 7-14 days apart for classic scabies, while those with crusted scabies also receive a topical agent and may need more frequent dosing (e.g., on days 1, 2, and 8).

Achieving high treatment coverage is essential for ideal efficacy.

Studies have shown that a single round of ivermectin MDA can reduce scabies prevalence by about 90%, with sustained suppression rates of up to 93% reported at two years.

The 2015 GBD study assigned scabies a disability weight of 0.027.

To guarantee the success of ivermectin MDA for scabies control in communities, several key components should be addressed:

• Implement extensive community education campaigns to raise awareness about scabies, its transmission, and the importance of treatment participation.
• Establish accessible and well-coordinated treatment delivery systems to reach all affected individuals, including those in remote or underserved areas.
• Provide adequate training and support for health workers to diagnose scabies effectively, distribute treatments, and monitor for adverse events.

While ivermectin MDA has demonstrated a significant impact in high-prevalence settings, its safety in young children and pregnant women requires further study.

Furthermore, the ideal control strategies for communities with a moderate prevalence of scabies (2-10%) are less clear and may necessitate a more targeted approach.

Clinical Diagnosis

Diagnosing scabies clinically requires a keen eye and attention to detail.

The hallmark scabies symptoms include an intensely pruritic rash that’s often worse at night, tiny erythematous papules, vesicles or pustules, and the pathognomonic sign of linear burrows.

In severe cases, you may see large areas of crusting, especially in immunocompromised patients.

Excoriations and ulcerations can also occur due to scratching, along with a generalised hypersensitivity reaction that may feature urticaria.

However, clinical diagnosis isn’t always straightforward and presents certain diagnostic challenges.

The variable appearance of lesions and absence of classic signs like burrows can limit the sensitivity of clinical assessment alone.

Scabies symptoms also overlap with other dermatological conditions, necessitating a carefully considered differential diagnosis.

In some cases, expert dermatological evaluation may be needed to diagnose scabies accurately.

Dermatoscopy can be a useful adjunctive tool for visualising mites and their eggs, but definitive diagnosis ultimately involves microscopic identification of the mite itself.

When evaluating a patient for possible scabies, performing a thorough skin examination, eliciting a detailed history of symptoms and potential exposures, and considering the full spectrum of clinical findings to arrive at the correct diagnosis and guide appropriate treatment with ivermectin or other agents is essential.

Combination Therapy

Combination therapy is the mainstay of treatment for severe and crusted scabies, involving simultaneous administration of oral ivermectin and topical permethrin.

The CDC recommends specific treatment protocols based on the severity of the infestation.

For typical cases, you’ll take ivermectin orally according to your body weight, with a second dose 7 days later.

Permethrin 5% cream is applied topically from head to toe, with a repeat treatment after 1 week.

Crusted scabies require multiple doses of both medications, often given at the same time.

The benefits of combination therapy for severe scabies include:

• Improved efficacy compared to using either medication alone
• Targeting different life stages of the mite for thorough eradication
• Reduced risk of treatment failure and reinfestation

It’s essential to follow the prescribed dosing schedule carefully.

Ivermectin should be taken with food under direct observation to guarantee proper administration and maximise effectiveness.

Permethrin application must be thorough, covering all skin surfaces, and reapplied as directed.

Accurate diagnosis is critical for the effective management of scabies and the selection of the appropriate treatment regimen.

Isolation is necessary for crusted scabies until the skin lesions are resolved, typically within a minimum of 8 days.

While combination therapy is generally safe and effective, some important considerations exist.

Ivermectin is contraindicated in pregnant or breastfeeding women.

Permethrin has a high alcohol content, posing a flammability risk and potential for diversion.

Mite resistance to ivermectin is a concern with overuse, emphasising the need for judicious use and alternative treatments when appropriate.

Treatment failure can occur due to inadequate dosing, incorrect application, or unidentified underlying causes, warranting careful evaluation and follow-up.

Frequently Asked Questions

Can you drink alcohol while taking ivermectin for scabies?

While ivermectin’s standard dosage for scabies hasn’t shown significant adverse effects with alcohol interaction in a pilot study, there’s insufficient data to assess safety fully.

Additional research is needed to understand potential interactions.

Following treatment guidelines and your healthcare provider’s recommendations when taking ivermectin is best.

Abstaining from alcohol during treatment is advised to guarantee the medication’s effectiveness and minimise any risks until more conclusive evidence is available.

How Long Does Ivermectin Stay in Your System After Taking It?

Ivermectin’s half-life is 12-56 hours, so it’s detectable for around 2.5 days after your last dose.

However, it is primarily eliminated in faeces and may be present longer in those with slower metabolisms.

The standard dosage for scabies is 200μg/kg, taken orally with food.

For effective treatment, you will take two doses spaced 7-14 days apart.

This allows ivermectin to kill newly hatched mites that survived the initial dose.

Can you use ivermectin cream and take the oral tablets together?

Do not use ivermectin cream and oral tablets together for scabies.

Ivermectin cream isn’t approved for scabies; it is a topical application for rosacea.

Oral ivermectin, dosed at 200 µg/kg, is the appropriate systemic treatment for scabies.

Combining oral and topical ivermectin formulations could increase side effects.

Follow established scabies treatment guidelines, focusing on either permethrin cream or oral ivermectin at the proper dosage, not combined ivermectin cream and tablets.

Is it safe to take Ivermectin if you have liver problems?

If you have liver problems, speak to your doctor before taking ivermectin.

While generally safe, ivermectin may rarely cause liver injury or exacerbate pre-existing liver conditions.

Your doctor will determine if the benefits outweigh the risks and adjust your dosage accordingly.

They’ll closely monitor your liver health during treatment.

Following your doctor’s guidance is essential and reporting any concerning symptoms, such as jaundice, abdominal pain, or nausea.

Can you obtain Ivermectin over the counter at a pharmacy?

You can’t get ivermectin over the counter at pharmacies in the UK.

It’s only available by prescription for treating scabies.

Pharmacies must follow regulations restricting ivermectin’s availability without a valid prescription from a healthcare provider.

While other scabies treatments, like permethrin cream, may be available OTC in some areas, oral ivermectin requires a doctor’s oversight to ensure it’s used safely and appropriately based on the patient’s specific needs.

Conclusion

To banish the itch and defeat the mite, follow your doctor’s instructions for ivermectin dosing based on your weight and the severity of the infection.

Administer it orally, typically as a single dose, although crusted scabies may require multiple doses.

While generally safe, ivermectin can cause side effects such as dizziness or nausea.

It’s a powerful weapon in your scabies-fighting arsenal, but always use it under medical supervision to ensure you emerge victorious against these pesky parasites.