Ivermectin

Question 1

Ivermectin

Answer 1

Given for scabies as an alternative for scabies; also for highly contagious “Norwegian scabies”

Also for several diseases that may be endemic in tropical settings (causative agents of river blindness, Strongyloidiasis, cutaneous larva migrans; the latter two infrequently occur in the US

Can be used for strongyloides hyperinfection syndrome- increasingly recognized cause of life threatening illness in immunocompromised patients

Question 2

Ivermectin MOA

Answer 2

Binds to parasitic neuromuscular junction- causing muscular paralysis of the parasite
Parasite does directly from the effects or from starvation

Question 3

Ivermectin Spectrum

Answer 3

Ectoparasites 
Sarcoptes scabiei (scabies mite)
Pediculus humanus (lice)

Nematodes (roundworms)
Onchocerca volvulus (river blindness)
Strongyloides stercoralis (strongylodiasis)
Ancylostoma braziliense (cutaneous larva migrans)
Other nematodes

Question 4

Ivermectin Adverse Effects

Answer 4

Very well tolerated for scabies

When used for nematodes in endemic settings
Severe adverse reactions (fever, myalgia, hypotension); thought to be a result of the host’s immune response to antigens released from killed parasites; these effects more severe in patients with higher worm burdens and generally resolve soon after drug administration

Question 5

Ivermectin Important Facts

Answer 5

Same drug as for dog’s heartworms

For treatment of ectoparasitic (scabies or lice) infestation, give as 2 doses (1 week apart)
Only giving single dose increases risk of relapse

Question 6

Ivermectin Good For

Answer 6

Alternative to topical permethrin for scabies and topical therapies for head or body louse infestation, and Ancylostoma infections

Drug of choice for Strongyloides or Onchocerca