Ivermectin

Dosage Forms & Strengths

tablet

• 3mg

Strongyloidiasis of the Intestinal Tract

15-24 kg: 3 mg PO once

25-35 kg: 6 mg PO once

36-50 kg: 9 mg PO once

51-65 kg: 12 mg PO once

66-79 kg: 15 mg PO once

>80 kg: 200 mcg/kg PO once 

Dosing considerations

• In general repeat doses not necessary; perform stool examinations to verify eradication of infection

River Blindness (Onchocerciasis)

15-25 kg: 3 mg PO; may repeat in 3-12 mo

26-44 kg: 6 mg PO; may repeat in 3-12 mo

45-64 kg: 9 mg PO; may repeat in 3-12 mo

65-84 kg: 12 mg PO; may repeat in 3-12 mo

≥85 kg: 150 mcg/kg PO; may repeat in 3-12 mo 

Dosing considerations

• Note: Does not treat adult worms (must be surgically excised)

Head Lice (Pediculosis capitis; Off-label)

200 mcg/kg PO once; may require 1-2 additional doses repeated after 7 days 

Blepharitis (Demodex folliculorum; Off-label)

200 mcg/kg PO once as a single dose, THEN repeat dose once in 7 days 

Filariasis Due to Mansonella Ozzardi (Off-label)

6 mg PO as single dose

Filariasis Due to Mansonella Streptocera (Off-label)

150 mcg/kg as single dose

Scabies Due to Sarcoptes Scabiel

Immunocompromised patients: 200 mcg/kg as single dose; may repeat in 14 days if necessary

Gnathostoma Spinigerum

Gnathostomiasis: 200 mcg/kg as single dose

Administration

Take on empty stomach

Monitor: Stool exams (Strongyloides)

Dosage Forms & Strengths

tablet

• 3mg

River Blindness (Onchocerciasis)

<15 kg: Safety and efficacy not established

15-25 kg: 3 mg PO; may repeat in 3-12 mo

26-44 kg: 6 mg PO; may repeat in 3-12 mo

45-64 kg: 9 mg PO; may repeat in 3-12 mo

65-84 kg: 12 mg PO; may repeat in 3-12 mo

≥85 kg: 150 mcg/kg PO; may repeat in 3-12 mo 

Dosing considerations

• Note: Does not treat adult worms (must be surgically excised)

Strongyloidiasis of the Intestinal Tract

<15 kg: Safety and efficacy not established

15-24 kg: 3 mg PO once

25-35 kg: 6 mg PO once

36-50 kg: 9 mg PO once

51-65 kg: 12 mg PO once

66-79 kg: 15 mg PO once

>80 kg: 200 mcg/kg PO once 

Dosing considerations

• In general repeat doses not necessary; perform stool examinations to verify eradication of infection

Administration

Take on empty stomach

Monitor: Stool exams (Strongyloides)

Ivermectin is also sometimes used to treat certain other roundworm infections, head or pubic lice infestation, and scabies (itchy skin condition caused by infestation with small mites that live under the skin). Talk to your doctor about the risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Ivermectin is the generic name of the prescription drug Stromectol, also available as a lotion (Sklice) and a cream (Soolantra).

Doctors prescribe ivermectin to treat parasites in the intestines, river blindness, scabies, and lice on the head and in the pubic area.

Ivermectin belongs to group of drugs known as antiparasitics. It works by increasing the amount of chloride that flows into the parasite's nervous system, which ultimately paralyzes and kills the parasite.

The Food and Drug Administration (FDA) first approved ivermectin under the brand name Stromectol in 1996. Merck Sharpe & Dohme manufactures it.

Ivermectin Warnings

You shouldn’t take ivermectin if you’re allergic to ivermectin or any ingredients in the drug.

Talk to your doctor before taking ivermectin if you have asthma or a skin condition called onychodermatitis.

Pregnancy and Ivermectin

Ivermectin has not been well studied in pregnant humans.

Before taking ivermectin, talk to your doctor about whether the drug benefits outweigh the potential risks to your unborn baby.

Whether or not ivermectin is for mothers who are breastfeeding has not been determined.

Tell your doctor if you’re pregnant, planning a pregnancy, or breastfeeding before taking ivermectin.

Ivermectin for Dogs and Cats

Veterinarians often prescribe ivermectin (under the brand names Heartgard, Ivomec, Iverhart, and others) for dogs and cats.

The drug is used to treat parasitic infections such as heartworm, mange, and ear mites.

Low doses of ivermectin are generally considered safe for animals.

However, ivermectin is not suitable for all dogs. Some carry a mutated gene (MDR-1) that makes the dog especially sensitive to ivermectin toxicity.

In dogs with this mutation, ivermectin can pass into the brain and nervous system with deadly consequences.

There are some dog breeds that are more sensitive to ivermectin than others. These include Australian and German Shepherds; English, Old English, and Shelton Sheepdogs; Syke Terriers; and Collies.

However, your dog's breed is not necessarily a guarantee that there will or will not be a problem with ivermectin.

Significant lethality was observed in mice and rats after single oral doses of 25 to 50 mg/kg and 40 to 50 mg/kg, respectively. No significant lethality was observed in dogs after single oral doses of up to 10 mg/kg. At these doses, the treatment-related signs that were observed in these animals include ataxia, bradypnea, tremors, ptosis, decreased activity, emesis, and mydriasis.

In accidental intoxication with, or significant exposure to, unknown quantities of veterinary formulations of ivermectin in humans, either by ingestion, inhalation, injection, or exposure to body surfaces, the following adverse effects have been reported most frequently: rash, edema, headache, dizziness, asthenia, nausea, vomiting, and diarrhea. Other adverse effects that have been reported include: seizure, ataxia, dyspnea, abdominal pain, paresthesia, urticaria, and contact dermatitis.

In case of accidental poisoning, supportive therapy, if indicated, should include parenteral fluids and electrolytes, respiratory support (oxygen and mechanical ventilation if necessary) and pressor agents if clinically significant hypotension is present. Induction of emesis and/or gastric lavage as soon as possible, followed by purgatives and other routine anti-poison measures, may be indicated if needed to prevent absorption of ingested material.

Ivermectin lotion is a prescription medication used to treat head lice infestations in adults and children 6 months of age and older.

The ivermectin tablet is a prescription medication used to treat strongyloidiasis (threadworm; infection with a type of roundworm that enters the body through the skin, moves through the airways and lives in the intestines) and to control onchocerciasis (river blindness; infection with a type of roundworm that may cause rash, bumps under the skin, and vision problems including vision loss or blindness).

Ivermectin cream is used for the treatment of inflammatory lesions, or bumps and pimples, of rosacea. 

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information. 

Ivermectin is part of the drug class:

• Avermectines

Oral:

The most common side effects of ivermectin tablets include:

• dizziness
• loss of appetite
• nausea
• vomiting
• stomach pain or bloating
• diarrhea
• constipation
• weakness
• sleepiness
• uncontrollable shaking of a part of the body
• chest discomfort

Topical:

The most common side effects of ivermectin lotion include:

• eye redness or soreness
• eye irritation
• dandruff
• dry skin
• burning sensation of the skin

Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of ivermection. For more information, ask your healthcare provider or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Oral:

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• medications for anxiety
• mental illness or seizures
• muscle relaxants
• sedatives
• sleeping pills
• tranquilizers

This is not a complete list of all drug interactions. Ask your doctor or pharmacist for more information.

Topical:

Ivermectin lotion is unlikely to affect the actions of other medications you are taking, and other medications are unlikely to affect ivermectin lotion.

No drug interactions have been identified by the manufacturer. However, you should tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Not all drug interactions are known or reported and new drug interactions are continually being reported.

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of ivermectin lotion and tablets, there are no specific foods that you must exclude from your diet.

Oral:

• Ivermectin comes as a tablet to take by mouth. It is usually taken as a single dose on an empty stomach with water. If you are taking ivermectin to treat onchocerciasis, additional doses 3, 6, or 12 months later may be necessary to control your infection. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ivermectin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
• If you are taking ivermectin to treat strongyloidiasis, you will need to have a stool exam at least three times during the first 3 months after your treatment to see if your infection has cleared. If your infection has not cleared, your doctor will probably prescribe additional doses of ivermectin.
• Ivermectin tablets are usually taken as a single dose. Tell your doctor if you do not take your medication.

Topical:

• Use ivermection lotion exactly as prescribed. Your healthcare provider will prescribe the treatment that is right for you. Do not change your treatment unless you talk to your healthcare provider.
• Use ivermection lotion when your hair is dry.
• It is important to use enough ivermection lotion to completely coat all of your hair and scalp. Leave lotion on your hair and scalp for a full 10 minutes.
• You need to completely cover all the scalp and hair with lotion.
• Children will need an adult to apply ivermection lotion for them.
• Do not swallow ivermection lotion. If swallowed, call your healthcare provider or go to the nearest emergency room right away.
• Do not get ivermection lotion into your eyes. If ivermection lotion gets in your eye, gently flush with water.
• Wash your hands after applying ivermection lotion.

When you complete your dose of ivermection lotion, do not use ivermection lotion again without talking to your healthcare provider first.

Before you use ivermection lotion, ask your healthcare provider or pharmacist if you have questions about the right way to use ivermection lotion.

• Your hair and scalp must be dry before applying ivermection lotion.
• Use the top of cap to break the tamper seal on the tube.
• Apply ivermection lotion directly to dry hair and scalp.
• Completely cover your scalp and hair closest to the scalp first, and then apply outwards towards the ends of your hair.
• Rub ivermection lotion throughout hair.
• It is important to completely cover your entire head so that all lice and eggs are exposed to the lotion. Be sure that each hair is coated from the scalp to the tip.
• Use up to 1 entire tube (4 oz) to completely cover hair and scalp.
• Allow ivermection lotion to stay on your hair and scalp for 10 minutes after it has been applied. Use a timer or clock. Start timing after you have completely covered your hair and scalp with ivermection lotion.
• After 10 minutes, completely rinse ivermection lotion from your hair and scalp using only water.
• You or anyone who helps you apply ivermection lotion should wash their hands after application.
• Do not use ivermection lotion again without talking to your healthcare provider first.

To help prevent the spread of lice from one person to another, here are some steps you can take:

• Avoid direct head-to-head contact with anyone known to have live, crawling lice.
• Do not share combs, brushes, hats, scarves, bandannas, ribbons, barrettes, hair bands, towels, helmets, or other hair-related personal items with anyone else, whether they have lice or not.
• Avoid sleepovers and slumber parties during lice outbreaks. Lice can live in bedding, pillows, and carpets that have recently been used by someone with lice.
• After finishing treatment with lice medicine, check everyone in your family for lice after one week. Be sure to talk to your healthcare provider about treatments for those who have lice.
• Machine wash any bedding and clothing used by anyone having lice. Machine wash at high temperatures (150°F) and tumble in a hot dryer for 20 minutes.

Oral:

If you take too much this medication, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

Topical:

If you apply too much ivermectin lotion to your scalp, you are not likely to experience severe side effects. However, if this medication in taken by mouth, call your local Poison Control Center or seek emergency medical attention right away.

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Ivermectin is best taken as a single dose with a full glass (8 ounces) of water on an empty stomach (1 hour before breakfast), unless otherwise directed by your doctor.

To help clear up your infection, take ivermectin exactly as directed. Your doctor may want you to take another dose every 3 to 12 months.

Your doctor may also prescribe a corticosteroid (a cortisone-like medicine) for certain patients with river blindness, especially those with severe symptoms. This is to help reduce the inflammation caused by the death of the worms. If your doctor prescribes these two medicines together, it is important to take the corticosteroid along with ivermectin. Take them exactly as directed by your doctor. Do not miss any doses.

Dosing

The dose of ivermectin will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of ivermectin. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage form (tablets):
  • For river blindness:
    • Adults and teenagers—Dose is based on body weight and must be determined by your doctor. The usual dose is 150 micrograms (mcg) per kilogram (kg) (68 mcg per pound) of body weight as a single dose. The treatment may be repeated every three to twelve months.
    • Children—Dose is based on body weight and must be determined by your doctor. For children weighing 15 kg (33 pounds) or more, the usual dose is 150 mcg per kg (68 mcg per pound) of body weight as a single dose. If necessary, the treatment may be repeated every three to twelve months. For children weighing less than 15 kg, use and dose must be determined by your doctor.
  • For strongyloidiasis:
    • Adults and teenagers—Dose is based on body weight and must be determined by your doctor. The usual dose is 200 micrograms (mcg) per kilogram (kg) (91 mcg per pound) of body weight as a single dose. Additional doses usually are not needed.
    • Children—Dose is based on body weight and must be determined by your doctor. For children weighing 15 kg (33 pounds) or more, the usual dose is 200 mcg per kg (91 mcg per pound) of body weight as a single dose. For children weighing less than 15 kg, use and dose must be determined by your doctor.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Store away from excessive heat (104°F/40°C) and protect from light.

Use only in well-ventilated areas or outdoors.

Close container tightly when not in use.

Cattle should not be treated when hair or hide is wet since reduced efficacy may be experienced.

Do not use when rain is expected to wet cattle within six hours after treatment.

This product is for application to skin surface only. Do not give orally or parenterally.

Cloudiness in the formulation may occur when Ivermectin (Ivermectin) Pour-On is stored at temperatures below 32° F Allowing it to warm at room temperature will restore the normal appearance without affecting efficacy.

Antiparasitic activity of Ivermectin will be impaired if the formulation is applied to areas of the skin with mange scabs or lesions, or with dermatoses or adherent materials, e.g. caked mud or manure.

Ivermectin has been associated with adverse reactions in sensitive dogs; therefore. Ivermectin Pour-On is not recommended for use in species other than cattle.

When to Treat Cattle with Grubs

Ivermectin Pour-On effectively controls all stages of cattle grubs. However, proper timing of treatment is important. For the most effective results, cattle should be treated as soon as possible after the end of the heel fly (warble fly) season. While this is not peculiar to Ivermectin, destruction of Hypoderma larvae (cattle grubs) at the period when these grubs are in vital areas may cause undesirable host-parasite reactions. Killing Hypoderma lineatum when it is in the esophageal tissues may cause bloat: killing H. bows when it is in the vertebral canal may cause staggering or paralysis. Cattle should be treated either before or after these stages of grub development.

Cattle treated with Ivermectin Pour-On at the end of the fly season may be re-treated with Ivermectin during the winter without danger of grub-related reactions. For further information and advice on a planned parasite control program, consult your veterinarian.

Ivermectin Pour-On is available in a 33.8 fl oz/1 L collapsible pack for use with the dispensing cap provided, or in an 84.5 fl oz/2.5 L collapsible pack, in a 169 fl oz/5 L collapsible pack and a 676 fl oz/20 L container intended for use with appropriate automatic dosing equipment.

Manufactured for:
Durvet, Inc.
Blue Springs, MO 64014
USA

Restricted Drug - California. Use Only as Directed.

Made in the UK

Rev: 5/09

009215I03

0.2 mg/kg orally once

0.2 mg/kg orally once

Study (n=26,000)
Mass treatment in Papua, New Guinea:
Bancroftian filariasis: 0.4 mg/kg orally once yearly (with a single annual dose of diethylcarbamazine 6 mg/kg), for 4 to 6 years

0.2 mg/kg orally once, and repeated in 2 weeks
Ivermectin therapy may be combined with a topical scabicide.