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Ivermectin (systemic): Drug information

Ivermectin (systemic): Drug information
(For additional information see "Ivermectin (systemic): Patient drug information" and see "Ivermectin (systemic): Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Special Alerts
Ivermectin: Coronavirus Disease 2019 (COVID-19) Updated May 2022

Most recent update(s): The Infectious Diseases Society of America's COVID-19 guidelines and the National Institutes of Health's COVID-19 guidelines panel continue to suggest against ivermectin use outside of the context of a clinical trial in outpatients or hospitalized patients with COVID-19.

As part of our response to the evolving COVID-19 pandemic, published literature and guidelines from major health organizations are continuously monitored for potential content updates. At this time, only investigational medications with data determined to be of relatively high quality and/or consistently showing positive clinical outcomes to support dosing recommendations will be included in the monograph, outside of this Special Alert field.

Further information may be found at:

ClinicalTrials.gov: https://www.clinicaltrials.gov/ct2/results?cond=covid19&term=ivermectin&cntry=&state=&city=&dist=

Brand Names: US
  • Stromectol
Pharmacologic Category
  • Anthelmintic
Dosing: Adult
Ascariasis

Ascariasis (alternative agent) (off-label use):

Note: For patients with complications (eg, intestinal obstruction, acute cholangitis), initiate therapy after resolution of acute symptoms (Leder 2022a).

Oral: 150 to 200 mcg/kg as a single dose (Belizario 2003; Drugs for Parasitic Infections 2013; Marti 1996; Naquira 1989).

Demodex folliculitis

Demodex folliculitis (off-label use): Oral: 200 mcg/kg once weekly for 2 doses (Jackson 2022; Salem 2013).

Gnathostomiasis, cutaneous

Gnathostomiasis, cutaneous (off-label use):

Note: Not recommended for CNS disease due to inflammatory response from dying larvae (Herman 2009; Ramirez-Avila 2009; Weller 2022).

Oral: 200 mcg/kg once daily for 2 days (Drugs for Parasitic Infections 2013; Nontasut 2005).

Hookworm-related cutaneous larva migrans

Hookworm-related cutaneous larva migrans (off-label use): Oral: 200 mcg/kg once daily for 1 or 2 days (Drugs for Parasitic Infections 2013; Monsel 2015; Vanhaecke 2014).

Lice, refractory

Lice, refractory (off-label use):

Note: Reserve for patients with an insufficient response to topical therapy (Goldstein 2022a; Goldstein 2022b). Optimal dose, dosing interval, and frequency are uncertain (Drugs for Parasitic Infections 2013).

Pediculus capitis: Oral: 200 mcg/kg once weekly for 2 doses (Drugs for Parasitic Infections 2013; Goldstein 2022a); some experts suggest 400 mcg/kg once weekly for 2 doses (Chosidow 2010; Drugs for Parasitic Infections 2013).

Pediculosis pubis: Oral: 200 mcg/kg once weekly for 2 doses (Goldstein 2022b); some experts suggest 250 mcg/kg once, with a repeat dose in 7 to 14 days (Burkhart 2004; CDC [Workowski 2021]).

Mansonella infection

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 (Boussinesq 1998; Gardon 1997).

Mansonella ozzardi: Oral: 150 mcg/kg as a single dose (de Almeida Basano 2018; Lima 2016).

Mansonella streptocerca infection (alternative agent): Oral: 150 mcg/kg as a single dose (Drugs for Parasitic Infections 2013; Fischer 1997; Fischer 1999).

Onchocerciasis

Onchocerciasis:

Note: For individuals from Loa loa–endemic areas, rule out co-infection prior to ivermectin administration to avoid life-threatening encephalopathy (Boussinesq 1998; Gardon 1997; Murdoch 2022).

Oral: 150 mcg/kg once; repeat dose every 3 to 6 months until asymptomatic (CDC 2021; Drugs for Parasitic Infections 2013; Gardon 2002; Murdoch 2022). For patients outside endemic areas or in areas with low transmission, doxycycline therapy is initiated 1 week after the initial ivermectin dose (CDC 2021; Drugs for Parasitic Infections 2013; Murdoch 2022).

Scabies

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 (Goldstein 2022c).

Classic scabies, treatment: Oral: 200 mcg/kg once; repeat dose in 7 to 14 days (CDC 2019b; CDC [Workowski 2021]; Salavastru 2017).

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) (CDC 2019b; CDC [Workowski 2021]; Salavastru 2017).

Strongyloidiasis

Strongyloidiasis:

Note: For individuals from Loa loa–endemic areas, rule out co-infection prior to ivermectin administration to avoid life-threatening encephalopathy (Leder 2022b).

Uncomplicated infection:

Patients who are immunocompetent: Oral: 200 mcg/kg once daily for 1 or 2 days (CDC 2022; Henriquez-Camacho 2016; Leder 2022b; Repetto 2018; Segarra-Newnham 2007).

Patients who are immunocompromised: Oral: 200 mcg/kg once daily for 2 days; repeat dosing regimen in 2 weeks (Leder 2022b).

Severe, disseminated infection: Oral: 200 mcg/kg once daily until symptoms have resolved and stool and/or sputum examination is negative for ≥2 weeks (CDC 2022; Leder 2022b). Some experts suggest switching to an alternative approach for patients who are immunocompromised or critically ill with persistently positive (eg, ≥3 days) stool examination (Leder 2022b). For patients with persistent immunosuppression after clinical improvement, some experts use suppressive ivermectin 200 mcg/kg once monthly for ≥6 months (Leder 2022b; Segarra-Newnham 2007).

Trichuriasis

Trichuriasis (whipworm) (alternative agent) (off-label use): Oral: 600 mcg/kg once daily for 3 days in combination with albendazole (Leder 2022c; Matamoros 2021).

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) (expert opinion).

Hemodialysis, intermittent (thrice weekly): Unlikely to be significantly dialyzed (highly protein bound; large Vd): No supplemental dose or dosage adjustment necessary (expert opinion).

Peritoneal dialysis: Unlikely to be significantly dialyzed (highly protein bound; large Vd): No dosage adjustment necessary (expert opinion).

CRRT: No dosage adjustment necessary (expert opinion).

PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (expert opinion).

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in manufacturer’s labeling.

Dosing: Pediatric

(For additional information see "Ivermectin (systemic): Pediatric drug information")

Note: Following the indication-specific dosing information are weight-band dosing tables to assist with calculation and rounding of doses.

Ascariasis due to Ascaris lumbricoides

Ascariasis due to Ascaris lumbricoides (roundworm): Limited data available: Children ≥15 kg and Adolescents: Oral: 150 to 200 mcg/kg/dose as a single dose (Red Book [AAP 2015])

Cutaneous larva migrans

Cutaneous larva migrans (dog and cat hookworm) : Limited data available: Children ≥15 kg and Adolescents: Oral: 200 mcg/kg once daily for 1 to 2 days (Red Book [AAP 2015])

Filariasis

Filariasis:

Mansonella ozzardi: Limited data available: Children ≥15 kg and Adolescents: Oral: 200 mcg/kg/dose as a single dose (Red Book [AAP 2015])

Mansonella streptocerca : Limited data available: Children ≥15 kg and Adolescents: Oral: 150 mcg/kg/dose as a single dose (Red Book [AAP 2015])

Wuchereria bancrofti: Limited data available: Children ≥15 kg and Adolescents: Oral: 200 mcg/kg/dose as a single dose given in combination with albendazole (Red Book [AAP 2015])

Gnathostomiasis due to Gnathostoma spinigerum

Gnathostomiasis due to Gnathostoma spinigerum: Limited data available: Children ≥15 kg and Adolescents: Oral: 200 mcg/kg once daily for 2 days (Red Book [AAP 2015])

Onchocerciasis

Onchocerciasis (Onchocerca volvulus, river blindness): Children ≥15 kg and Adolescents: Oral: 150 mcg/kg/dose as a single dose; may repeat every 6 to 12 months until asymptomatic; for prevention of blindness due to ocular onchocerciasis, doses repeated every 3 to 12 months are suggested (Red Book [AAP 2015])

Pediculosis

Pediculosis (lice): Limited data available: Note: Ivermectin is not ovicidal; therefore, repeat doses are necessary to eradicate infestation:

Head lice: Children ≥15 kg and Adolescents: Oral: 400 mcg/kg/dose on days 1 and 8 (Chosidow 2010) or 200 mcg/kg/dose repeated once after 10 days (Jones 2003) have been shown to be effective (AAP [Devore 2015]; Red Book [AAP 2015])

Pubic lice: Children ≥15 kg and Adolescents: Oral: 250 mcg/kg/dose for 2 doses administered 14 days apart (CDC [Workowski 2015])

Scabies due to Sarcoptes scabiei

Scabies due to Sarcoptes scabiei: Limited data available: Children ≥15 kg and Adolescents: Oral: 200 mcg/kg/dose for 2 doses administered at least 7 days apart (Red Book [AAP 2015]); others suggest doses be separated by 14 days (CDC [Workowski 2015])

Strongyloidiasis

Strongyloidiasis: Children ≥15 kg and Adolescents: Oral: 200 mcg/kg once daily for 2 days (Red Book [AAP 2015]). Immunocompromised patients or patients with disseminated disease may need to repeat therapy.

Trichuriasis due to Trichuris trichiura

Trichuriasis due to Trichuris trichiura (whipworm): Limited data available: Children ≥15 kg and Adolescents: Oral: 200 mcg/kg once daily for 3 days (Red Book [AAP 2015])

Weight-band dosing tables:

Weight-Band Dosing to Provide ~150 mcg/kg

Patient Weight

(kg)

Single Oral Dose

15 to 25

3 mg

26 to 44

6 mg

45 to 64

9 mg

65 to 84

12 mg

≥85

150 mcg/kg

Weight-Band Dosing to Provide ~200 mcg/kg

Patient Weight

(kg)

Single Oral Dose

15 to 24

3 mg

25 to 35

6 mg

36 to 50

9 mg

51 to 65

12 mg

66 to 79

15 mg

≥80

200 mcg/kg

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 manufacturer's labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in manufacturer's labeling.

Dosing: Older Adult

Refer to adult dosing.

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

Administration: Adult

Oral: Administer on an empty stomach with water (manufacturer’s labeling). Some experts recommend administering with food to increase absorption (CDC [Workowski 2021]; Currie 2010).

Administration: Pediatric

Oral: Administer on an empty stomach with water (manufacturer's labeling). Some experts recommend administering with food to increase absorption (CDC [Workowski 2015]; Currie 2010).

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
Pediatric patients: High-risk medication:

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]).

Adverse Reactions (Significant): Considerations
CNS effects

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).

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)

Hypersensitivity reactions (delayed)

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).

Immunologic post-treatment reaction (Mazzoti reaction)

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 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)

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 (associated with 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

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:

• Appropriate use: Onchocerca volvulus: Ivermectin has no activity against adult O. volvulus parasites. L. loa: Ivermectin is not active against adult worms.

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 Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

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

Immune Checkpoint Inhibitors: Antibiotics may diminish the therapeutic effect of Immune Checkpoint Inhibitors. Risk C: Monitor therapy

Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. 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

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).

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

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: Vd: 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: 18 hours

Time to peak, serum: ~4 hours

Excretion: Feces; urine (<1%)

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.

Brand Names: International
  • Ascapil (IN);
  • Detebencil (AR);
  • Ectin (IN);
  • Gilou (NL);
  • Ivactin (BD);
  • Iver P (AR);
  • Ivermine (EG);
  • Ivertal (AR);
  • Iverx (CL);
  • Iverzine (EG);
  • Ivexterm (CR, DO, GT, HN, MX, NI, PA, SV);
  • Ivomec (CH);
  • Kaonol (CL, PE);
  • Kilox (CO, CR, DO, EC, GT, HN, NI, PA, SV);
  • Leverctin (BR);
  • Maikeding (CN);
  • Mectizan (BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU, MW, NE, NG, SC, SD, SL, SN, TN, TZ, UG, VN, ZA, ZM, ZW);
  • Presteme (MX);
  • Quamox (PE);
  • Quanox Gotas (CO);
  • Razimectin (EG);
  • Revectina (BR);
  • Sanifer (UY);
  • Scabo (BD);
  • Securo (AR);
  • Soolantra (AU, BE, LB, NL, NO);
  • Stromectol (AU, BB, FR, GR, NL, NZ, SG, TW, VN);
  • Veratin (BD);
  • Vermectil (BR);
  • Vermectin (TH);
  • Vermokill (PY);
  • Yvermil (PY)


For country code abbreviations (show table)
  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. 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]
  4. 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]
  5. 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]
  6. 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]
  7. 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]
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