Iveraxiro (Ivermectin)

Ivermectin is an antiparasitic macrocyclic lactone indicated for the treatment of several helminth infections.

• Onchocerciasis: eliminates microfilariae, reduces skin and ocular lesions, diminishes inflammatory responses, and helps prevent progressive blindness.
• Strongyloidiasis: clears intestinal larvae, prevents disseminated infection, reduces risk of hyperinfection syndrome, and supports recovery of gastrointestinal function.
• Lymphatic filariasis: kills adult worms, lowers microfilarial density, alleviates lymphatic obstruction, and contributes to community‑level disease control.
• Other helminth infections: provides broad‑spectrum activity against various nematodes, aiding treatment of soil‑transmitted helminths and supporting public‑health deworming initiatives.

• Ivermectin binds selectively to glutamate‑gated chloride channels found in the nerve and muscle cells of invertebrates. This binding increases the permeability of the cell membrane to chloride ions, leading to hyperpolarization, paralysis, and death of the parasite. Mammalian cells lack these channels, which accounts for the drug’s selective toxicity. The effect is dose‑dependent and persists for several days, allowing a single oral dose to clear many infections.

Ivermectin may cause adverse reactions, most of which are mild and transient.

Common Side Effects

• Nausea: mild stomach upset that usually resolves without treatment.
• Diarrhea: loose stools occurring shortly after dosing.
• Dizziness: transient light‑headedness or vertigo.
• Pruritus: skin itching, often related to parasite die‑off.
• Fatigue: feeling of tiredness that may last a day.
• Headache: mild to moderate head pain.
• Abdominal pain: mild cramps or discomfort in the stomach area.

Serious or Rare Side Effects

• Severe skin reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Neurological events: seizures, ataxia, or altered consciousness.
• Hepatic injury: marked elevation of liver enzymes or hepatitis.
• Hypersensitivity: anaphylaxis or severe allergic reaction.
• Cardiac effects: arrhythmias or hypotension.
• Renal impairment: acute kidney injury in rare cases.

When prescribing Ivermectin, certain precautions should be observed to ensure safe use.

• Pregnancy: use only if potential benefit justifies potential risk; data limited.
• Breastfeeding: consider risk to infant; monitor for adverse effects.
• Liver disease: dose adjustment may be required; monitor hepatic function.
• Drug interactions: review concomitant medications for major interactions.
• Renal impairment: assess kidney function before use; adjust dose if severe.
• Age considerations: use with caution in elderly patients due to possible increased sensitivity.
• Storage: Store below 25°C: keep in original packaging, protect from moisture and light.

Ivermectin can interact with other medicines; awareness of clinically relevant interactions helps prevent reduced efficacy or increased toxicity.

Major Interactions (Avoid)

• Strong CYP3A4 inducers: such as rifampicin, carbamazepine, may lower ivermectin plasma levels.
• P-glycoprotein inhibitors: such as verapamil, amiodarone, may increase ivermectin exposure.
• Antifungal azoles: ketoconazole can raise ivermectin concentrations, increasing risk of neurotoxicity.

Moderate Interactions (Monitor Closely)

• Anticoagulants: warfarin may have enhanced anticoagulant effect; monitor INR.
• CNS depressants: benzodiazepines may potentiate dizziness; observe patient.
• Macrolide antibiotics: erythromycin may modestly increase ivermectin levels; check for toxicity.
• Statins: simvastatin may have additive muscle toxicity; monitor for myopathy.
• Antihistamines: diphenhydramine may increase sedation; advise caution.