Ivergalen (Ivermectin)

Ivermectin is an antiparasitic agent used to treat infections caused by nematodes and ectoparasites.

• Onchocerciasis: reduces microfilarial load in the skin and eyes, helping to prevent vision loss and skin disease.
• Strongyloidiasis: eliminates intestinal larvae, preventing chronic infection and the risk of hyperinfection syndrome in immunocompromised patients.
• Scabies: clears skin infestation by killing Sarcoptes scabiei mites, relieving intense itching and preventing secondary bacterial infection.
• Pediculosis: eradicates head lice and nits, providing rapid resolution of itching and reducing transmission.
• Other intestinal helminth infections: treats common worm infestations such as ascariasis, hookworm and Trichuris trichiura, improving gastrointestinal health.

• Ivermectin binds with high affinity to glutamate‑gated chloride channels that are present in the nerve and muscle cells of invertebrates. Activation of these channels increases the influx of chloride ions, causing hyperpolarization of the cell membrane, resulting in paralysis and death of the parasite. Mammalian cells lack these channels, which accounts for the drug’s selective toxicity. The drug is absorbed systemically after oral administration and distributes to tissues where parasites reside.

Ivermectin is generally well tolerated, but a range of adverse reactions have been reported.

Common Side Effects

• Nausea: mild stomach upset or queasiness.
• Diarrhea: loose stools that are usually self‑limiting.
• Dizziness: transient light‑headedness or vertigo.
• Pruritus: skin itching that may accompany parasite die‑off.
• Headache: mild to moderate pain in the head.
• Fatigue: feeling of tiredness or reduced energy.

Serious or Rare Side Effects

• Severe skin reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Neurologic events: seizures, ataxia or altered consciousness.
• Hepatic injury: elevated liver enzymes or hepatitis.

When prescribing ivermectin, clinicians should consider several precautionary measures to ensure safe use.

• Indication verification: confirm the specific parasitic infection and appropriate dosage.
• Contraindication assessment: avoid use in patients with known hypersensitivity to ivermectin or related compounds.
• Pregnancy considerations: use only if the potential benefit outweighs the potential risk, as safety data are limited.
• Drug interaction review: evaluate concomitant medications that may affect ivermectin metabolism or increase neurotoxicity.
• Monitoring requirements: observe for signs of severe adverse reactions, especially in patients with high parasite burden.
• Store at ambient temperature: keep tablets in the original container, protect from moisture and direct sunlight.

Ivermectin may interact with other medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Strong CYP3A4 inducers: drugs such as rifampicin or carbamazepine can markedly reduce ivermectin plasma levels, compromising therapeutic effect.
• P‑glycoprotein inhibitors: co‑administration with agents like clarithromycin may increase ivermectin exposure and risk of neurotoxicity.

Moderate Interactions (Monitor Closely)

• Anticoagulants: ivermectin may enhance the effect of warfarin, requiring closer INR monitoring.
• CNS depressants: concurrent use with benzodiazepines or alcohol can potentiate dizziness or sedation.
• Antiparasitic combinations: using ivermectin with other macrocyclic lactones may increase toxicity; dose adjustment may be needed.