Ivermectin Stada Arzneimittel Ag (Ivermectin)

Ivermectin is an antiparasitic agent used to treat several helminthic and ectoparasitic infections.

• Onchocerciasis (river blindness): eliminates microfilariae, reducing skin and ocular disease.
• Strongyloidiasis: eradicates intestinal Strongyloides stercoralis infection.
• Scabies: kills Sarcoptes scabiei mites, relieving itching and skin lesions.
• Pediculosis (lice infestation): destroys head and body lice, preventing reinfestation.
• Other helminth infections: treats various nematode infections as indicated by clinical guidelines.

• Ivermectin binds selectively to glutamate‑gated chloride channels that are present in invertebrate nerve and muscle cells. This binding increases the permeability of the membrane to chloride ions, causing hyperpolarization, paralysis and eventual death of the parasite, while mammalian cells lack these channels, providing a wide safety margin. The drug’s high affinity for these channels disrupts neurotransmission, leading to immobilization of the parasite within hours of administration.

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

Common Side Effects

• Nausea: mild stomach upset or queasiness.
• Diarrhea: loose stools, usually self‑limiting.
• Dizziness: transient light‑headedness or vertigo.
• Pruritus: itching at the site of parasite death.
• Abdominal pain: cramp‑like discomfort in the abdomen.
• Fatigue: feeling unusually tired or weak.

Serious or Rare Side Effects

• Severe skin reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Neurological events: seizures, encephalopathy or altered consciousness.
• Hepatotoxicity: elevated liver enzymes or jaundice.
• Hypotension: sudden drop in blood pressure, potentially leading to fainting.

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

• Indication verification: confirm the infection type and severity before initiating therapy.
• Concomitant medications: review patient’s current drugs for potential interactions, especially with CYP3A4 modulators.
• Hepatic function: assess liver function, as impaired metabolism may increase drug exposure.
• Pregnancy and lactation: avoid use unless benefits outweigh potential risks, due to limited safety data.
• Pediatric use: adjust dosing carefully and monitor for adverse reactions in children.
• Store at ambient temperature: keep tablets in the original container, protect from moisture and direct sunlight.

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

Major Interactions (Avoid)

• Strong CYP3A4 inducers: drugs such as rifampicin or carbamazepine may markedly reduce ivermectin plasma levels.
• P‑glycoprotein inhibitors: co‑administration with verapamil or quinidine can increase ivermectin exposure and risk of toxicity.

Moderate Interactions (Monitor Closely)

• Anticoagulants: monitor INR or clotting parameters as ivermectin may potentiate bleeding risk.
• CNS depressants: concurrent use with barbiturates or benzodiazepines may enhance central nervous system effects.
• Immunosuppressants: observe for altered parasite clearance when combined with agents like corticosteroids.