Ivermectine Sigillata (Ivermectin)

Ivermectin acts on a broad range of parasitic infections by targeting the nervous system of the organisms.

• Onchocerciasis (river blindness): reduces microfilarial load and prevents disease progression.
• Strongyloidiasis: eradicates intestinal larvae and prevents autoinfection.
• Scabies: eliminates Sarcoptes mites and resolves skin lesions.
• Pediculosis (lice infestation): kills head and body lice, stopping transmission.
• Other helminth infections: provides parasitological cure for various nematode species.

• Ivermectin binds selectively to glutamate‑gated chloride channels that are present in invertebrate nerve and muscle cells. This binding increases the permeability of the cell membrane to chloride ions, causing hyperpolarization, paralysis, and ultimately death of the parasite while having minimal effect on mammalian cells.

Ivermectin is generally well tolerated, but adverse reactions can occur.

Common Side Effects

• Nausea: mild to moderate gastrointestinal upset.
• Diarrhea: loose stools occurring shortly after dosing.
• Dizziness: transient light‑headedness.
• Pruritus: itching at the site of parasite death.
• Headache: mild tension‑type headache.
• Fatigue: temporary feeling of tiredness.

Serious or Rare Side Effects

• Severe skin reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Neurological events: seizures, encephalopathy, or ataxia.
• Hepatic dysfunction: elevated liver enzymes or hepatitis.
• Visual disturbances: blurred vision or optic neuritis.
• Cardiac arrhythmias: rare conduction abnormalities.
• Anaphylaxis: acute allergic reaction requiring emergency care.

Before prescribing Ivermectin, clinicians should consider patient‑specific factors and safety measures.

• Pregnancy: safety data are limited; use only if potential benefit outweighs risk.
• Breastfeeding: assess risk versus benefit; drug may be excreted in milk.
• Liver impairment: dose adjustment may be needed in moderate to severe hepatic dysfunction.
• Concomitant CNS depressants: monitor for additive central nervous system effects.
• Storage: Store below 25°C: keep in the original container, protect from moisture and direct sunlight.

Ivermectin may interact with other medicines, requiring careful management.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): may increase ivermectin plasma concentrations.
• P‑glycoprotein inhibitors (e.g., verapamil): can raise systemic exposure.

Moderate Interactions (Monitor Closely):\n- Anticoagulants (e.g., warfarin): monitor INR for potential enhancement of anticoagulant effect.

• CNS depressants (e.g., benzodiazepines): observe for increased sedation.
• Antiepileptic drugs (e.g., carbamazepine): may reduce ivermectin efficacy.
• Immunosuppressants (e.g., cyclosporine): watch for altered drug levels.
• Herbal supplements (e.g., St. John’s wort): possible induction of metabolism.