Iverscab (Ivermectin)

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

• Strongyloidiasis: eradicates intestinal Strongyloides stercoralis, preventing chronic infection.
• Onchocerciasis: eliminates Onchocerca volvulus microfilariae, reducing skin and ocular disease.
• Scabies: kills Sarcoptes scabiei mites, relieving itching and skin lesions.
• Pediculosis (lice): destroys head and body lice, interrupting the life cycle.
• Other intestinal nematode infections: clears various soil‑transmitted helminths such as Ascaris and hookworm.

• Ivermectin binds selectively to glutamate‑gated chloride channels found in invertebrate nerve and muscle cells. This binding increases chloride ion influx, hyperpolarizing the cell membrane, which leads to paralysis and death of the parasite. Mammalian cells lack these channels, providing a high therapeutic margin. The drug is absorbed systemically after oral administration, achieving concentrations sufficient to affect parasites residing in the gastrointestinal tract and skin.

Ivermectin may cause a range of adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Nausea: mild stomach upset or queasiness.
• Diarrhea: loose stools, often transient.
• Dizziness: feeling light‑headed or unsteady.
• Pruritus: itching at the site of parasite die‑off.

Serious or Rare Side Effects

• Severe skin reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Hepatotoxicity: elevated liver enzymes or jaundice.
• Neurological events: seizures, encephalopathy or loss of consciousness.

When prescribing ivermectin, clinicians should consider several safety measures to minimize risk.

• Pregnancy: avoid use unless benefits outweigh potential risks, as safety data are limited.
• Breastfeeding: assess risk‑benefit; drug may be excreted in milk.
• Concomitant CNS disease: use caution in patients with seizures or other neurological disorders.
• Liver impairment: adjust therapy if hepatic function is compromised.
• Store at ambient temperature: keep below 25 °C, protect from moisture and light in original packaging.

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

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): may increase ivermectin plasma levels, raising toxicity risk.
• Anticoagulants (e.g., warfarin): enhanced anticoagulant effect reported, requiring close monitoring.

Moderate Interactions (Monitor Closely)

• P‑glycoprotein substrates (e.g., digoxin): ivermectin may affect transport, modestly altering concentrations.
• Other antiparasitics (e.g., albendazole): combined use may increase adverse event frequency.
• St. John’s wort: induces CYP3A4, potentially lowering ivermectin exposure.