IVERMECTIN oral

Prescription under medical supervision


Therapeutic action

– Anthelminthic, scabicide

Indications

– Onchocerciasis
– Scabies

Forms and strengths

– 3 mg tablet

Dosage and duration

Onchocerciasis
Child over 15 kg and adult: 150 micrograms/kg single dose. A 2nd dose should be administered after 3 months if clinical signs persist. Repeat the treatment every 6 or 12 months to maintain the parasite load below the threshold at which clinical signs appear.

Height

Weight

0 to < 90 cm

< 15 kg

90 to < 120 cm

15 to < 25 kg

120 to < 140 cm

25 to < 45 kg

140 to < 160 cm

45 to < 65 kg

≥ 160 cm

≥ 65 kg

3 mg tablet

Do not administer

1 tab

2 tab

3 tab

4 tab

Ordinary scabies
Child over 15 kg and adult: 200 micrograms/kg single dose. A single dose may be sufficient; a 2nd dose one week later reduces the risk of treatment failure.

Crusted scabies
Child over 15 kg and adult: 2 doses of 200 micrograms/kg one week apart, in combination with a topical keratolytic and topical scabicide; additional doses may be necessary.

Contra-indications, adverse effects, precautions

– May cause:
• increased itching;
• moderate reactions in patients with onchocerciasis: ocular irritation, headache, arthralgia, myalgia, lymphadenopathy, fever, oedema;
• severe reactions in patients co-infected with Loa loa: marked functional impairment if Loa loa microfilaraemia > 8,000 mf/ml; encephalopathy if Loa loa microfilaraemia > 30,000 mf/ml.
– Administer with caution in regions where loiasis is endemic:
For symptomatic onchocerciasis:
Evaluate the severity of Loa loa microfilaraemia and manage accordingly: either treat as an out-patient under supervision, or hospitalise, or choose an alternative treatment (doxycycline).
If it is not possible to perform a thick film examination: ivermectin may be administered if the patient has no history of loiasis (migration of an adult worm under the conjunctiva or transient « Calabar » swellings), nor history of severe adverse reactions following a previous treatment with ivermectin. In other cases, it is wiser either to treat under supervision, or to choose an alternative treatment (doxycycline), or decide not to treat, according to the severity of the onchocerciasis and the previous history.
For ordinary scabies: review the patient’s history and if in doubt, topical scabicidal treatment is preferred.
Pregnancy: avoid (safety is not established)
Breast-feeding: no contra-indication

Remarks

– Take tablets on an empty stomach. Tablets may be crushed for administration to small children.
– Ivermectin is also used for the treatment of strongyloidiasis (200 micrograms/kg single dose) and cutaneous larva migrans (200 micrograms/kg daily for 1 to 2 days).
Storage: below 25 °C