Ivermectin is a semisynthetic anthelmintic agent used for oral administration. Ivermectin is a derivative of avermectins, a class of extremely active broad-spectrum anti-parasitic agents derived from the fermentation of Streptomyces avermitilis.
What do you need to know about Ivermectin?
Ivermectin oral tablets are sold as generic drugs as well as brand-name drugs such as Stromectol. Ivermectin is also accessible as Ivermectin cream and Ivermectin lotion that can be applied on the skin. Ivermectin oral tablets are used to treat various parasitic infections of the intestinal tract, eyes and skin.
Ivermectin the Wonder Drug
Only a few medications can seriously put claim to the ‘Wonder Drug’ title. Aspirin and Penicillin are two that have feasibly had the utmost valuable influence on the health and well-being of mankind. However, Ivermectin can also be well-thought-out together with those worthy nominees because of its safety, versatility and positive impact worldwide, particularly on numerous poorest people across the globe.
When Ivermectin was launched, it appeared as a truly revolutionary drug. It was the first endectocide in the world, the forerunner of an entirely new class of antiparasitic agents, strongly active against a broad range of external and internal arthropods and nematodes.
It is extremely effective against an extensive range of parasites such as gastrointestinal roundworms, lungworms, head lice, mites and horn flies. Ivermectin is also very effective against ticks such as ixodid tick Rhipicephalus microplus, a most significant cattle parasite in the subtropics and tropics that causes massive economic damage.
Ivermectin has been proven to be even more of a ‘Wonder Drug’ for human health, improving the health and well-being of numerous people worldwide ever since it arrived in 1988. It is used to efficiently treat an array of internal nematode infections such as onchocerciasis, strongyloidiasis, trichuriasis, ascariasis, gnathostomiasis and cutaneous larva migrans. Ivermectin is also prescribed as an oral treatment for certain ectoparasitic infections including treating scabies and pediculosis.
Ivermectin is the vital support of two global disease elimination campaigns that should soon free the world of its two most spoiling and upsetting diseases, Lymphatic filariasis and Onchocerciasis. These two disease blight the billions of poor lives throughout the tropics. Probably, all over the next decade, over 200 million people will get this drug semi-annually or annually through innovative globally-coordinated Mss Drug Administration programmes (MDA).
The origin of this incredible drug Ivermectin for humans is inextricably associated with Onchocerciasis (river blindness), a chronic human filarial disease. The infection-causing parasites are transmitted through the bite of infected blackflies which breed in highly oxygenated watercourses ad fast-flowing rivers.
These parasites move through the body and as they die they cause many conditions such as skin lesions, rashes, intense itching and skin pigmentation. The microfilariae also enter the eye causing loss of vision and visual impairment in the sufferer. Onchocerciasis is the second major cause of blindness due to infectious diseases. Ivermectin has constantly proved to be amazingly safe for human use. It is a safe medicine with minimal possible side effects.
Ivermectin is used worldwide to treat parasitic infections
This medicine is prescribed as an effective treatment to treat certain parasitic roundworm infections and improve the life quality of the sufferer. Curing roundworm infections in patients with weakened immune systems can significantly lessen the risk of acquiring severe and life-threatening infections.
Ivermectin drug belongs to the class of drugs called anthelmintics. It acts by numbing and killing the infection-causing parasites. It binds to the internal parts of the parasite making them permeable to chloride causing paralysis in the infection-causing parasites. Ultimately it stops the parasites from reproducing larvae and leads to the death of the parasite.
Ivermectin is not FDA-approved to treat or prevent coronavirus disease unless you are enrolled in trials or studies. Talk to your doctor to know about the associated risk and benefits of using Ivermectin for covid 19.
Ivermectin resistance may occur as a result of exposure-induced alterations to chloride ion channels influencing Ivermectin binding affinity. Some biochemical studies in mites have associated detoxification genes linked to metabolic resistance as potential cause of Ivermectin resistance.
How to use Ivermectin (single dose or annual dose)?
Make sure you follow the instructions provided by your doctor or pharmacist. Take it exactly as suggested by your healthcare provider to get the maximum benefits and avoid any possible adverse effects.
Usually, it is recommended to take Ivermectin tablets on an empty stomach at least 2 hours before and after the meal. Take the Ivermectin tablet by mouth with a full glass of water. Mostly Ivermectin is prescribed as a single dose or a series of doses, depending on your condition, age, body weight, and severity of the disease.
Tell your healthcare professional if you do not notice any improvements, your condition lasts longer or gets worse. Do not share your medicine with others. Get your medical tests (for example, stool examination for intestinal parasites) done while you are under medication.
If you are getting Ivermectin therapy to treat onchocerciasis (river blindness) you may need to take repeated treatment and more medical examinations because Ivermectin does not kill adult Onchocerca worms that cause onchocerciasis. Keep up with all your medical and lab test appointments.
Is Single Dose Ivermectin Sufficient To Treat Infection?
A single dose of Ivermectin to treat strongyloidiasis has been reported to be as effective as multidose treatment and better tolerated by patients. Because the ideal dose of Ivermectin to treat strongyloidiasis is indeterminate, researchers commenced a multicenter, open-label phase 3 trial to evaluate whether multiple-dose treatment with Ivermectin is superior to a single dose.
They enrolled nonimmunocompromised patients above 5 years of age who were diagnosed with strongyloidiasis at nine European sites. The study comprised 309 patients randomised to get a single Ivermectin dose (200 μg/kg) and the same dose was given on days 1, 2, 15 and 16. Most of these participants had developed an infection in Africa or Latin America and presently they were living in regions nonendemic for Strongyloides stercoralis.
After 12 months in the altered full-analysis set, 86% of single-dose and 85% of multidose patients had cleared or improved infection. Adverse events of medicine were more recurrent among multidose patients than among patients treated with a single dose however the adverse effects were mild. Infection clearance rates were more among younger patients.
How Long Does Ivermectin Stay In Your Body?
Ivermectin can stay in the human body for an appreciable period. The half-life period of Ivermectin in humans is 12 to 36 hours while metabolite may keep on for up to 3 days. Ivermectin begins to eliminate from your bloodstream after around a8 hours, however, it remains in your intestines and continues to kill the worms left there.
After taking the Ivermectin medications for humans, it gets metabolized in the liver and its metabolites are defecated almost completely in the faeces over approximately 12 days with less than 1% of the administered dose of the drug excreted in the urine. Thus after oral administration, the half-life period of Ivermectin is about 18 hours in humans.
Ivermectin for Scabies
Ivermectin is an indicated treatment for scabies, a parasitic infestation of the skin caused by scabies mites. In Australia Aboriginal, and Torres Strait Islander communities and people in residential aged-care facilities were at the most possible risk for scabies infestations. In both settings, Ivermectin has shown great advantages over other topical treatments.
Ivermectin is also prescribed to treat crusted scabies in combination with topical scabicides and keratolytics. Begin the treatment only when the diagnosis of scabies has been clinically established or by parasitological examination. This treatment is not justified for pruritus alone.
Controlled Clinical Trials
No controlled clinical trials have been published to assess the proper dosing regimen of Ivermectin for treating typical or crusted scabies. Possible dosing regimens have been assessed in cohort and case series studies. Overall, the trials comparing Ivermectin treatment with topical treatment for treating typical scabies recommend a single dose.
Clinical trials
A single-arm community intervention trial was performed to assess the efficiency of mass drug administration with Ivermectin for controlling scabies and impetigo with the coadministration of Azithromycin.
During small community-based trials, mass drug administration of Ivermectin has demonstrated a substantial reduction in the occurrence of scabies and secondary impetigo, however, their impact at large scale is not tested. Also, combined mass administration of drugs for two or more neglected conditions has possible practical advantages but the usefulness of potential combinations should be established.
Mass drug administration was presented to the whole population of Choiseul Province, Solomon Islands. Randomly two sets of ten sentry villages from this entire population were selected for monitoring, one at the baseline and the other at 12 months.
The participants were administered a single dose (20 mg/kg) of Azithromycin. Children with less than 12.5 kg body weight were offered Azithromycin oral suspension (20 mg/kg) and infants younger than 6 months were given topical 1% tetracycline ointment.
For Ivermectin, the participants were given two doses of oral Ivermectin administered (200 μg/kg) 7 to 14 days apart using weight-based bands and 5% permethrin cream 7 to 14 days apart if Ivermectin was challenged.
The study has primary outcomes of feasibility and safety of large-scale mass coadministration of oral Ivermectin and Azithromycin. The occurrence of scabies and impetigo was reported in residents of ten baseline villages compared to those in ten 12-month villages, the secondary outcome of the trial was measured by skin examination. The results were a comparison of the number of all-cause outpatient attendances at government clinics in Choiseul Province at different time points before and after the mass treatment.
After 4 weeks, 26188 people were treated. In the baseline group, 1399 of 1622 people of the first ten villages had their skin examined and 261 of them had scabies and 347 had impetigo. At 12 months after mass drug administration, 1261 of 1625 people from the second set of 10 villages had their skin examined 29 of them had scabies and 81 had impetigo. In the 3 months post mass drug administration 10614 visited outpatient clinics for any reason compared with 16602 in the 3 months before the mass drug administration and during this period visits for skin cores, boils and abscesses decreased by 50.9%.
So the conclusion is, the Azithromycin Ivermectin mass administration(AIM) trial was extremely effective at reducing scabies and impetigo occurrence at 12 months after the intervention in over 25000 people in the Solomon Islands. Another considerable short-term hea;th benefit was noticed with a prominent reduction in all-cause outpatient clinic visits and the presentation of various communicable diseases.
Precautions for Ivermectin Treatment
Make sure you tell your doctor if you have an allergic reaction to this drug or other ingredients before starting with Ivermectin. The medicine may contain certain inactive ingredients that may cause allergic reactions or other complications.
Talk to your doctor about your medical history, particularly liver problems or any medications, vitamins or supplements you are taking. If you have lived or travelled to West or Central Africa, you may be infected with certain parasites such as Loa loa that can cause snags with Ivermectin treatment.
You may feel dizzy while taking Ivermectin. Combining Ivermectin treatment with marijuana or alcohol can make you even dizzier so avoid using these products. Avoid driving, using machinery or doing it very carefully.
Ivermectin Overdose
If someone has overdosed on Ivermectin and experiences severe symptoms such as trouble breathing, loss of coordination, numbness, tingling, seizures or passing out, seek immediate medical help. In case of a drug overdose, you can call a poison control centre immediately. US residents can call a local poison control center and Canadian residents can call a provincial poison control center.
Missed dose
Usually, Ivermectin is prescribed as a single dose however in certain cases you may be suggested to take a series of doses. If you missed a dose, take it immediately as you remember. If you realize this at the time of your next dose, skip the missed one and continue with the regular dosing schedule. Do not take a double dose ever. If you are confused about your missed dose call your doctor right away.
Ivermectin Drug Interaction
Drug interactions and adverse reactions may occur with Ivermectin due to Ivermectin toxicity. Certain other drugs (Warfarin) may interfere with the way Ivermectin therapy works against infections. Ask your doctor about the drugs that need to be avoided or adjusted during Ivermectin treatments. Ivermectin toxicity may cause nausea, abdominal pain, vomiting, dizziness, low blood pressure, diarrhoea, headache, blurred vision and confusion etc.
Pregnancy
Ivermectin should not be used by pregnant women since safety during pregnancy has not been established. There are no well-controlled and sufficient studies regarding Ivermrctin use to treat pregnant women. Talk to your healthcare professional before taking Ivermectin during pregnancy.
Breast Feeding
Ivermectin passes into the breast milk, however, there have been no reports of affecting the nursing baby. If you are breastfeeding your baby tell your doctor and discuss the impacts.
Ivermectin Warnings
For people with asthma
This medicine may make your asthma worse so before taking this drug ask your doctor if is it safe for you.
For people with liver conditions
If you have a history of liver disease or currently suffering from liver problems this medicine may harm your liver. Your body may not be capable to process the drug properly. It may rise the drug levels in your body and make you prone to developing side effects. Discuss with your doctor if you can use it safely.
People with seizures
Seizures are among the serious side effects caused by this drug. Although it is extremely rare but if have a history of seizures make sure you talk to your doctor to make sure this medicine is safe for you.
People with HIV
If you have HIV or any other condition that causes a weak immune system, a single dose of Ivermectin may not be sufficient to treat your infection. You may need a series of treatments with this medication.
For children
It is not known if this drug is safe and effective for children weighing less than 33 pounds. Children weighing more than 33 pounds can be prescribed a single dose of Ivermectin.
