Official reprint from UpToDate®

www.uptodate.com © 2022 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Ivermectin (systemic): Pediatric drug information

Copyright 1978-2022 Lexicomp, Inc. All rights reserved.

Contributor Disclosures

(For additional information see "Ivermectin (systemic): Drug information" and see "Ivermectin (systemic): Patient
drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp ( show table)

Special Alerts
Ivermectin: Coronavirus Disease 2019 (COVID-19) Updated May 2022

Most recent update(s): The Infectious Diseases Society of America's COVID-19 guidelines
and the National Institutes of Health's COVID-19 guidelines panel continue to suggest
against ivermectin use outside of the context of a clinical trial in outpatients or hospitalized
patients with COVID-19.

As part of our response to the evolving COVID-19 pandemic, published literature and
guidelines from major health organizations are continuously monitored for potential
content updates. At this time, only investigational medications with data determined to be
of relatively high quality and/or consistently showing positive clinical outcomes to support
dosing recommendations will be included in the monograph, outside of this Special Alert
field.

Further information may be found at:

ClinicalTrials.gov: https://www.clinicaltrials.gov/ct2/results?
cond=covid19&term=ivermectin&cntry=&state=&city=&dist=

Brand Names: US
Stromectol

Brand Names: Canada

Stromectol

Therapeutic Category
Anthelmintic; Anti-ectoparasitic Agent

Dosing: Pediatric
Note: Following the indication-specific dosing information are weight-band dosing tables to
assist with calculation and rounding of doses.
Collapse All

Ascariasis due to Ascaris lumbricoides 

Ascariasis due to Ascaris lumbricoides (roundworm): Limited data available: Children

≥15 kg and Adolescents: Oral: 150 to 200 mcg/kg/dose as a single dose (Red Book [AAP
2015])

Cutaneous larva migrans 

Cutaneous larva migrans (dog and cat hookworm) : Limited data available: Children ≥15
kg and Adolescents: Oral: 200 mcg/kg once daily for 1 to 2 days (Red Book [AAP 2015])

Filariasis 

Filariasis:

Mansonella ozzardi: Limited data available: Children ≥15 kg and Adolescents: Oral:
200 mcg/kg/dose as a single dose (Red Book [AAP 2015])

Mansonella streptocerca : Limited data available: Children ≥15 kg and Adolescents:

Oral: 150 mcg/kg/dose as a single dose (Red Book [AAP 2015])

Wuchereria bancrofti: Limited data available: Children ≥15 kg and Adolescents: Oral:
200 mcg/kg/dose as a single dose given in combination with albendazole (Red Book
[AAP 2015])

Gnathostomiasis due to Gnathostoma spinigerum 

Gnathostomiasis due to Gnathostoma spinigerum: Limited data available: Children ≥15

kg and Adolescents: Oral: 200 mcg/kg once daily for 2 days (Red Book [AAP 2015])

Onchocerciasis 

Onchocerciasis (Onchocerca volvulus, river blindness): Children ≥15 kg and

Adolescents: Oral: 150 mcg/kg/dose as a single dose; may repeat every 6 to 12 months
until asymptomatic; for prevention of blindness due to ocular onchocerciasis, doses
repeated every 3 to 12 months are suggested (Red Book [AAP 2015])

Pediculosis 

Pediculosis (lice): Limited data available: Note: Ivermectin is not ovicidal; therefore,
repeat doses are necessary to eradicate infestation:

Head lice: Children ≥15 kg and Adolescents: Oral: 400 mcg/kg/dose on days 1 and 8
(Chosidow 2010) or 200 mcg/kg/dose repeated once after 10 days (Jones 2003) have
been shown to be effective (AAP [Devore 2015]; Red Book [AAP 2015])

Pubic lice: Children ≥15 kg and Adolescents: Oral: 250 mcg/kg/dose for 2 doses
administered 14 days apart (CDC [Workowski 2015])

Scabies due to Sarcoptes scabiei 

Scabies due to Sarcoptes scabiei: Limited data available: Children ≥15 kg and
Adolescents: Oral: 200 mcg/kg/dose for 2 doses administered at least 7 days apart (Red
Book [AAP 2015]); others suggest doses be separated by 14 days (CDC [Workowski 2015])

Strongyloidiasis 

Strongyloidiasis: Children ≥15 kg and Adolescents: Oral: 200 mcg/kg once daily for 2
days (Red Book [AAP 2015]). Immunocompromised patients or patients with disseminated
disease may need to repeat therapy.

Trichuriasis due to Trichuris trichiura 

Trichuriasis due to Trichuris trichiura (whipworm): Limited data available: Children ≥15
 kg and Adolescents: Oral: 200 mcg/kg once daily for 3 days (Red Book [AAP 2015])

Weight-band dosing tables:

Weight-Band Dosing to Provide

~150 mcg/kg

Patient Weight
Single Oral Dose
(kg)

15 to 25 3 mg

26 to 44 6 mg

45 to 64 9 mg

65 to 84 12 mg

≥85 150 mcg/kg

Weight-Band Dosing to Provide

~200 mcg/kg

Patient Weight
Single Oral Dose
(kg)

15 to 24 3 mg

25 to 35 6 mg

36 to 50 9 mg

51 to 65 12 mg

66 to 79 15 mg

≥80 200 mcg/kg

Dosage adjustment for concomitant therapy: Significant drug interactions exist,

requiring dose/frequency adjustment or avoidance. Consult drug interactions database for
more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in manufacturer's labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in manufacturer's labeling.

Dosing: Adult
(For additional information see "Ivermectin (systemic): Drug information")
Collapse All

Ascariasis 

Ascariasis (alternative agent) (off-label use):

Note: For patients with complications (eg, intestinal obstruction, acute cholangitis),
initiate therapy after resolution of acute symptoms (Leder 2022a).

Oral: 150 to 200 mcg/kg as a single dose (Belizario 2003; Drugs for Parasitic
Infections 2013; Marti 1996; Naquira 1989).

Demodex folliculitis 

Demodex folliculitis (off-label use): Oral: 200 mcg/kg once weekly for 2 doses (Jackson
2022; Salem 2013).

Gnathostomiasis, cutaneous 

Gnathostomiasis, cutaneous (off-label use):

Note: Not recommended for CNS disease due to inflammatory response from dying
larvae (Herman 2009; Ramirez-Avila 2009; Weller 2022).

Oral: 200 mcg/kg once daily for 2 days (Drugs for Parasitic Infections 2013; Nontasut
2005).

Hookworm-related cutaneous larva migrans 

Hookworm-related cutaneous larva migrans (off-label use): Oral: 200 mcg/kg once
daily for 1 or 2 days (Drugs for Parasitic Infections 2013; Monsel 2015; Vanhaecke 2014).

Lice, refractory 

Lice, refractory (off-label use):

Note: Reserve for patients with an insufficient response to topical therapy (Goldstein
2022a; Goldstein 2022b). Optimal dose, dosing interval, and frequency are uncertain
 (Drugs for Parasitic Infections 2013).

Pediculus capitis: Oral: 200 mcg/kg once weekly for 2 doses (Drugs for Parasitic
Infections 2013; Goldstein 2022a); some experts suggest 400 mcg/kg once weekly
for 2 doses (Chosidow 2010; Drugs for Parasitic Infections 2013).

Pediculosis pubis: Oral: 200 mcg/kg once weekly for 2 doses (Goldstein 2022b); some
experts suggest 250 mcg/kg once, with a repeat dose in 7 to 14 days (Burkhart 2004;
CDC [Workowski 2021]).

Mansonella infection 

Mansonella infection (off-label use):

Note: For individuals from Loa loa–endemic areas, rule out co-infection prior to
ivermectin administration to avoid life-threatening encephalopathy (Boussinesq
1998; Gardon 1997).

Mansonella ozzardi: Oral: 150 mcg/kg as a single dose (de Almeida Basano 2018;
Lima 2016).

Mansonella streptocerca infection (alternative agent): Oral: 150 mcg/kg as a single dose
(Drugs for Parasitic Infections 2013; Fischer 1997; Fischer 1999).

Onchocerciasis 

Onchocerciasis:

Note: For individuals from Loa loa–endemic areas, rule out co-infection prior to
ivermectin administration to avoid life-threatening encephalopathy (Boussinesq
1998; Gardon 1997; Murdoch 2022).

Oral: 150 mcg/kg once; repeat dose every 3 to 6 months until asymptomatic (CDC
2021; Drugs for Parasitic Infections 2013; Gardon 2002; Murdoch 2022). For patients
outside endemic areas or in areas with low transmission, doxycycline therapy is
initiated 1 week after the initial ivermectin dose (CDC 2021; Drugs for Parasitic
Infections 2013; Murdoch 2022).

Scabies 
Scabies (off-label use):

Note: For cohabitants or other individuals who have had prolonged skin-to-skin
contact within the previous 6 weeks, simultaneous treatment is recommended
(Goldstein 2022c).

Classic scabies, treatment: Oral: 200 mcg/kg once; repeat dose in 7 to 14 days (CDC
2019b; CDC [Workowski 2021]; Salavastru 2017).

Crusted scabies, treatment: Oral: 200 mcg/kg once daily in combination with
permethrin for 3, 5, or 7 nonconsecutive days depending on infection severity (eg,
for 3 days: give on days 1, 2, and 8; for 5 days: give on days 1, 2, 8, 9, and 15; for 7
days: give on days 1, 2, 8, 9, 15, 22, and 29) (CDC 2019b; CDC [Workowski 2021];
Salavastru 2017).

Strongyloidiasis 

Strongyloidiasis:

Note: For individuals from Loa loa–endemic areas, rule out co-infection prior to
ivermectin administration to avoid life-threatening encephalopathy (Leder 2022b).

Uncomplicated infection:

Patients who are immunocompetent: Oral: 200 mcg/kg once daily for 1 or 2
days (CDC 2022; Henriquez-Camacho 2016; Leder 2022b; Repetto 2018; Segarra-
Newnham 2007).

Patients who are immunocompromised: Oral: 200 mcg/kg once daily for 2 days;
repeat dosing regimen in 2 weeks (Leder 2022b).

Severe, disseminated infection: Oral: 200 mcg/kg once daily until symptoms have
resolved and stool and/or sputum examination is negative for ≥2 weeks (CDC 2022;
Leder 2022b). Some experts suggest switching to an alternative approach for
patients who are immunocompromised or critically ill with persistently positive (eg,
≥3 days) stool examination (Leder 2022b). For patients with persistent
immunosuppression after clinical improvement, some experts use suppressive
ivermectin 200 mcg/kg once monthly for ≥6 months (Leder 2022b; Segarra-
Newnham 2007).
 Trichuriasis 

Trichuriasis (whipworm) (alternative agent) (off-label use): Oral: 600 mcg/kg once
daily for 3 days in combination with albendazole (Leder 2022c; Matamoros 2021).

Dosage adjustment for concomitant therapy: Significant drug interactions exist,

requiring dose/frequency adjustment or avoidance. Consult drug interactions database for
more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical
expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts,
PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Altered kidney function: No dosage adjustment necessary for any degree of kidney
dysfunction (<1% excreted in the urine) (expert opinion).

Hemodialysis, intermittent (thrice weekly): Unlikely to be significantly dialyzed (highly

protein bound; large Vd): No supplemental dose or dosage adjustment necessary (expert
opinion).

Peritoneal dialysis: Unlikely to be significantly dialyzed (highly protein bound; large Vd): No
dosage adjustment necessary (expert opinion).

CRRT: No dosage adjustment necessary (expert opinion).

PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary

(expert opinion).

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in manufacturer’s labeling.

Dosage Forms: US
Excipient information presented when available (limited, particularly for generics); consult
specific product labeling.

Tablet, Oral:

Stromectol: 3 mg

Generic: 3 mg
Generic Equivalent Available: US
Yes

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult
specific product labeling.

Tablet, Oral:

Stromectol: 3 mg

Administration: Pediatric
Oral: Administer on an empty stomach with water (manufacturer's labeling). Some experts
recommend administering with food to increase absorption (CDC [Workowski 2015]; Currie
2010).

Administration: Adult
Oral: Administer on an empty stomach with water (manufacturer’s labeling). Some experts
recommend administering with food to increase absorption (CDC [Workowski 2021]; Currie
2010).

Storage/Stability
Store at temperatures below 30°C (86°F).

Use
Treatment of intestinal strongyloidiasis (FDA approved in pediatric patients ≥15 kg and adults);
treatment of onchocerciasis due to the immature form of Onchocerca volvulus (FDA approved in
pediatric patients ≥15 kg and adults). Has also been used for the treatment of other parasitic
infections including but not limited to: Ancylostoma braziliense, Ascaris lumbricoides,
Gnathostoma spinigerum, Mansonella ozzardi, Mansonella streptocerca, Pediculus humanus capitis,
Pediculus humanus corporis, Phthirus pubis, Trichuris trichiura, Sarcoptes scabiei, and Wuchereria
bancrofti

Medication Safety Issues

Pediatric patients: High-risk medication:

KIDs List: Ivermectin (systemic), when used in infants <1 year of age, is identified on
the Key Potentially Inappropriate Drugs in Pediatrics (KIDs) list and should be avoided
 due to risk of encephalopathy (weak recommendation; low quality of evidence) (PPA
[Meyers 2020]).

Adverse Reactions (Significant): Considerations

CNS effects

CNS effects including neurotoxicity (eg, ataxia, confusion, disorientation,

encephalopathy, impaired consciousness [including coma], stupor, tremor) and central
nervous system depression with subsequent breathing difficulties, have rarely been
reported in humans, but are well known to occur in animals (Ref). Theoretical risk for CNS
effects in infants and young children due to immature blood-brain barrier has been
extrapolated from animal data and has minimized use in patients <15 kg. Existing data in
younger pediatric patients are limited, with recent evaluations describing ivermectin use in
patients <15 kg for a variety of indications with no reports of serious adverse events (Ref).

Mechanism: CNS effects occur when ivermectin crosses the blood-brain barrier into the
spinal cord, midbrain or cerebrum and blocks important neuronal transmission that
involves glutamate or gamma-amino butyric acid (Ref). In infants and young children, it
has been proposed that ivermectin may cross the immature blood-brain barrier,
resulting in CNS toxicity (Ref). In patients with a well-developed blood-brain barrier, the
neurological adverse effects of ivermectin are thought to occur when the ATP-binding
cassette subfamily B member 1 (ABCB1) transporter (also known as P-glycoprotein) is
altered and fails to prevent the uptake of ivermectin into the brain (Ref).

Onset: Rapid; typically occurs within hours of dosing, although has also been described
as late as 7 days after administration (Ref).

Risk factors:

• Immature blood-brain barrier (Ref)

• Body weight <15 kg as a surrogate marker for an immature blood-brain barrier

(Ref)

• Mutation in ABCB1 (P-glycoprotein) transporter (Ref)

Hypersensitivity reactions (delayed)

A variety of delayed hypersensitivity reactions, ranging from skin rash to severe cutaneous
adverse reactions (SCAR), including Stevens-Johnson syndrome/toxic epidermal
 necrolysis and drug reaction with eosinophilia and systemic symptoms have been
reported with ivermectin use (Ref).

Mechanism: Non–dose-related; immunologic. Delayed hypersensitivity reactions,

including rashes (often maculopapular) and SCARs are T-cell-mediated (Ref).

Onset: Delayed hypersensitivity reactions: Varied. SCARs usually occur within 1 to 8

weeks after initiation (Ref), although cases associated with ivermectin have been
reported within 3 days after receiving a single dose (Ref).
Immunologic post-treatment reaction (Mazzoti reaction)

Ivermectin may cause an immunologic post-treatment reaction, also known as a Mazzoti

reaction, which is associated with pruritus, skin rash, fever, fatigue, lymphadenopathy,
arthralgia, tachycardia, hypotension (including orthostatic hypotension), edema, and
abdominal pain (Ref). Most cases have been reported in association with the treatment of
onchocerciasis, but cases have also been reported in association with the treatment of
other infections (eg, scabies) (Ref). Symptoms are mostly mild and usually resolve in 4 days;
however, cases of coma and death have been reported, although these deaths are often
attributed to Loa loa-associated encephalopathy (Ref). Serious Mazzoti reactions are
estimated to occur in 19% to 81% of patients exposed to ivermectin for the treatment of
filarial parasites, which is disproportionality more than other antinematodal drugs (Ref).

Mechanism: Non–dose-related; immunologic. Ivermectin exerts a strong microfilaricidal

effect on filariae, leading to a destruction of microfilariae. In patients with high
densities of microfilariae in the skin or blood, this may induce complex inflammatory
reactions resulting in local tissue damage and degradation of host structures (Ref).

Onset: Varied; within 1 to 7 days of therapy initiation (Ref).

Risk factors:

• High densities of microfilariae (ie, the larval stages of the filarial parasites) (Ref)

• Treatment of filarial parasites (Ref)

Adverse Reactions
The following adverse drug reactions and incidences are derived from product labeling unless
otherwise specified.

≥10%: Miscellaneous: Mazzotti reaction (associated with onchocerciasis: pruritus: 28%;

fever: 23%; skin edema, papular rash, pustular rash, and urticaria: ≤23%; arthralgia and
synovitis: ≤9%; lymphadenitis [axillary node: 4% to 11%, cervical node: 1% to 5%, inguinal
node: 13% to 14%, other lymph node: 2% to 3%])

1% to 10%:

Cardiovascular: Orthostatic hypotension (1%), peripheral edema (3%), tachycardia (4%)

Dermatologic: Pruritus (associated with strongyloidiasis: 3%)

Gastrointestinal: Diarrhea (2%), nausea (2%)

Hematologic & oncologic: Decreased white blood cell count (3%), eosinophilia (3%),
increased hemoglobin (1%)

Hepatic: Increased serum alanine aminotransferase (2%), increased serum aspartate

aminotransferase (2%)

Hypersensitivity: Facial edema (1%)

Nervous system: Dizziness (3%)

Ophthalmic: Inflammation of limbus of eyes (4% to 6%), punctate cataract (1% to 2%)

<1%:

Dermatologic: Skin rash, urticaria (associated with strongyloidiasis)

Gastrointestinal: Abdominal pain, anorexia, constipation, vomiting

Hematologic & oncologic: Anemia, leukopenia

Nervous system: Asthenia, drowsiness, fatigue, headache, tremor, vertigo

Neuromuscular & skeletal: Myalgia

Ophthalmic: Vision loss

Frequency not defined:

Cardiovascular: Chest discomfort

Gastrointestinal: Abdominal distention

Postmarketing:

Cardiovascular: Hypotension
 Dermatologic: Stevens-Johnson syndrome (Oshikoya 2020), toxic epidermal necrolysis
(Oshikoya 2020)

Hepatic: Hepatitis (Veit 2006), increased liver enzymes, increased serum bilirubin

Hypersensitivity: Drug reaction with eosinophilia and systemic symptoms (Kerneuzet

2018)

Nervous system: Central nervous system depression (Chandler 2018), neurotoxicity

(including ataxia, confusion, disorientation, encephalopathy, impaired consciousness
[including coma], stupor) (Baudou 2020; Chandler 2018), seizure (Chandler 2018)

Ophthalmic: Abnormal sensation in eyes, anterior uveitis, chorioretinitis (including

choroiditis), conjunctival hemorrhage, conjunctivitis, diplopia (Campillo 2021), eyelid
edema, keratitis

Respiratory: Exacerbation of asthma

Contraindications
Hypersensitivity to ivermectin or any component of the formulation

Warnings/Precautions

Special populations:

• Immunocompromised patients: Repeated treatment may be required in

immunocompromised patients (eg, HIV); control of extraintestinal strongyloidiasis may
necessitate suppressive (once monthly) therapy.

Other warnings/precautions:

• Appropriate use: Onchocerca volvulus: Ivermectin has no activity against adult O.

volvulus parasites. L. loa: Ivermectin is not active against adult worms.

Metabolism/Transport Effects
Substrate of CYP3A4 (minor), P-glycoprotein/ABCB1 (minor); Note: Assignment of Major/Minor
substrate status based on clinically relevant drug interaction potential

Drug Interactions
(For additional information: Launch drug interactions program)

Note: Interacting drugs may not be individually listed below if they are part of a group
interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a
complete list of drug interactions by individual drug name and detailed management
recommendations, use the Lexicomp drug interactions program by clicking on the “Launch
drug interactions program” link above.

Note: Interacting drugs may not be individually listed below if they are part of a group
interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a
complete list of drug interactions by individual drug name and detailed management
recommendations, use the Lexicomp drug interactions program

Bacillus clausii: Antibiotics may diminish the therapeutic effect of Bacillus clausii.
Management: Bacillus clausii should be taken in between antibiotic doses during
concomitant therapy. Risk D: Consider therapy modification

BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk
X: Avoid combination

BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine
(Immunization). Risk C: Monitor therapy

Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine.
Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14
days following the use of oral or parenteral antibiotics. Risk X: Avoid combination

Immune Checkpoint Inhibitors: Antibiotics may diminish the therapeutic effect of Immune
Checkpoint Inhibitors. Risk C: Monitor therapy

Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus
and Estriol. Risk C: Monitor therapy

Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate.
Management: Consider using an alternative product for bowel cleansing prior to a
colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk
D: Consider therapy modification

Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only
the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated
typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents.
Postpone vaccination until 3 days after cessation of antibiotics and avoid starting
antibiotics within 3 days of last vaccine dose. Risk D: Consider therapy modification

Vitamin K Antagonists (eg, warfarin): Ivermectin (Systemic) may enhance the anticoagulant
effect of Vitamin K Antagonists. Risk C: Monitor therapy
Food Interactions
Bioavailability appears to be increased with food, but the extent of the interaction is uncertain.
When administered following a high-fat meal, bioavailability has been shown to increase 1.18-
to 2.57-fold with a wide range of doses studied (6 to 30 mg) (Duthaler 2020; Guzzo 2002;
Miyajima 2016). Management: The manufacturer recommends to administer on an empty
stomach, although some experts recommend administering with food to increase absorption
(CDC [Workowski 2021]; Currie 2010).

Reproductive Considerations
Evaluate pregnancy status prior to use in patients who may become pregnant; patients arriving
as refugees from specific countries should not be given ivermectin for the presumptive
treatment of intestinal parasites without a reliable history of their last menstrual period (CDC
2019a).

Pregnancy Considerations

Outcome information following maternal use of ivermectin during pregnancy is primarily

limited to inadvertent exposure during mass treatment programs (Chippaux 1993; Gyapong
2003; Ndyomugyenyi 2008; Nicolas 2020; Pacqué 1990; Westlake 2020).

The decision to use ivermectin during pregnancy should consider the specific indication (eg,
onchocerciasis or Strongyloides infection) and the risk of disease progression in the absence of
treatment (CDC 2021; CDC 2022) Although use in pregnancy is likely low risk, other agents are
currently recommended for the treatment of pediculosis pubis or scabies in pregnant patients
(CDC [Workowski 2021]).

Monitoring Parameters
Skin and eye microfilarial counts, periodic ophthalmologic exams; follow up stool examinations;
blood pressure (mainly orthostatic hypotension has been observed); periodic liver function
tests; signs and symptoms of neurotoxicity.

Mechanism of Action
Ivermectin is a semisynthetic anthelminthic agent; it binds selectively and with strong affinity to
glutamate-gated chloride ion channels which occur in invertebrate nerve and muscle cells. This
leads to increased permeability of cell membranes to chloride ions then hyperpolarization of
the nerve or muscle cell, and death of the parasite.

Pharmacokinetics (Adult data unless noted)

 Absorption: Well absorbed in the fasting state (Baraka 1996; Edwards 1988; Okonkwo
1993); may be increased with a high-fat meal (Duthaler 2020; Guzzo 2002; Miyajima 2013).

Distribution: Vd: 3.1 to 3.5 L/kg in healthy volunteers; mean 9.9 L/kg (range: 6.9 to 15.3 L/kg)
in patients with onchocerciasis; high concentration in the liver and adipose tissue; does not
readily cross the blood-brain barrier (Gonzalez Canga 2008; Okonkwo 1993).

Protein binding: ~93% primarily to albumin (Gonzalez Canga 2008)

Metabolism: Hepatic via CYP3A4 (major), CYP2D6 (minor), and CYP2E1 (minor)

Half-life elimination: 18 hours

Time to peak, serum: ~4 hours

Excretion: Feces; urine (<1%)

Pricing: US

Tablets (Ivermectin Oral)

3 mg (per each): $4.97

Tablets (Stromectol Oral)

3 mg (per each): $5.58

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as
reference price only. A range is provided when more than one manufacturer's AWP price is
available and uses the low and high price reported by the manufacturers to determine the
range. The pricing data should be used for benchmarking purposes only, and as such should
not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or
considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly
disclaims all warranties of any kind or nature, whether express or implied, and assumes no
liability with respect to accuracy of price or price range data published in its solutions. In no
event shall Medi-Span be liable for special, indirect, incidental, or consequential damages
arising from use of price or price range data. Pricing data is updated monthly.

Brand Names: International

Ascapil (IN); Detebencil (AR); Ectin (IN); Gilou (NL); Ivactin (BD); Iver P (AR); Ivermine (EG); Ivertal
(AR); Iverx (CL); Iverzine (EG); Ivexterm (CR, DO, GT, HN, MX, NI, PA, SV); Ivomec (CH); Kaonol (CL,
PE); Kilox (CO, CR, DO, EC, GT, HN, NI, PA, SV); Leverctin (BR); Maikeding (CN); Mectizan (BF, BJ,
CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU, MW, NE, NG, SC, SD, SL, SN, TN, TZ, UG, VN, ZA, ZM,
ZW); Presteme (MX); Quamox (PE); Quanox Gotas (CO); Razimectin (EG); Revectina (BR); Sanifer
(UY); Scabo (BD); Securo (AR); Soolantra (AU, BE, LB, NL, NO); Stromectol (AU, BB, FR, GR, NL, NZ,
SG, TW, VN); Veratin (BD); Vermectil (BR); Vermectin (TH); Vermokill (PY); Yvermil (PY)

For country code abbreviations ( show table)

Use of UpToDate is subject to the Terms of Use.

REFERENCES

1. Addiss DG, Beach MJ, Streit TG, et al, "Randomised Placebo-Controlled Comparison of Ivermectin and Albendazole
Alone and in Combination for Wuchereria bancrofti Microfilaraemia In Haitian Children," Lancet, 1997,
350(9076):480–4. [PubMed 9274584]

2. American Academy of Pediatrics (AAP). Devore CD, Schutze GE; The Council on School Health and Commitee on
Infectious Diseases. Head Lice. Pediatrics. 2015; 135:e1355-e1365.

3. Aroke D, Tchouakam DN, Awungia AT, Mapoh SY, Ngassa SN, Kadia BM. Ivermectin induced Steven-Johnsons
syndrome: case report. BMC Res Notes. 2017;10(1):179. doi:10.1186/s13104-017-2500-5 [PubMed 28482929]

4. Baraka OZ, Mahmoud BM, Marschke CK, Geary TG, Homeida MM, Williams JF. Ivermectin distribution in the
plasma and tissues of patients infected with Onchocerca volvulus. Eur J Clin Pharmacol. 1996;50(5):407-410.
doi:10.1007/s002280050131 [PubMed 8839664]

5. Baudou E, Lespine A, Durrieu G, et al. Serious ivermectin toxicity and human ABCB1 nonsense mutations. N Engl J
Med. 2020;383(8):787-789. doi:10.1056/NEJMc1917344 [PubMed 32813957]

6. Belizario VY, Amarillo ME, de Leon WU, de los Reyes AE, Bugayong MG, Macatangay BJ. A comparison of the
efficacy of single doses of albendazole, ivermectin, and diethylcarbamazine alone or in combinations against
Ascaris and Trichuris spp. Bull World Health Organ. 2003;81(1):35-42. [PubMed 12640474]

7. Bellón T. Mechanisms of severe cutaneous adverse reactions: Recent advances. Drug Saf. 2019;42(8):973-992.
doi:10.1007/s40264-019-00825-2 [PubMed 31020549]

8. Boussinesq M, Gardon J, Gardon-Wendel N, Kamgno J, Ngoumou P, Chippaux JP. Three probable cases of Loa loa
encephalopathy following ivermectin treatment for onchocerciasis. Am J Trop Med Hyg. 1998;58(4):461-469.
doi:10.4269/ajtmh.1998.58.461 [PubMed 9574793]

9. Brockow K, Przybilla B, Aberer W, et al. Guideline for the diagnosis of drug hypersensitivity reactions: S2K-
Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) and the German
Dermatological Society (DDG) in collaboration with the Association of German Allergologists (AeDA), the German
Society for Pediatric Allergology and Environmental Medicine (GPA), the German Contact Dermatitis Research
Group (DKG), the Swiss Society for Allergy and Immunology (SGAI), the Austrian Society for Allergology and
Immunology (ÖGAI), the German Academy of Allergology and Environmental Medicine (DAAU), the German Center
for Documentation of Severe Skin Reactions and the German Federal Institute for Drugs and Medical Products
(BfArM). Allergo J Int. 2015;24(3):94-105. doi:10.1007/s40629-015-0052-6 [PubMed 26120552]
10. Brooks PA, Grace RF. Ivermectin is better than benzyl benzoate for childhood scabies in developing countries. J
Paediatr Child Health. 2002;38(4):401-414. doi:10.1046/j.1440-1754.2002.00015.x [PubMed 12174005]

11. Burkhart CG, Burkhart CN. Oral Ivermectin for Phthirus pubis. J Am Acad Dermatol. 2004;51(6):1037; author reply
1037-1038. doi:10.1016/j.jaad.2004.04.041 [PubMed 15583618]

12. Burkhart CN, Burkhart CG. Before using ivermectin therapy for scabies. Pediatr Dermatol. 1999;16(6):478-479;
discussion 480. doi:10.1046/j.1525-1470.1999.00124.x [PubMed 10632951]

13. Campillo JT, Boussinesq M, Bertout S, Faillie JL, Chesnais CB. Serious adverse reactions associated with ivermectin:
A systematic pharmacovigilance study in sub-Saharan Africa and in the rest of the World. PLoS Negl Trop Dis.
2021;15(4):e0009354. doi:10.1371/journal.pntd.0009354 [PubMed 33878105]

14. Carme B, Ebikili B, Mbitsi A, Copin N. [Therapeutic trial with ivermectin in loiasis with medium and high
microfilaremia]. [Article in French]. Am J Trop Med Hyg. 1988;39(5):480-483. [PubMed 2043000]

15. Centers for Disease Control and Prevention (CDC). Guidelines for overseas presumptive treatment of
strongyloidiasis, schistosomiasis, and soil-transmitted helminth infections for refugees resettling to the United
States. https://www.cdc.gov/immigrantrefugeehealth/guidelines/overseas/intestinal-parasites-overseas.html.
Updated February 2019a. Accessed November 9, 2020.

16. Centers for Disease Control and Prevention (CDC). Parasites - Onchocerciasis (also known as River Blindness).
https://www.cdc.gov/parasites/onchocerciasis/health_professionals/index.html. Updated November 10, 2021.
Accessed July 25, 2022.

17. Centers for Disease Control and Prevention (CDC). Parasites - Strongyloides.
https://www.cdc.gov/parasites/strongyloides/health_professionals/index.html. Updated July 7, 2022. Accessed July
13, 2022.

18. Centers for Disease Control and Prevention (CDC). Scabies.

http://www.cdc.gov/parasites/scabies/health_professionals/meds.html. Updated October 2019b. Accessed April
15, 2022.

19. Chandler RE. Serious neurological adverse events after ivermectin-do they occur beyond the indication of
onchocerciasis? Am J Trop Med Hyg. 2018;98(2):382-388. doi:10.4269/ajtmh.17-0042 [PubMed 29210346]

20. Chippaux JP, Gardon-Wendel N, Gardon J, Ernould JC. Absence of any adverse effect of inadvertent ivermectin
treatment during pregnancy. Trans R Soc Trop Med Hyg. 1993;87(3):318. doi:10.1016/0035-9203(93)90146-h
[PubMed 8236406]

21. Chosidow O, Giraudeau B, Cottrell J, et al. Oral ivermectin versus malathion lotion for difficult-to-treat head lice. N
Engl J Med, 2010;362(10):896-905. doi:10.1056/NEJMoa0905471 [PubMed 20220184]

22. Currie BJ, McCarthy JS. Permethrin and ivermectin for scabies. N Engl J Med. 2010;362(8):717-725.
doi:10.1056/NEJMct0910329 [PubMed 20181973]

23. de Almeida Basano S, de Souza Almeida Aranha Camargo J, Fontes G, et al. Phase III clinical trial to evaluate
ivermectin in the reduction of Mansonella ozzardi infection in the Brazilian Amazon. Am J Trop Med Hyg.
2018;98(3):786-790. doi:10.4269/ajtmh.17-0698 [PubMed 29313486]

24. de Silva N, Guyatt H, and Bundy D, “Anthelmintics. A Comparative Review of Their Clinical Pharmacology,” Drugs,
1997, 53(5):769-88. [PubMed 9129865]
25. Devore CD, Schutze GE, Council on School Health and Committee on Infectious Diseases, American Academy of
Pediatrics. Head lice. Pediatrics. 2015;135(5):e1355-1365. [PubMed 25917986]

26. Drugs for Parasitic Infections. In: The Medical Letter. 2013;11(143):e1-e31.
27. Duthaler U, Leisegang R, Karlsson MO, Krähenbühl S, Hammann F. The effect of food on the pharmacokinetics of
oral ivermectin. J AntimicrobChemother. 2020;75(2):438-440. doi:10.1093/jac/dkz466 [PubMed 31691813]

28. Edwards G. Ivermectin: does P-glycoprotein play a role in neurotoxicity? Filaria J. 2003;2 Suppl 1(Suppl 1):S8.
doi:10.1186/1475-2883-2-S1-S8 [PubMed 14975065]

29. Edwards G, Dingsdale A, Helsby N, Orme ML, Breckenridge AM. The relative systemic availability of ivermectin
after administration as capsule, tablet, and oral solution. Eur J Clin Pharmacol. 1988;35(6):681-684.
doi:10.1007/BF00637608 [PubMed 3234475]

30. Eismann R, Bramsiepe I, Danz B, Wohlrab J, Marsch WC, Fiedler E. Abscessing nodular demodicosis--therapy with
ivermectin and permethrin. J Eur Acad Dermatol Venereol. 2010;24(1):79-81. [PubMed 19453783]

31. Elston DM. Demodex mites: facts and controversies. Clin Dermatol. 2010;28(5):502-504.
doi:10.1016/j.clindermatol.2010.03.006 [PubMed 20797509]

32. Fischer P, Bamuhiiga J, and Büttner DW. Treatment of human Mansonella streptocerca infection with ivermectin.
Trop Med Int Health,1997;2(2):191-199. doi:10.1046/j.1365-3156.1997.d01-233.x [PubMed 9472305]

33. Fischer P, Tukesiga E, Büttner DW. Long-term suppression of Mansonella streptocerca microfilariae after
treatment with ivermectin. J Infect Dis. 1999;180(4):1403-1405. doi:10.1086/315014 [PubMed 10479183]

34. Foucault C, Ranque S, Badiaga S, Rovery C, Raoult D, Brouqui P. Oral ivermectin in the treatment of body lice. J
Infect Dis. 2006;193(3):474-476. [PubMed 16388498]

35. Frankowski BL and Bocchini JA Jr, “Head Lice,” Pediatrics, 2010, 126(2):392-403. [PubMed 20660553]
36. Gardon J, Boussinesq M, Kamgno J, Gardon-Wendel N, Demanga-Ngangue, Duke BO. Effects of standard and high
doses of ivermectin on adult worms of Onchocerca volvulus: a randomised controlled trial. Lancet.
2002;360(9328):203-210. doi:10.1016/S0140-6736(02)09456-4 [PubMed 12133654]

37. Gardon J, Gardon-Wendel N, Demanga-Ngangue, Kamgno J, Chippaux JP, Boussinesq M. Serious reactions after
mass treatment of onchocerciasis with ivermectin in an area endemic for Loa loa infection. Lancet.
1997;350(9070):18-22. doi:10.1016/S0140-6736(96)11094-1 [PubMed 9217715]

38. Goldstein AO, Goldstein BG. Pediculosis capitis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc.
http://www.uptodate.com. Accessed July 13, 2022a.

39. Goldstein AO, Goldstein BG. Pediculosis pubis and pediculosis ciliaris. Post TW, ed. UpToDate. Waltham, MA:
UpToDate Inc. http://www.uptodate.com. Accessed July 13, 2022b.

40. Goldstein BG, Goldstein AO. Scabies: management. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc.
http://www.uptodate.com. Accessed July 13, 2022c.

41. Gonzalez AA, Chadee DD, Rawlins SC. Ivermectin treatment of mansonellosis in Trinidad. West Indian Med J.
1999;48(4):231-234. [PubMed 10639847]

42. González Canga A, Sahagún Prieto AM, Diez Liébana MJ, et al, The pharmacokinetics and interactions of
 ivermectin in humans--a mini-review. AAPS J. 2008;10(1):42-46. [PubMed 18446504]

43. Guzzo CA, Furtek CI, Porras AG, et al. Safety, tolerability, and pharmacokinetics of escalating high doses of
ivermectin in healthy adult subjects. J ClinPharmacol. 2002;42(10):1122-1133. doi:10.1177/009127002401382731
[PubMed 12362927]

44. Gyapong JO, Chinbuah MA, Gyapong M. Inadvertent exposure of pregnant women to ivermectin and albendazole
during mass drug administration for lymphatic filariasis. Trop Med Int Health. 2003;8(12):1093-1101.
doi:10.1046/j.1360-2276.2003.01142.x [PubMed 14641844]

45. Henriquez-Camacho C, Gotuzzo E, Echevarria J, et al. Ivermectin versus albendazole or thiabendazole for
Strongyloides stercoralis infection. Cochrane Database Syst Rev. 2016;2016(1):CD007745.
doi:10.1002/14651858.CD007745.pub3 [PubMed 26778150]

46. Herman JS, Chiodini PL. Gnathostomiasis, another emerging imported disease. Clin Microbiol Rev. 2009;22(3):484-
92. doi:10.1128/CMR.00003-09 [PubMed 19597010]

47. Ismail MM, Jayakody RL, Weil GJ, et al, "Long-Term Efficacy of Single-Dose Combinations of Albendazole,
Ivermectin and Diethylcarbamazine for the Treatment of Bancroftian Filariasis," Trans R Soc Trop Med Hyg, 2001,
95(3):332–5. [PubMed 11491010]

48. Ito T. Mazzotti reaction with eosinophilia after undergoing oral ivermectin for scabies. J Dermatol. 2013;40(9):776-
777. doi:10.1111/1346-8138.12243 [PubMed 23855317]

49. Ivermectin tablets [prescribing information]. Parsippany, NJ: Edenbridge Pharmaceuticals, LLC; March 2022.
50. Jackson JD. Infectious folliculitis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com.
Accessed July 13, 2022.

51. Jittamala P, Monteiro W, Smit MR, et al. A systematic review and an individual patient data meta-analysis of
ivermectin use in children weighing less than fifteen kilograms: Is it time to reconsider the current
contraindication? PLoS Negl Trop Dis. 2021;15(3):e0009144. doi:10.1371/journal.pntd.0009144 [PubMed
33730099]

52. Jones KN and English JC 3rd, “Review of Common Therapeutic Options in the United States for the Treatment of
Pediculosis Capitis,” Clin Infect Dis, 2003, 36(11):1355-61. [PubMed 12766828]

53. Kerneuzet I, Blind E, Darrieux L, Moreau S, Safa G. Ivermectin-induced drug reaction with eosinophilia and
systemic symptoms (DRESS) syndrome. JAAD Case Rep. 2018;4(6):524-527. doi:10.1016/j.jdcr.2018.05.002
[PubMed 30023418]

54. Kimberlin DW, Brady MT, Jackson MA, Long SA, eds; ; Committee on Infectious Diseases; American Academy of
Pediatrics. Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL:
American Academy of Pediatrics; 2015.

55. Kraivichian K, Nuchprayoon S, Sitichalernchai P, Chaicumpa W, Yentakam S. Treatment of cutaneous

gnathostomiasis with ivermectin. Am J Trop Med Hyg. 2004;71(5):623-628. [PubMed 15569795]

56. Leder K, Weller PF. Enterobiasis (pinworm) and trichuriasis (whipworm). Post TW, ed. UpToDate. Waltham, MA:
UpToDate Inc. http://www.uptodate.com. Accessed July 13, 2022c.

57. Leder K, Weller PF. Strongyloidiasis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc.
http://www.uptodate.com. Accessed July 13, 2022b.
58. Leder K, Weller PF, Nageshwar Reddy D. Ascariasis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc.
http://www.uptodate.com. Accessed July 13, 2022a.

59. Lima NF, Veggiani Aybar CA, Dantur Juri MJ, Ferreira MU. Mansonella ozzardi: a neglected New World filarial
nematode. Pathog Glob Health. 2016;110(3):97-107. doi:10.1080/20477724.2016.1190544 [PubMed 27376501]

60. Mackenzie CD, Geary TG, Gerlach JA. Possible pathogenic pathways in the adverse clinical events seen following
ivermectin administration to onchocerciasis patients. Filaria J. 2003;2 suppl 1(suppl 1):S5. doi:10.1186/1475-2883-
2-S1-S5 [PubMed 14975062]

61. Marti H, Haji HJ, Savioli L, et al. A comparative trial of a single-dose ivermectin versus three days of albendazole
for treatment of Strongyloides stercoralis and other soil-transmitted helminth infections in children. Am J Trop
Med Hyg. 1996;55(5):477-481. doi:10.4269/ajtmh.1996.55.477 [PubMed 8940976]

62. Matamoros G, Sánchez A, Gabrie JA, et al. Efficacy and safety of albendazole and high-dose ivermectin
coadministration in school-aged children infected with Trichuris trichiura in Honduras: a randomized controlled
trial. Clin Infect Dis. 2021;73(7):1203-1210. doi:10.1093/cid/ciab365 [PubMed 33906234]

63. Meinking TL, Taplin D, Hermida JL, et al, “The Treatment of Scabies With Ivermectin,” N Engl J Med, 1995,
333(1):26-30. [PubMed 7776990 ]

64. Meyers RS, Thackray J, Matson KL, et al. Key Potentially Inappropriate Drugs in Pediatrics: The KIDs List. J Pediatr
Pharmacol Ther. 2020;25(3):175-191. [PubMed 32265601]

65. Miyajima A, Hirota T, Sugioka A, et al. Effect of high-fat meal intake on the pharmacokinetic profile of ivermectin
in Japanese patients with scabies. JDermatol. 2016;43(9):1030-1036. doi:10.1111/1346-8138.13321 [PubMed
26918286]

66. Monsel G, Caumes E. What's new in travel-associated dermatology? J Travel Med. 2015;22(4):221-224.
doi:10.1111/jtm.12224 [PubMed 26146819]

67. Murdoch ME. Onchocerciasis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com.
Accessed July 13, 2022.

68. Naquira C, Jimenez G, Guerra JG. Ivermectin for human strongyloidiasis and other intestinal helminths. Am J Trop
Med Hyg. 1989;40(3):304-309. doi:10.4269/ajtmh.1989.40.304 [PubMed 2929853]

69. National Institute for Health and Care Excellence (NICE). Drug allergy: diagnosis and management. Clinical
guideline 183. Published September 3, 2014. Accessed April 12, 2022. www.nice.org.uk/guidance/cg183.

70. Ndyomugyenyi R, Kabatereine N, Olsen A, Magnussen P. Efficacy of ivermectin and albendazole alone and in
combination for treatment of soil-transmitted helminths in pregnancy and adverse events: a randomized open
label controlled intervention trial in Masindi district, western Uganda. Am J Trop Med Hyg. 2008;79(6):856-863.
[PubMed 19052293]

71. Nicolas P, Maia MF, Bassat Q, Kobylinski KC, Monteiro W, Rabinovich NR, Menéndez C, Bardají A, Chaccour C.
Safety of oral ivermectin during pregnancy: a systematic review and meta-analysis. Lancet Glob Health.
2020;8(1):e92-e100. doi:10.1016/S2214-109X(19)30453-X [PubMed 31839144]

72. Nontasut P, Bussaratid V, Chullawichit S, Charoensook N, Visetsuk K. Comparison of ivermectin and albendazole
treatment for gnathostomiasis. Southeast Asian J Trop Med Public Health. 2000;31(2):374-377. [PubMed
11127342]
73. Nontasut P, Claesson BA, Dekumyoy P, Pakdee W, Chullawichit S. Double-dose ivermectin vs albendazole for the
treatment of gnathostomiasis. Southeast Asian J Trop Med Public Health. 2005;36(3):650-652. [PubMed 16124432]

74. Ogbuokiri JE, Ozumba BC, Okonkwo PO. Ivermectin levels in human breast milk. Eur J Clin Pharmacol.
1994;46(1):89-90. doi:10.1007/BF00195923 [PubMed 8005194]

75. Okonkwo PO, Ogbuokiri JE, Ofoegbu E, Klotz U. Protein binding and ivermectin estimations in patients with
onchocerciasis. Clin Pharmacol Ther. 1993;53(4):426-430. doi:10.1038/clpt.1993.46 [PubMed 8477558]

76. Oshikoya KA, Ogunyinka IA, Ogar CK, Abiola A, Ibrahim A, Oreagba IA. Severe cutaneous adverse drug reactions
manifesting as Stevens-Johnson syndrome and toxic epidermal necrolysis reported to the national
pharmacovigilance center in Nigeria: a database review from 2004 to 2017. Ther Adv Drug Saf.
2020;11:2042098620905998. doi:10.1177/2042098620905998 [PubMed 32110375]

77. Ottesen EA and Campbell WC, “Ivermectin in Human Medicine,” J Antimicrob Chemother, 1994, 34(2):195-203.
[PubMed 7814280]

78. Pacqué M, Muñoz B, Poetschke G, Foose J, Greene BM, Taylor HR. Pregnancy outcome after inadvertent ivermectin
treatment during community-based distribution. Lancet. 1990;336(8729):1486-9. doi:10.1016/0140-
6736(90)93187-t [PubMed 1979100]

79. Ramirez-Avila L, Slome S, Schuster FL, et al. Eosinophilic meningitis due to Angiostrongylus and Gnathostoma
species. Clin Infect Dis. 2009;48(3):322-327. doi:10.1086/595852 [PubMed 19123863]

80. Repetto SA, Ruybal P, Batalla E, et al. Strongyloidiasis outside endemic areas: long-term parasitological and
clinical follow-up after ivermectin treatment. Clin Infect Dis. 2018;66(10):1558-1565. doi:10.1093/cid/cix1069
[PubMed 29360939]

81. Richard-Lenoble D, Kombila M, Rupp EA, Pappayliou ES, Gaxotte P, Nguiri C, Aziz MA. Ivermectin in loiasis and
concomitant O. volvulus and M. perstans infections. Am J Trop Med Hyg. 1988;39(5):480-483. [PubMed 3195695]

82. Rodari P, Buonfrate D, Pomari E, et al. Ivermectin concentration in breastmilk of a woman with Strongyloides
stercoralis and human T-lymphotropic virus-I co-infection. Acta Trop. 2020;202:105249.
doi:10.1016/j.actatropica.2019.105249 [PubMed 31678122]

83. Romani L, Whitfield MJ. Koroiyueta J, Kama M, Wand H, et al. Mass drug administration for scabies control in a
population with endemic disease. N Engl J Med. 2015;373:2305-2313. [PubMed 26650152]

84. Salavastru CM, Chosidow O, Boffa MJ, Janier M, Tiplica GS. European guideline for the management of scabies. J
Eur Acad Dermatol Venereol. 2017;31(8):1248-1253. doi:10.1111/jdv.14351 [PubMed 28639722]

85. Salem DA, El-Shazly A, Nabih N, El-Bayoumy Y, Saleh S. Evaluation of the efficacy of oral ivermectin in comparison
with ivermectin-metronidazole combined therapy in the treatment of ocular and skin lesions of Demodex
folliculorum. Int J Infect Dis. 2013;17(5):e343-347. doi:10.1016/j.ijid.2012.11.022 [PubMed 23294870]

86. Schrijvers R, Gilissen L, Chiriac AM, Demoly P. Pathogenesis and diagnosis of delayed-type drug hypersensitivity
reactions, from bedside to bench and back. Clin Transl Allergy. 2015;5:31. doi:10.1186/s13601-015-0073-8
[PubMed 26339470]

87. Seegobin K, Bueno E, Maharaj S, Ashby T, Brown M, Jones L. Toxic epidermal necrolysis after ivermectin. Am J
Emerg Med. 2018;36(5):887-889. doi:10.1016/j.ajem.2017.09.021 [PubMed 28927997]
 88. Segarra-Newnham M. Manifestations, diagnosis, and treatment of Strongyloides stercoralis infection. Ann
Pharmacother. 2007;41(12):1992-2001. doi:10.1345/aph.1K302 [PubMed 17940124]

89. Stromectol (ivermectin) [prescribing information]. Whitehouse Station, NJ: Merck Sharp & Dohme; March 2022.
90. Twum-Danso NA. Serious adverse events following treatment with ivermectin for onchocerciasis control: a review
of reported cases. Filaria J. 2003;2(suppl 1):S3. doi:10.1186/1475-2883-2-S1-S3 [PubMed 14975060]

91. Vanhaecke C, Perignon A, Monsel G, Regnier S, Bricaire F, Caumes E. The efficacy of single dose ivermectin in the
treatment of hookworm related cutaneous larva migrans varies depending on the clinical presentation. J Eur Acad
Dermatol Venereol. 2014;28(5):655-357. doi:10.1111/jdv.12097 [PubMed 23368818]

92. Veit O, Beck B, Steuerwald M, Hatz C. First case of ivermectin-induced severe hepatitis. Trans R Soc Trop Med Hyg.
2006;100(8):795-797. doi:10.1016/j.trstmh.2006.02.003 [PubMed 16682062]

93. Weller PF. Eosinophilic meningitis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com.
Accessed July 13, 2022.

94. Westlake CS, Aronoff DM. Evaluating the risks of systemic maternal ivermectin exposure during pregnancy in
human and vertebrate animals: a scoping review. Curr Drug Saf. Published August 20, 2020.
doi:10.2174/1574886315999200820125001 [PubMed 33109066]

95. Wilkins AL, Steer AC, Cranswick N, Gwee A. Question 1: Is it safe to use ivermectin in children less than five years of
age and weighing less than 15 kg? Arch Dis Child. 2018;103(5):514-519. doi:10.1136/archdischild-2017-314505
[PubMed 29463522]

96. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR
Recomm Rep. 2021;70(4):1-187. doi:10.15585/mmwr.rr7004a1 [PubMed 34292926]

97. Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment
guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1-137. [PubMed 26042815]

Topic 83316 Version 153.0