Home Drug Guide Ivermectin

Drug Guide

Generic Name

Ivermectin

Brand Names Stromectol, Sklice, Soolantra

Classification

Therapeutic: Antiparasitic

Pharmacological: Endectocide, Antihelminthic

FDA Approved Indications

  • Onchocerciasis (river blindness)
  • Strongyloidiasis
  • Pediculosis (lice infestation)
  • Rosacea (Soolantra)

Mechanism of Action

Ivermectin binds to glutamate-gated chloride channels in nerve and muscle cells of parasites, causing increased permeability to chloride ions, hyperpolarization of the nerve or muscle cell, and eventual paralysis and death of the parasite.

Dosage and Administration

Adult: For onchocerciasis: 150 mcg/kg as a single dose, may be repeated after 3-12 months; for rosacea (Soolantra): 1 dose applied topically once daily for 8 weeks.

Pediatric: Dosing based on weight for parasitic infections; for lice in children, 5% topical formulation applied to affected area once or twice.

Geriatric: No specific dosage adjustment, but caution advised due to potential comorbidities and concomitant medications.

Renal Impairment: No specific dose adjustment recommendation; caution advised.

Hepatic Impairment: No specific dose adjustment; limited data.

Pharmacokinetics

Absorption: Orally well absorbed, especially on an empty stomach.

Distribution: Widely distributed in body fluids and tissues, crosses blood-brain barrier to a limited extent.

Metabolism: Metabolized in the liver, primarily via CYP3A4 enzyme.

Excretion: Excreted mainly in feces; small amount in urine.

Half Life: Approximately 12-16 hours.

Contraindications

  • hypersensitivity to ivermectin or components

Precautions

  • Caution in individuals with compromised blood-brain barrier, or with concomitant medications that may affect CNS or hepatic function. Use in pregnancy and lactation only if clearly needed.

Adverse Reactions - Common

  • Mild skin rash (Common)
  • Dizziness (Common)
  • Gastrointestinal upset (nausea, diarrhea) (Common)

Adverse Reactions - Serious

  • Neurotoxicity (ataxia, confusion, mydriasis) (Rare)
  • Severe hypersensitivity reactions (Rare)

Drug-Drug Interactions

  • CYP3A4 inhibitors (e.g., azoles, macrolides) may increase ivermectin levels

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Assess for parasitic infections, neurological symptoms, and hypersensitivity.

Diagnoses:

  • Risk for neurological impairment due to neurotoxicity
  • Risk for hypersensitivity reactions

Implementation: Administer as prescribed; monitor for adverse effects, especially neurotoxicity.

Evaluation: Evaluate treatment efficacy and monitor for adverse reactions.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report any neurological symptoms such as dizziness, confusion.
  • Avoid driving or operating machinery if experiencing dizziness.
  • Maintain good hygiene to prevent reinfestation.
  • Use topical formulations as directed, do not exceed recommended frequency.

Special Considerations

Black Box Warnings:

  • Potential for neurotoxicity, especially in individuals with blood-brain barrier compromise or high parasite burdens.

Genetic Factors: Variations in CYP3A4 activity may affect drug metabolism.

Lab Test Interference: No significant impact reported.

Overdose Management

Signs/Symptoms: Neurological symptoms such as dizziness, ataxia, confusion.

Treatment: Supportive care; no specific antidote. Induce vomiting or administer activated charcoal if ingestion is recent.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable under recommended conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.