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ivermectin (Stromectol, Sklice)

Tradename: Stromectol. Indications: - Strongyloidiasis (Strongyloides) - Onchocerciasis - Filiariasis - Scabies - pediculosis (Lice) - off-label use for treatment of COVID-19* * in vitro activity against COVID-19 [5] * NIH no longer recommends against or for use of ivermectin for treatment of COVID-19 [7] * WHO & FDA recommend against use of ivermectin for treatment of COVID-19 [8] * 5-day course of ivermectin does not reduce time to resolution of symptoms [9] * ivermectin does not prevent progression to severe disease [17] * ivermectin does not reduce all-cause mortality, length of stay or viral clearance in randomized controlled trials in Covid-19 patients [10] * ivermectin 400 ug/kg/day for 3 days of no benefits for mild-moderate Covid-19 [20] * ivermectin 600 ug/kg/day for 6 days of no benefits for mild-moderate Covid-19 [20] * meta-analysis of 15 trials found ivermectin reduced risk of death (RR=0.38) [11] * meta-analysis of 11 trials found ivermectin reduced risk of death (RR=0.44) [12] - 9% deaths in controls vs 3% on ivermectin [12] * Cochrane review concludes reliable evidence available does not support use of ivermectin for prevention or treatment of COVID-19 outside of clinical trials [15] * no evidence suggests ivermectin prevents mortality from COVID-19 in regions where strongyloidiasis is not endemic [18] * treatment of early Covid-19 does not lower risk for hospitalization or reduce length of time spent in the emergency department [19] Dosage: 1) Strongyloides: 200 ug/kg single dose 2) Onchocerciasis: 150 ug/kg single dose 3) Filiariasis: 150-200 ug/kg single dose 4) Scabies: 159-200 ug/kg single dose 5) Lice: a) 12 mg PO weekly, 3 doses b) topical treatment once with 0.5% lotion (Sklice) - now OTC [6] 6) off-label use to treat COVID-19 not recommended [7,8] Tabs: 6 mg. Lotion: 0.5% (now OTC) Adverse effects: 1) fever/chills 2) arthralgias 3) headache 4) nausea/vomiting 5) confusion [16] Notes: - non-prescription ivermectin is available over-the-counter to treat head lice [6]

Interactions

drug interactions

Related

Strongyloides

General

antihelmintic

Properties

MISC-INFO: elimination route LIVER pregnancy-category C safety in lactation ?

Database Correlations

PUBCHEM correlations

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1214.
  3. Foucault C et al, Oral ivermectin in the treatment of body lice J Infect Dis 2006, 193:474 PMID: 16388498
  4. Pariser DM et al Topical 0.5% Ivermectin Lotion for Treatment of Head Lice N Engl J Med 2012; 367:1687-1693 PMID: 23113480 http://www.nejm.org/doi/full/10.1056/NEJMoa1200107 - Chosidow O and Giraudeau B Topical Ivermectin - A Step toward Making Head Lice Dead Lice? N Engl J Med 2012; 367:1750-1752 PMID: 23113487
  5. Caly L, Druce JD, Catton MG et al The FDA-approved Drug Ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Research. Published online April 3, 2020 PMID: 32251768 Free PMC Article https://www.sciencedirect.com/science/article/pii/S0166354220302011 - FDA Safety information. April 10, 2020 Ivermectin Intended for Animals: Letter to Stakeholders - Do Not Use in Humans as a Treatment for COVID-19. https://www.fda.gov/safety/medical-product-safety-information/ivermectin-intended-animals-letter-stakeholders-do-not-use-humans-treatment-covid-19
  6. FDA News Release. Oct 27, 2020 FDA Approves Lotion for Nonprescription Use to Treat Head Lice https://www.fda.gov/news-events/press-announcements/fda-approves-lotion-nonprescription-use-treat-head-lice
  7. Frontline COVID-19 Critical Care Alliance (FLCCC) Prophylaxis & Treatment Protocols for COVID-19 https://covid19criticalcare.com/ - Kory P et al Clinical and Scientific Rationale for the "MATH+" Hospital Treatment Protocol for COVID-19 Journal of Intensive Care. Dec 2020 https://covid19criticalcare.com/wp-content/uploads/2020/12/MATH-plus-Rationale-Journal-of-Intensive-Care-Medicine-Dec2020.pdf - Sax PE Ivermectin for COVID-19 - Breakthrough Treatment or Hydroxychloroquine Redux? N Eng J Med Journal Watch HIV and ID Observations. Jan 4, 2021 https://blogs.jwatch.org/hiv-id-observations/index.php/ivermectin-for-covid-19-breakthrough-treatment-or-hydroxychloroquine-redux/2021/01/04/ - Frellick M Controversy Flares Over Ivermectin for COVID-19. Medscape. Jan 20, 2021 https://www.medscape.com/viewarticle/944440 - COVID-19 Treatment Guidelines Panel. The COVID-19 Treatment Guidelines Panel's statement on the use of ivermectin for the treatment of COVID-19. 2021 Jan 14 https://www.covid19treatmentguidelines.nih.gov/statement-on-ivermectin
  8. Reuters Staff WHO Joins Europe, Merck in Recommending Against Ivermectin for COVID-19. Medscape - Mar 31, 2021 https://www.medscape.com/viewarticle/948471
  9. Lopez-Medina E, Lopez P, Hurtado IC et al Effect of Ivermectin on Time to Resolution of Symptoms Among Adults With Mild COVID-19. A Randomized Clinical Trial, JAMA. Published online March 4, 2021 PMID: 33662102 https://jamanetwork.com/journals/jama/fullarticle/2777389
  10. Roman YM, Burela PA, Pasupuleti V et al Ivermectin for the treatment of COVID-19: A systematic review and meta-analysis of randomized controlled trials. medRxiv 2021. May 25 Not indexed in PubMed https://www.medrxiv.org/content/10.1101/2021.05.21.21257595v1
  11. Bryant A, Lawrie TA, Dowswell T et al Ivermectin for Prevention and Treatment of COVID-19 Infection. A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines. Am J Ther. 2021 Jun 17. PMID: 34145166 https://journals.lww.com/americantherapeutics/Abstract/9000/Ivermectin_for_Prevention_and_Treatment_of.98040.aspx
  12. Hill A, Garratt A, Levi J et al Meta-analysis of randomized trials of ivermectin to treat SARS-CoV-2 infection. Open Forum Infectious Diseases. 2021. July 6 https://academic.oup.com/ofid/advance-article/doi/10.1093/ofid/ofab358/6316214
  13. Wilson FP Ivermectin for COVID: How Do We Know What to Believe? Medscape - Jul 14, 2021 https://www.medscape.com/viewarticle/954681
  14. Fiore K Large Ivermectin Study Retracted. Preprint publisher finds evidence of plagiarism, problems with raw data. MedPage Today July 20, 2021 https://www.medpagetoday.com/special-reports/exclusives/93658
  15. Popp M, Stegemann M, Metzendorf MI et al Ivermectin for preventing and treating COVID-19. Cochrane Database of Systematic Reviews. 2021. July 28 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015017.pub2/full
  16. Temple C, Hoang R, Hendrickson RG. Toxic Effects from Ivermectin Use Associated with Prevention and Treatment of Covid-19. N Engl J Med. October 20, 2021. PMID: 34670041 https://www.nejm.org/doi/full/10.1056/NEJMc2114907
  17. Lim SCL, Hor CP, Tay KH et al Efficacy of Ivermectin Treatment on Disease Progression Among Adults With Mild to Moderate COVID-19 and Comorbidities. The I-TECH Randomized Clinical Trial. JAMA Intern Med. Published online February 18, 2022. PMID: 35179551 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2789362
  18. Bitterman A, Martins CP, Cices A et al Comparison of Trials Using Ivermectin for COVID-19 Between Regions With High and Low Prevalence of StrongyloidiasisA Meta-analysis. JAMA Netw Open. 2022;5(3):e223079 PMID: 35311963 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790173
  19. Reis G, Siva EASM, Silva DCM et al Effect of Early Treatment with Ivermectin among Patients with Covid-19. N Engl J Med 2022. March 30 PMID: 35353979 https://www.nejm.org/doi/full/10.1056/NEJMoa2115869
  20. Naggie S, Boulware DR, Lindsell CJ et al Effect of Ivermectin vs Placebo on Time to Sustained Recovery in Outpatients With Mild to Moderate COVID-19. A Randomized Clinical Trial. JAMA. Published online October 21, 2022 PMID: 36269852 https://jamanetwork.com/journals/jama/fullarticle/2797483 - Naggie S, Boulware DR, Lindsell CJ et al Effect of Ivermectin vs Placebo on Time to Sustained Recovery in Outpatients With Mild to Moderate COVID-19: A Randomized Clinical Trial. medRxiv. Dec 15, 2022 https://www.medrxiv.org/content/10.1101/2022.12.15.22283488v1 - Naggie S, Boulware DR, Lindsell CJ et al Effect of Higher-Dose Ivermectin for 6 Days vs Placebo on Time to Sustained Recovery in Outpatients With COVID-19. A Randomized Clinical Trial. JAMA. Published online February 20, 2023 PMID: 36807465 PMCID: PMC9941969 (available on 2023-08-20) https://jamanetwork.com/journals/jama/fullarticle/2801827

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clorsulon/ivermectin ivermectin/praziquantel ivermectin/praziquantel/pyrantel ivermectin/pyrantel