How it works
Ivermectin selectively binds to glutamate-gated chloride channels in the nerve and muscle cells of susceptible parasites. This increases chloride-ion permeability, causing hyperpolarization, paralysis, and eventual death of the parasite. Humans do not have these glutamate-gated chloride channels, and ivermectin does not readily cross the blood-brain barrier at standard therapeutic exposure.
Who it may be recommended for
Ivermectin is a well-established antiparasitic medicine. Clinical studies of intestinal strongyloidiasis found cure rates of approximately 64–100% following a single dose of about 200 mcg/kg. Comparative studies found ivermectin to be more effective than albendazole in the studied regimens and comparable to thiabendazole.
For onchocerciasis, clinical studies included more than 1,400 patients in endemic areas of West Africa. Ivermectin substantially reduces microfilarial levels but does not kill adult Onchocerca volvulus parasites, so follow-up and repeated treatment may be required.
Oral ivermectin is also included in clinical recommendations for scabies in several countries. The dosing schedule differs from that used for strongyloidiasis or onchocerciasis and should be determined by a healthcare professional. CDC guidance, for example, recommends a second dose for scabies because ivermectin has limited activity against mite eggs.
Ivermectin is primarily indicated for intestinal strongyloidiasis caused by Strongyloides stercoralis and onchocerciasis caused by Onchocerca volvulus. Depending on local regulations and clinical guidelines, it may also be used for certain other parasitic infections, including scabies.
The medicine acts on the nervous and muscular systems of susceptible parasites, disrupting their signaling and causing paralysis and death.
Ivermectin should be taken orally with water exactly as prescribed by a healthcare professional. The dose is generally determined according to body weight and the specific parasitic infection, so the 6 mg tablet strength does not correspond to a fixed number of tablets for every patient. Some indications require a single dose, while others may require repeated treatment. For strongyloidiasis, follow-up stool examinations are recommended to confirm eradication.
Side effects
During treatment of onchocerciasis, reactions associated with the death of microfilariae may occur, including itching, rash, fever, headache, muscle or joint pain, and other inflammatory reactions.
