Ivermectin is a broad-spectrum antiparasitic drug primarily used to treat infections caused by nematodes and certain arthropod parasites. This medication works by blocking the nervous conduction and muscle contraction of parasites, leading to their paralysis and death. Common clinical indications include river blindness, scabies, head lice infections, and the treatment of specific parasitic diseases. Its mechanism of action differs from other antiparasitic drugs, exhibiting high specificity with minimal effects on human cells.
Ivermectin was initially developed for veterinary medicine, and subsequent clinical trials have confirmed its safety and efficacy for human parasitic infections. This drug can be administered orally or applied topically, demonstrating high selectivity and low impact on host cells, making it one of the preferred treatment options recommended by health organizations in multiple countries. However, its use must strictly adhere to physician instructions and should not be used for unapproved indications.
Different countries may sell it under various trademark names, but the active ingredient is always Ivermectin. The pharmaceutical forms include tablets, creams, or oral suspensions, with the specific form depending on the treatment needs. Patients should verify the active ingredient on the medication label to avoid confusion with similarly named drugs.
Ivermectin is classified as a "macrolide antiparasitic drug" and belongs to chemically synthesized antiparasitic agents. Its chemical structure is similar to antibiotic compounds like erythromycin, but its mechanism of action is entirely different, primarily targeting the glutamate-gated ion channels of parasites to block nervous conduction. This drug is not an antibiotic and cannot be used to treat bacterial infections.
This drug's classification is characterized by its high selectivity, having almost no effect on human cells, thus holding a unique position in the field of parasitic treatment. However, its effectiveness is limited against certain types of parasites (such as protozoa or flukes) and may need to be used in conjunction with other medications.
Approved indications by health authorities include: onchocerciasis (river blindness), scabies, head lice infections, and nematode infections (such as strongyloidiasis). In specific countries or regions, it may also be approved for other parasitic infections, subject to the contents of the drug license.
It is important to note: this drug is not approved for the treatment or prevention of COVID-19, and related claims lack sufficient clinical evidence. Physicians may only use it for non-approved indications after a strict assessment of risks, and it must comply with pharmaceutical regulations.
Severe but rare side effects include: allergic reactions (hives, difficulty breathing), liver function abnormalities, seizures, peripheral neuropathy. If symptoms such as difficulty breathing or facial swelling occur, seek medical attention immediately. If persistent dizziness or coordination issues arise after use, discontinue the medication and notify healthcare personnel.
Contraindicated in the following patients:
During treatment, avoid alcohol, as it may exacerbate dizziness and other central nervous system symptoms. Patients with severe liver or kidney dysfunction need dosage adjustments, and children under 15 kg should use it only after a physician assesses safety. Use during breastfeeding may secrete into breast milk; thus, breastfeeding should be paused or alternative options should be considered.
Combining with the following medications may increase the risk of side effects:
Inform your physician before taking any prescription drugs, over-the-counter medications, or herbal remedies, including vitamin supplements. Especially avoid combining with medications that affect neuromuscular junctions (such as muscle relaxants), as they may exacerbate muscle weakness symptoms.
The oral dosage is typically calculated in mg/kg of body weight, with the common dose for adults treating river blindness being 150-200 micrograms/kg, taken as a single dose. For treating scabies, it may require two consecutive days of dosing, adjusted according to the type of infection. The topical cream form (1% concentration) is usually applied to the affected area once daily.
The tablets should be swallowed whole and not chewed, taken with a glass of water. If using a suspension, it should be shaken well before measuring, and an attached measuring cup should be used to ensure the correct dosage. When treating head lice infections, it should be used in conjunction with shampoo to clean the scalp and avoid contact with the eyes.
If a scheduled dose is missed, it should be taken immediately upon remembering, but if it is close to the next dose time, skip the missed dose and resume the normal dosing schedule. Never take double the dose to make up for a missed one, as this may lead to toxic reactions.
If a topical application is missed, it should be reapplied immediately but do not use double the amount. If an excessive amount of topical ointment is used, thoroughly wash the affected area with clean water and consult a healthcare provider.
If an overdose occurs, severe neurological symptoms such as coma, respiratory depression, or seizures may arise. Seek medical attention immediately and bring the medication bottle for reference, informing the physician of the actual dosage and time taken. Emergency measures may include inducing vomiting (within 1 hour of ingestion), activated charcoal adsorption, or hospitalization for observation.
Topical overdose may cause redness and blistering at the contact site, requiring immediate cleaning with soap and water, and covering with clean gauze. If systemic symptoms such as dizziness or difficulty breathing occur, treat it as an emergency and call emergency services.
Do I need to take Ivermectin on an empty stomach to enhance its efficacy?
It is generally recommended to take Ivermectin on an empty stomach, as food may delay drug absorption. However, if significant gastrointestinal discomfort occurs after taking the medication, a light meal can be consumed 30 minutes to 1 hour later, and the physician should be informed to adjust the dosage or timing. Avoid taking it with high-fat or high-fiber foods to maintain stable drug efficacy.
What long-term side effects may arise from prolonged use of Ivermectin?
Long-term or high-dose use may lead to neurological effects such as dizziness and headaches, with very few patients potentially experiencing peripheral neuropathy. Skin-related issues may include persistent itching or rashes. It is recommended to monitor blood and neurological function every 3-6 months and regularly evaluate the necessity of the medication with a physician.
What should I be aware of when using Ivermectin alongside antibiotics or other antiparasitic drugs?
Combining with certain antibiotics (such as tetracyclines) may increase the risk of gastrointestinal discomfort, requiring a 2-4 hour interval between doses. If used with antiparasitic drugs like albendazole, prior evaluation by a physician is necessary, as it may increase the metabolic burden on the liver. Avoid self-mixing with over-the-counter antipruritic medications to prevent interactions.
Should I adjust my diet or daily activities during the treatment period?
It is advisable to refrain from alcohol and high-fat diets, as alcohol may exacerbate dizziness, and fats may delay drug absorption. Avoid vigorous exercise during treatment, as dehydration may increase drug concentration. Patients with skin lesions should avoid sun exposure, as the medication may increase the risk of photosensitivity.
If symptoms do not improve after treatment, can I increase the dosage or shorten the interval myself?
Do not adjust the dosage on your own, as overdose may lead to severe neurotoxicity. If symptoms persist after treatment, return to the clinic immediately; the physician may conduct re-testing for the type of parasite or consider alternative treatment options. Self-increasing the dosage may lead to liver and kidney dysfunction, and strict adherence to medical advice is required.
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