Ivermectin – Uses, Mechanism and Dosage
Ivermectin is an antiparasitic medication used to treat a wide range of parasitic infections in humans and animals. It is listed as an essential medicine by the WHO.
Things worth knowing about "Ivermectin"
Ivermectin is an antiparasitic medication used to treat a wide range of parasitic infections in humans and animals. It is listed as an essential medicine by the WHO.
What is Ivermectin?
Ivermectin is an antiparasitic drug belonging to the class of macrocyclic lactones. Discovered in the 1970s, it has become one of the most widely used antiparasitic agents globally. The World Health Organization (WHO) includes ivermectin on its List of Essential Medicines. It is used in both human medicine and veterinary medicine.
Indications – What is Ivermectin Used For?
In human medicine, ivermectin is approved for the treatment of the following conditions:
- Onchocerciasis (river blindness): a disease caused by parasitic worms that can lead to permanent blindness
- Strongyloidiasis: an intestinal infection caused by the threadworm Strongyloides stercoralis
- Scabies: a skin condition caused by mite infestation
- Lymphatic filariasis: a parasitic disease affecting the lymphatic system
- Pediculosis (head lice infestation): approved in some countries
Mechanism of Action
Ivermectin works by selectively binding to glutamate-gated chloride ion channels found in the nerve and muscle cells of parasites. This binding increases the permeability of the cell membrane to chloride ions, leading to hyperpolarization of nerve cells. The result is paralysis and subsequent death of the parasite. Because these specific ion channels are not present in the same form in humans, ivermectin is generally well tolerated at therapeutic doses.
Dosage and Administration
Ivermectin is typically administered as an oral tablet. The dosage is weight-based and depends on the condition being treated. A standard dose is 150–200 micrograms per kilogram of body weight. For some conditions such as scabies or strongyloidiasis, repeated doses may be required. It is generally recommended to take ivermectin on an empty stomach with water to optimize absorption.
Side Effects
Ivermectin is generally well tolerated. Potential side effects include:
- Headache and dizziness
- Nausea and vomiting
- Skin rash or itching
- Mazzotti reaction: an immune response during treatment of onchocerciasis caused by dying parasites (fever, swelling, muscle pain)
- Rarely: neurological symptoms such as confusion or drowsiness at high doses
Ivermectin and COVID-19
During the COVID-19 pandemic, ivermectin was controversially discussed as a potential treatment option. The WHO, the European Medicines Agency (EMA), and the FDA explicitly do not recommend the use of ivermectin for COVID-19, as clinical trials have not provided sufficient evidence of efficacy against the SARS-CoV-2 virus. Self-medication without a medical prescription is not advised.
Contraindications and Precautions
Ivermectin should not be used in:
- Patients with known hypersensitivity to the active ingredient
- Children weighing less than 15 kg (depending on regulatory approval)
- Pregnancy (use only after careful benefit-risk assessment)
Special caution is required in patients with a Loa loa infection (African eye worm disease), as ivermectin can cause severe neurological complications in the presence of high parasite loads.
References
- World Health Organization (WHO) – Model List of Essential Medicines, 23rd Edition (2023). Available at: https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2023.02
- Merck & Co. – Ivermectin: Pharmacology and Clinical Use. In: The Merck Manual of Diagnosis and Therapy, 20th Edition (2023).
- Crump A, Omura S. Ivermectin, wonder drug from Japan: the human use perspective. Proc Jpn Acad Ser B Phys Biol Sci. 2011;87(2):13–28. DOI: 10.2183/pjab.87.13
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