Ivermectin Forms, Cost, Possible Side Effects

Ivermectin is a macrocyclic lactone medication, a complex compound that has a potent parasiticidal activity and shows great efficacy in treating worm infestations in both humans and animals. This anthelmintic drug is helpful against infections caused by:

intestinal worms (onchocerciasis, strongyloidiasis, cutaneous larva migrans (CLM), and lymphatic filariasis)
ectoparasites (scabies, lice infestation)

In the United States, the FDA has approved only two medical uses of this drug in humans: for the treatment of onchocerciasis and strongyloidiasis. All other uses of ivermectin are termed by the agency as “off-label”. Despite this, ivermectin has gained wide popularity as an efficient, affordable, and safe medicine that can treat a wide range of parasitic infections.

Dosage and forms

Oral ivermectin tablets are marketed as both brand-name and generic drugs. The generic medication is named after its active drug substance – ivermectin – and is available as oral 3mg tablets. The brand-name medication is Stromectol, which also comes as 3mg oral tablets. Additionally, there is ivermectin-containing Soolantra topical cream 1% and Sklice topical lotion 0.5% for treating some ectoparasitic skin conditions.

When used to treat intestinal parasitic infections, the typical single dose of ivermectin is 200 mcg/kg of body mass. The standard dosage of ivermectin for treating parasitic infections in the skin or eyes is 150 mcg/kg of body weight.

Only the prescribing physician can determine the correct dosage of ivermectin based on the condition being treated and after taking into account the patient’s age and overall health status, the severity of their symptoms, the availability of concomitant diseases, their first-dose response, etc.

Patients should take ivermectin oral tablets on an empty stomach with a glass of water at the time suggested by their doctor (usually, 1 hour before breakfast unless the prescribing doctor directs otherwise).

Ivermectin 3mg cost

The cost of generic ivermectin 3mg is around $79. This price is relevant for a supply of 20 oral tablets. The brand-name Stromectol will cost about $107 for the same quantity of 3mg oral tablets.

The cost of ivermectin topical cream 1% (Soolantra) in U.S. pharmacies is around $463 for a tube of 45 grams, and the 0.5% topical lotion (Sklice) costs $280. The exact price of the drug depends on the pharmacy that fills the prescription.

How does ivermectin work?

Ivermectin works by stimulating an enhanced release of certain neurochemical messengers known as GABA neurotransmitters in the peripheral nervous system (PNS) of the infection-causing parasites. The drug binds to the invertebrate nerve and muscle cells of the parasites, causing the paralysis of the parasite or total inactivation of their gut. As a result, the parasites are unable to move and feed themselves and thus starve to death and are removed from the human body with waste.

Since it only affects glutamate-gated chloride channels (GluCls) present in invertebrates but not in mammals, ivermectin is considered safe for humans, in whom a similar channel in the CNS is protected by the blood-brain barrier that keeps the toxic substances away.

Side effects

Ivermectin is usually a well-tolerated drug, with only around 5% of all patients experiencing mild and brief adverse reactions. The most commonly reported side effects that the patient can notice after taking oral ivermectin include:

loss of appetite,
fever,
itchiness,
skin rash,
headache,
drowsiness,
fatigue,
mild indigestion,
constipation,
nausea and vomiting,
stomach ache,
low blood pressure.

The above symptoms are not considered dangerous and usually do not require the patient to seek immediate medical attention. However, if any of them persist or aggravate over time, consulting the prescribing physician is advised.

Patients should also watch out for the following more severe and unsafe side effects:

signs of an allergic reaction,
chest discomfort,
heartbeat irregularities,
pain in joints or muscles,
tender glands,
ocular problems,
trouble breathing,
trouble walking (loss of balance),
loss of bowel or bladder control.

Although these symptoms are very rare, patients need to immediately contact their doctor or seek emergency medical care at a hospital if any of the side effects listed above occur after taking oral ivermectin or applying ivermectin in any other form.

This is not the complete list of side effects that ivermectin may cause in patients. People who experience any unwanted or increasingly uncomfortable symptoms after taking the drug should consult with their doctor as quickly as possible.

Pregnancy, breastfeeding, and use in children: children under 15kg, pregnant women, or breastfeeding mothers should avoid taking ivermectin since the drug’s effectiveness or safety in these groups of patients have not been reliably studied and established.

Drug interactions

While ivermectin can mildly-to-moderately interact with 75 brand and generic drugs, no significant or life-threatening interactions have been discovered. Some of the drugs ivermectin actively interacts with are antidepressant medications (barbiturates), valproic acid, benzodiazepines, sodium oxybate, and warfarin.

Before they are prescribed ivermectin, patients should tell their physician about all other prescription and over-the-counter medications they are taking, including vitamins, minerals, herbs, and dietary supplements.

Patients are advised against mixing ivermectin with alcohol as such a combination can contribute to the adversity and complexity of side effects.

Contraindications

The use of ivermectin might be contraindicated in the following groups of patients:

people hypersensitive to any of the drug’s components,
people with hepatic or renal impairment,
patients with asthma,
people with seizures,
patients with Loa loa coinfection,
patients with sowda (a localized type of onchocerciasis),
immunosuppressed patients (HIV infected or organ transplant recipients).

It is crucial to always provide the attending doctor with complete and exhaustive medical history data to avoid the situation where the physician unwittingly prescribes a drug that can pose a significant threat to the patient’s health and safety.

Uses in veterinary medicine

Ivermectin is a broad-spectrum antiparasitic therapy that was developed in the 1970s as a product of the international collaboration between the Merck & Co pharmaceutical company and the Japanese Kitasato Institute. First introduced as an efficient drug that could cure a wide range of internal and external parasitic diseases in animals, ivermectin quickly became a selling hit in the field of veterinary medicine.

Today, ivermectin for dogs and ivermectin for cats – two versions of the same drug in different dosages – are widely used to prevent and treat heartworm infections in domestic animals. The FDA also approves this medication for the treatment of certain internal and external parasitic diseases in livestock. For example, the pour-on ivermectin for goats at 1ml per 22lbs can quickly rid the sick animals of nematode worms, lungworms, and sucking lice.

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