From the Guidelines
Ivermectin can be used to treat scabies in patients with Down syndrome, but with appropriate medical supervision. The standard treatment for scabies typically involves applying permethrin 5% cream or taking oral ivermectin at a dose of 200 mcg/kg, often repeated after 1-2 weeks 1. For a patient with Down syndrome, the same dosing guidelines apply, but a healthcare provider should be consulted first as they may need to consider potential drug interactions with other medications the patient might be taking.
Important Considerations
- Patients with Down syndrome may have other medical conditions that require careful medication management.
- When treating scabies, it's also important to wash all bedding, clothing, and towels in hot water and dry on high heat to prevent reinfestation.
- Close contacts should be treated simultaneously even if they don't show symptoms, as scabies spreads easily through prolonged skin-to-skin contact.
- Ivermectin works by paralyzing and killing the scabies mites and their eggs, effectively resolving the infestation when used properly.
Treatment Options
- Permethrin 5% cream applied to all areas of the body from the neck down and washed off after 8–14 hours 1
- Ivermectin 200 mcg/kg orally, repeated in 2 weeks 1 It's worth noting that while ivermectin can be effective against scabies, its use in patients with Down syndrome should be carefully considered due to potential interactions with other medications and the need for close monitoring 1.
From the FDA Drug Label
Pregnancy Teratogenic Effects Pregnancy Category C Ivermectin has been shown to be teratogenic in mice, rats, and rabbits when given in repeated doses of 0.2,8.1, and 4. 5 times the maximum recommended human dose, respectively (on a mg/m 2/day basis). Pediatric Use Safety and effectiveness in pediatric patients weighing less than 15 kg have not been established Information for Patients STROMECTOL should be taken on an empty stomach with water. The FDA drug label does not answer the question.
From the Research
Treatment of Scabies
- Scabies is a skin infestation that can be treated with topical permethrin or oral ivermectin 2, 3, 4.
- The choice of treatment depends on the severity of the infestation and the presence of any comorbid conditions 2, 4.
- Topical permethrin is the first-line therapy for scabies, while oral ivermectin is an alternative treatment option 2, 4.
- A combination of permethrin and ivermectin can be used to treat crusted scabies or otherwise intractable cases 4.
Use of Ivermectin in Down Syndrome Patients
- There is limited information available on the use of ivermectin in patients with Down syndrome 5.
- Individuals with Down syndrome may experience altered drug disposition and response due to their complex pathobiology 5.
- Enhanced monitoring during drug therapy is justified in individuals with Down syndrome due to reports of altered drug disposition and response 5.
Safety and Efficacy of Ivermectin
- The safety and efficacy of ivermectin for the treatment of scabies have been evaluated in several studies 2, 6, 4.
- Ivermectin has been shown to be effective in treating scabies, with few and mild adverse events reported 2, 6.
- However, the certainty of the evidence is mostly low to moderate due to poor reporting and limited data 2.