What is the proper dosage and usage of Ivermectin for parasitic infections?

From the Guidelines

Ivermectin should be used at a dosage of 200 μg/kg as a single oral dose for the treatment of parasitic infections, with the possibility of retreatment 1 month after the resolution of pulmonary symptoms to ensure adult worms are treated, as recommended by expert opinion 1.

Key Considerations

• The dosage and treatment duration may vary depending on the specific parasite being treated, with some infections requiring repeated doses 1-2 weeks apart.
• Ivermectin works by paralyzing and killing parasites by disrupting their nervous system through binding to glutamate-gated chloride channels.
• Side effects are generally mild but may include dizziness, nausea, diarrhea, or skin rash.
• Patients should follow their healthcare provider's specific instructions as dosing may be adjusted based on weight, infection severity, and immune status.

Special Populations

• Pregnant women, children weighing less than 15kg, and people with certain neurological conditions should use ivermectin only under careful medical supervision due to potential risks.
• In areas co-endemic with onchocerciasis and loiasis, ivermectin treatment should be used with caution due to the risk of severe adverse events, particularly in individuals with high L. loa microfilaria loads 1.

Treatment Guidelines

• For strongyloidiasis, a single dose of ivermectin 200 μg/kg is often sufficient, while scabies treatment may require a second dose after 7 days.
• In cases where no organism is identified, empirical treatment with single dose ivermectin 200 μg/kg and albendazole 400 mg may be considered, with retreatment 1 month after the resolution of pulmonary symptoms 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Strongyloidiasis The recommended dosage of STROMECTOL for the treatment of strongyloidiasis is a single oral dose designed to provide approximately 200 mcg of ivermectin per kg of body weight. Table 1: Dosage Guidelines for STROMECTOL for Strongyloidiasis Body Weight (kg) Single Oral Dose Number of 3-mg Tablets 15-241 tablet 25-35 2 tablets 36-50 3 tablets 51-65 4 tablets 66-79 5 tablets ≥80200 mcg/kg Onchocerciasis The recommended dosage of STROMECTOL for the treatment of onchocerciasis is a single oral dose designed to provide approximately 150 mcg of ivermectin per kg of body weight Table 2: Dosage Guidelines for STROMECTOL for Onchocerciasis Body Weight (kg)Single Oral Dose Number of 3-mg Tablets 15-251 tablet 26-44 2 tablets 45-64 3 tablets 65-84 4 tablets ≥85150 mcg/kg

The proper dosage and usage of Ivermectin for parasitic infections are as follows:

• For Strongyloidiasis: a single oral dose of approximately 200 mcg of ivermectin per kg of body weight.
• For Onchocerciasis: a single oral dose of approximately 150 mcg of ivermectin per kg of body weight. Patients should take tablets on an empty stomach with water 2. Key points:
• The dosage guidelines are provided in Table 1 for Strongyloidiasis and Table 2 for Onchocerciasis.
• Additional doses are not necessary for Strongyloidiasis, but follow-up stool examinations should be performed to verify eradication of infection.
• For Onchocerciasis, retreatment may be considered at intervals as short as 3 months 2.

From the Research

Proper Dosage and Usage of Ivermectin

• The proper dosage of Ivermectin for parasitic infections is typically 150-200 micrograms/kg in a single dose or on 2 consecutive days, as seen in the treatment of strongyloidiasis 3.
• For onchocerciasis, a single oral dose of ivermectin (150 micrograms/kg) repeated once a year leads to a marked reduction in skin microfilaria counts and ocular involvement 4, 5.
• The World Health Organization (WHO) has managed many control programmes involving the use of Ivermectin to achieve elimination of onchocerciasis and lymphatic filariasis and to reduce malaria transmission 6.

Safety and Efficacy

• Ivermectin has been shown to be safe and effective in the treatment of human infection with Onchocerca volvulus, with minimal side effects and no significant exacerbation of either anterior or posterior segment eye disease 4, 5.
• Numerous studies report low rates of adverse events, with ivermectin having a good safety profile that may be attributed to its high affinity to invertebrate neuronal ion channels and its inability to cross the blood-brain barrier in humans and other mammals 7.
• Ivermectin has been used off-label to treat diseases associated with Demodex mites, such as blepharitis and demodicidosis, and has recently received FDA and EU approval for the treatment of adult patients with inflammatory lesions of rosacea 7.

Clinical Applications

• Ivermectin has been used to combat many parasitic diseases including filariasis, onchocerciasis, strongyloidiasis, scabies, and pediculosis, with approximately 250 million people using it annually 6.
• Its antiparasitic range has increased to cover more parasitic infections, but it still requires further exploration, e.g. for trichinosis and myiasis 6.
• Recent research is investigating the possibility of novel drug delivery systems for Ivermectin that increase its potential to treat a new range of diseases and to overcome the possibility of drug resistance 6.