Ivermectin

Ivermectin is used to treat human diseases caused by roundworms and a wide variety of external parasites. Worm infections For river blindness (onchocerciasis) and lymphatic filariasis, ivermectin is typically given as part of mass drug administration campaigns that distribute the drug to all members of a community affected by the disease. Adult worms survive in the skin and eventually recover to produce larval worms again; to keep the worms at bay, ivermectin is given at least once per year for the 1015-year lifespan of the adult worms. The World Health Organization (WHO) considers ivermectin the drug of choice for strongyloidiasis. Ivermectin is also the primary treatment for Mansonella ozzardi and cutaneous larva migrans. Ivermectin is sometimes added to albendazole or mebendazole for whipworm treatment, and is considered a second-line treatment for gnathostomiasis. Ivermectin/albendazole is indicated for use in people aged five years of age or older, for the treatment of soil-transmitted helminth infections, caused by different types of intestinal parasitic worms, which are spread through soil contaminated by human feces in areas with poor sanitation. For most scabies cases, ivermectin is used in a two-dose regimen: the first dose kills the active mites, but not their eggs. Over the next week, the eggs hatch, and a second dose kills the newly hatched mites. The two-dose regimen of ivermectin has similar efficacy to the single dose permethrin treatment. Ivermectin is, however, more effective than permethrin when used in the mass treatment of endemic scabies. Similarly, oral ivermectin is increasingly used to control scabies outbreaks in semi-closed institutions (care homes, refugee camps, prisons etc.), where mass topical treatments often fail for logistical reasons. For severe "crusted scabies", where the parasite burden is orders of magnitude higher than usual, the CDC recommends up to seven doses of ivermectin over the course of a month, along with a topical antiparasitic. Ivermectin is also used to treat rosacea and blepharitis, both of which can be caused or exacerbated by Demodex folliculorum mites. == Contraindications ==

The only absolute contraindication to the use of ivermectin is hypersensitivity to the active ingredient or any component of the formulation. In children under the age of five or those who weigh less than , there is limited data regarding the efficacy or safety of ivermectin, though the available data demonstrate few adverse effects. However, the American Academy of Pediatrics cautions against use of ivermectin in such patients, as the blood–brain barrier is less developed, and thus there may be an increased risk of particular CNS side effects such as encephalopathy, ataxia, coma, or death. The American Academy of Family Physicians also recommends against use in these patients, given a lack of sufficient data to prove drug safety. Ivermectin is secreted in very low concentration in breast milk. It remains unclear if ivermectin is safe during pregnancy. == Adverse effects ==

Side effects, although uncommon, include fever, itching, and skin rash when taken by mouth; and red eyes, dry skin, and burning skin when used topically for head lice. It is unclear if the drug is safe for use during pregnancy, but it is probably acceptable for use during breastfeeding. Ivermectin is known to cause severe encephalopathies in some circumstances., Based on the data drug safety sheet for ivermectin, side effects are uncommon. However, serious adverse events following ivermectin treatment are more common in people with very high burdens of larval Loa loa worms in their blood. Those who have over 30,000 microfilaria per milliliter of blood risk inflammation and capillary blockage due to the rapid death of the microfilaria following ivermectin treatment. Since drugs that inhibit the enzyme CYP3A4 often also inhibit P-glycoprotein transport, the risk of increased absorption past the blood-brain barrier exists when ivermectin is administered along with other CYP3A4 inhibitors. These drugs include statins, HIV protease inhibitors, many calcium channel blockers, lidocaine, benzodiazepines, and glucocorticoids such as dexamethasone. During a typical treatment course, ivermectin can cause minor aminotransferase elevations. In rare cases it can cause mild clinically apparent liver disease. To provide context for the dosing and toxicity ranges, the of ivermectin in mice is 25 mg/kg (oral), and 80 mg/kg in dogs, corresponding to an approximated human-equivalent dose LD50 range of 2.02–43.24 mg/kg, which is far more than its FDA-approved usage (a single dose of 0.150–0.200 mg/kg to be used for specific parasitic infections). high enough to be considered ivermectin poisoning. == Pharmacology ==

'' GluClR. IVM molecules interact with a binding pocket formed by the transmembrane domains of adjacent GluClR subunits, "locking" the receptor in an activated (open) conformation that allows unrestricted passage of chloride (Cl−) ions into the cell. (The plasma membrane is represented as a blue–pink gradient.) From . Mechanism of action Ivermectin and its related drugs act by interfering with the nerve and muscle functions of helminths and insects. The binding pushes the channels open, which increases the flow of chloride ions and hyper-polarizes the cell membranes, Ivermectin does not readily cross the blood-brain barrier of mammals due to the presence of P-glycoprotein (the MDR1 gene mutation affects the function of this protein). Crossing may still become significant if ivermectin is given at high doses, in which case brain levels peak 2–5 hours after administration. In contrast to mammals, ivermectin can cross the blood-brain barrier in tortoises, often with fatal consequences. Ivermectin is metabolized into eight different products by human CYP3A4, two of which (M1, M2) remain toxic to mosquitos. M1 and M2 also have longer elimination half-lives of about 55 hours. CYP3A5 produces a ninth metabolite. == Chemistry ==

Fermentation of Streptomyces avermitilis yields eight closely related avermectin homologues, of which B1a and B1b form the bulk of the products isolated. In a separate chemical step, the mixture is hydrogenated to give ivermectin, which is an approximately 80:20 mixture of the two 22,23-dihydroavermectin compounds. == History ==

The avermectin family of compounds was discovered by Satoshi Ōmura of Kitasato University and William Campbell of Merck. Ōmura sent the bacteria to William Campbell, who showed that the bacterial culture could cure mice infected with the roundworm Heligmosomoides polygyrus. The discovery of ivermectin has been described as a combination of "chance and choice." Merck was looking for a broad-spectrum anthelmintic, which ivermectin is; however, Campbell noted that they "...also found a broad-spectrum agent for the control of ectoparasitic insects and mites." Merck began marketing ivermectin as a veterinary antiparasitic in 1981. By the late 1980s, ivermectin was the bestselling veterinary medicine in the world. They found it to be highly safe and effective, triggering Merck to register ivermectin for human use as "Mectizan" in France in 1987. Ivermectin has been used safely by hundreds of millions of people to treat river blindness and lymphatic filariasis. ==Society and culture==

COVID-19 misinformation Economics The initial price proposed by Merck in 1987 was per treatment, which was unaffordable for patients who most needed ivermectin. The company donated hundreds of millions of courses of treatments since 1988 in more than 30 countries. Ivermectin is considered an inexpensive drug. As of 2019, ivermectin tablets (Stromectol) in the United States are the least expensive treatment option for lice in children at approximately , while Sklice, an ivermectin lotion, cost around for . , the cost effectiveness of treating scabies and lice with ivermectin has not been studied. Brand names It is sold under the brand names Heartgard, Sklice, and Stromectol in the United States, Ivomec worldwide by Merial Animal Health, Mectizan in Canada by Merck, Iver-DT in Nepal by Alive Pharmaceutical and Ivexterm in Mexico by Valeant Pharmaceuticals International. In Southeast Asian countries, it is marketed by Delta Pharma Ltd. under the trade name Scabo 6. The formulation for rosacea treatment is sold under the brand name Soolantra. While in development, it was assigned the code MK-933 by Merck. ==Research==

Parasitic disease Ivermectin has been researched in laboratory animals, as a potential treatment for trichinosis Ivermectin has also been tested on zebrafish infected with Pseudocapillaria tomentosa. Tropical diseases Ivermectin is also of interest in the prevention of malaria, as it is toxic to both the malaria plasmodium itself and the mosquitos that carry it. The performance of ivermectin's mosquitocidal efficacy was also favourably tested in An. gambiae mosquitoes although it was less effective killing older mosquitoes that are more likely to be transmitting the malaria parasite. A direct effect on malaria parasites could not be shown in an experimental infection of volunteers with Plasmodium falciparum. Use of ivermectin at higher doses necessary to control malaria is probably safe, though large clinical trials have not yet been done to definitively establish the efficacy or safety of ivermectin for prophylaxis or treatment of malaria. Whilst effective in killing malaria-bearing mosquitos, a 2021 Cochrane review found that, to date, the evidence shows no significant impact on reducing incidence of malaria transmission from the community administration of ivermectin. Moxidectin has a longer half-life than ivermectin and may eventually supplant ivermectin as it is a more potent microfilaricide, but there is a need for additional clinical trials, with long-term follow-up, to assess whether moxidectin is safe and effective for treatment of nematode infection in children and women of childbearing potential. There is tentative evidence that ivermectin kills bedbugs, as part of integrated pest management for bedbug infestations. However, such use may require a prolonged course of treatment which is of unclear safety. NAFLD In 2013, ivermectin was demonstrated as a novel ligand of the farnesoid X receptor, a therapeutic target for nonalcoholic fatty liver disease (NAFLD). COVID-19 During the COVID-19 pandemic, ivermectin was researched for possible utility in preventing and treating COVID-19, but no good evidence of benefit was found. Oncological research In January 2026, a perspective piece in The EMBO Journal proposed mechanistic parallels between cancer cell behavior and helminth (parasitic) infections, specifically regarding immune evasion, migration, and immune modulation. The piece suggested that because cancer cells and helminths share these biological strategies, anthelmintic drugs like ivermectin may be candidates for therapeutic repurposing. The proposed mechanism involves utilizing the drug's known antiparasitic action to disrupt oncogenic pathways and potentially trigger immunogenic responses in the host environment. While these theoretical frameworks and preclinical models identify ivermectin as a potential adjunct in cancer therapy, clinical efficacy in humans has not been established, and the research remains in the investigational phase. == Veterinary use ==

Ivermectin is routinely used to control parasitic worms in the gastrointestinal tract of ruminant animals. These parasites normally enter the animal when it is grazing, pass the bowel, and set and mature in the intestines, after which they produce eggs that leave the animal via its droppings and can infest new pastures. Ivermectin is only effective in killing some of these parasites, because of an increase in anthelmintic resistance. This resistance has arisen from the persistent use of the same anthelmintic drugs for the past 40 years. Additionally, the use of Ivermectin for livestock has a profound impact on dung beetles, such as T. lusitanicus, as it can lead to acute toxicity within these insects. In dogs, ivermectin is routinely used as prophylaxis against heartworm. Dogs with defects in the P-glycoprotein gene (MDR1), often collie-like herding dogs, can be severely poisoned by ivermectin. The mnemonic "white feet, don't treat" refers to Scotch collies that are vulnerable to ivermectin. Some other dog breeds (especially the Rough Collie, the Smooth Collie, the Shetland Sheepdog, and the Australian Shepherd), also have a high incidence of mutation within the MDR1 gene (coding for P-glycoprotein) and are sensitive to the toxic effects of ivermectin. For dogs, the insecticide spinosad may have the effect of increasing the toxicity of ivermectin. A 0.01% ivermectin topical preparation for treating ear mites in cats is available. Clinical evidence suggests 7-week-old kittens are susceptible to ivermectin toxicity. Ivermectin is sometimes used as an acaricide in reptiles, both by injection and as a diluted spray. While this works well in some cases, care must be taken, as several species of reptiles are very sensitive to ivermectin. Use in turtles is particularly contraindicated. A characteristic of the antinematodal action of ivermectin is its potency: for instance, to combat Dirofilaria immitis in dogs, ivermectin is effective at 0.001 milligram per kilogram of body weight when administered orally. == Notes ==