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Ivermectin is mainly used in humans in the treatment of onchocerciasis, but is also effective against other worm infestations (such as strongyloidiasis, ascariasis, trichuriasis and enterobiasis). Ivermectin binds selectively and with high affinity to glutamate-gated chloride ion channels in invertebrate muscle and nerve cells of the microfilaria. Using ethanol with ivermectin can increase the blood levels or add to the side effects of ivermectin. This syndrome has been seen very rarely following the use of ivermectin. Repeated follow-up and retreatment is usually required because ivermectin does not kill the adult onchocerca parasites.
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Alternatively, adding albendazole to ivermectin may be warranted. Systemic exposure from topical use of ivermectin is much lower than from oral use. According to the manufacturer, treatment with oral ivermectin in mothers who are breast-feeding should only be undertaken when the risk of delayed treatment to the mother outweighs the possible risk to the newborn. The amount of ivermectin present in human milk after topical application has not been studied however, systemic exposure from topical ivermectin use is much lower than from oral use. The topical administration of ivermectin to children should be under the direct supervision of an adult to prevent ingestion of the lotion and/or cream. There is also a potential increased risk of ivermectin toxicity due to an immature skin barrier. If ivermectin dose adjustments are made, re-adjust the dose upon completion of boceprevir treatment.
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Coadministration may result in elevated ivermectin plasma concentrations. If co-administration is unavoidable, consider an ivermectin dose reduction and monitor for ivermectin toxicity. Coadministration may result in decreased plasma concentrations of ivermectin however, ivermectin is administered as a single dose, and significant clinical interactions are not expected. These drugs used in combination may result in elevated ivermectin plasma concentrations, causing an increased risk for ivermectin-related adverse events. If ivermectin dose adjustments are made, re-adjust the dose upon completion of telaprevir treatment. The avermectins' selectivity is due to the fact that some mammals do not have glutamate-gated chloride channels and that the avermectins have a low affinity for mammalian ligand-gated chloride channels.
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However, ivermectin is administered as a single dose, and significant clinical interactions are not expected. Because of the possibility for adverse reactions in nursing infants from ivermectin, a choice should be made whether to stop nursing or to stop use of this medication. Patients treated with ivermectin therapy for onchocerciasis may experience these reactions in addition to clinical adverse reactions possibly, probably, or definitely related to the therapy itself. Although ivermectin is generally well tolerated by patients, it can cause side effects such as fever, dizziness, headache, and rash.
Some people might consider this to be a con of using ivermectin since they have to visit their doctors in order to gain access to this treatment. However, since the ivermectin effect is not immediate, care must be taken to prevent reinfestation from exposure to untreated animals or contaminated facilities. Free ivermectin may adversely affect fish and certain aquatic organisms. However, data are limited and further study is required to define the role of ivermectin for this condition. Comparison of ivermectin and diethylcarbamazine in the treatment of onchocerciasis. Ivermectin: novel systemic antiparasitic agent. Efficacy and tolerance of ivermectin in human onchocerciasis.
Controlled trial and dose-finding study of ivermectin for treatment of onchocerciasis. Side-effects of ivermectin in treatment of onchocerciasis. The relative systemic availability of ivermectin after administration as capsule, tablet, and oral solution. Ivermectin: a long-acting microfilaricidal agent. A controlled trial of ivermectin and diethylcarbamazine in lymphatic filariasis. Pregnancy outcome after inadvertent ivermectin treatment during community-based distribution.