Stromectol

ivermectin

(eye-ver-mek-tin) ivermectin,

Sklice

(trade name),

Stromectol

(trade name)

Classification

Therapeutic: anthelmintics
Pharmacologic: avermectins
Pregnancy Category: C

Indications

Intestinal strongyloidiasis (oral only).Onchocerciasis (nemotode form only) (oral only).Head lice (topical only)

Action

Binds selectively and with a high affinity to chloride channels in invertebrate nerve and muscle cells, resulting in parasite paralysis and death.Active against Strongyloides stercoralis and the nemotode form of Onchocerca volvulus.

Therapeutic effects

Death of infecting parasites with resolution of symptoms of infection.

Pharmacokinetics

Absorption: Some absorption follows oral administration; fat enhances absorption; little systemic absorption with topical administration.Distribution: Small amounts enter breast milk.Metabolism and Excretion: Metabolized by the liver; parent drug and metabolites excreted mainly in feces; <1% excreted unchanged in urine.Half-life: 18 hr.

Time/action profile (blood levels)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	4 hr	unknown
Topical	unknown	unknown	unknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Obstetric: Safety not established.Use Cautiously in: Lactation: Use only if risk of delayed treatment outweighs possible risk to newborn; Pediatric: Children <15 kg (oral) or <6 mo (topical) (safety and effectiveness not established).

Adverse Reactions/Side Effects

Central nervous system

dizziness
drowsiness
fatigue
vertigo
weakness

Ear, Eye, Nose, Throat

conjunctivitis (topical)

Gastrointestinal

abdominal pain
anorexia
constipation
diarrhea
nausea
vomiting

Dermatologic

burning sensation (topical)
dry skin (topical)
pruritus
rash
urticaria

Neurologic

tremor

Miscellaneous

Mazzotti reaction (onchocerciasis only)

Interactions

Drug-Drug interaction

May ↑ risk of bleeding with warfarin.

Route/Dosage

Strongyloidiasis

Oral (Adults and Children) 200 mcg/kg as a single dose (≥80 kg —200 mcg/kg, 66–79 kg —5 tablets, 51–65 kg —4 tablets, 36–50 kg —3 tablets, 25–35 kg —2 tablets, 15–24 kg —1 tablet).

Onchocerciasis

Oral (Adults and Children) 150 mcg/kg as a single dose (≥85 kg —150 mcg/kg, 65–84 kg —4 tablets, 45–64 kg —3 tablets, 26–44 kg —2 tablets, 15–25 kg —1 tablet); course may be repeated at 3–12 mo intervals.

Head Lice

Topical (Adults and Children ≥6 mo) Apply lotion (up to 1 tube) to dry hair and rub until scalp is moistened; leave on for up to 10 minutes, and then rinse off with water

Availability

Tablets: 3 mg Lotion: 0.5%

Nursing implications

Nursing assessment

Strongyloidiasis/Onchocerciasis: Monitor repeat stool samples for clearance of infection.
Strongyloidiasis/Onchocerciasis: Monitor for signs and symptoms of Mazzotti reactions (arthralgia/synovitis, enlargement and tenderness of axillary cervical, inguinal and other lymph nodes, skin involvement including edema, papular and pustular or frank urticarial rash, fever) in patients treated for Onchocerciasis. Treatment includes oral hydration, recumbency, IV normal saline, and/or parenteral corticosteroids to treat postural hypotension, and antihistamines and/or aspirin for most mild to moderate cases.
Head Lice: Assess scalp for presence of lice and their ova (nits) prior to and 1 wk after application of ivermectin.
Lab Test Considerations: May rarely cause ↑INR when co-administered with warfarin.
- May cause ↑ ALT and ↑ AST.
- May cause ↓ leukocyte count, eosinophilia, and ↑ hemoglobin.

Potential Nursing Diagnoses

Risk for infection (Indications)

Implementation

Oral: Administer on an empty stomach with water.
Topical: Apply sufficient amount of lotion to cover hair and scalp; up to 1 tube. Wait 10 minutes and rinse off with water; avoid contact with eyes. Tube is for single use only; discard unused portion. Wash hands after application.

Patient/Family Teaching

Instruct patient to take the single dose on an empty stomach with water.
Advise patient that ivermectin does not kill the adult Onchocerca parasites; repeated follow-up and retreatment is usually required.
Instruct patient to notify health care professional if scalp itching, numbness, redness, or rash occurs.
- Instruct patient to avoid getting Sklice lotion in eyes. If this occurs, eyes should be flushed thoroughly with water. Health care professional should be contacted if eye irritation persists.
- Advise patient that others residing in the home should also be checked for lice.
- Instruct patient on methods of preventing reinfestation. All clothes, including outdoor apparel and household linens, should be machine-washed using very hot water and dried for at least 20 min in a hot dryer. Dry-clean nonwashable clothes. Brushes and combs should be soaked in hot (130°F), soapy water for 5–10 min. Remind patient that brushes and combs should not be shared. Wigs and hairpieces should be shampooed. Rugs and upholstered furniture should be vacuumed. Toys should be washed in hot, soapy water. Items that cannot be washed should be sealed in a plastic bag for 2 wk.
- If patient is a child, instruct parents to notify school nurse or day care center so that classmates and playmates can be checked.
Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

Eradication of Strongyloidiasis and Onchocerca infections, and head lice.

Stromectol®

Ivermectin, see there.