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Ivermectin (Topical)

Pronunciation

Pronunciation

(eye ver MEK tin)

Index Terms

  • Ivermectin Cream
  • Ivermectin Lotion

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Cream, External:

Soolantra: 1% (30 g) [contains cetyl alcohol, edetate disodium, methylparaben, propylene glycol, propylparaben]

Lotion, External:

Sklice: 0.5% (117 g) [contains methylparaben, propylparaben]

Brand Names: U.S.

  • Sklice
  • Soolantra

Pharmacologic Category

  • Antiparasitic Agent, Topical
  • Pediculocide

Pharmacology

In pediculosis capitus treatment, ivermectin is a semisynthetic anthelminthic agent; it binds selectively and with strong affinity to glutamate-gated chloride ion channels which occur in invertebrate nerve and muscle cells. This leads to increased permeability of cell membranes to chloride ions then hyperpolarization of the nerve or muscle cell, and death of the parasite.

In rosacea treatment, the mechanism of action is unknown.

Metabolism

Metabolized hepatically by CYP3A4

Time to Peak

Cream: ~10 hours post application

Half-Life Elimination

Cream: ~6.5 days

Protein Binding

>99%

Use: Labeled Indications

Head lice (Pediculus capitis) (Sklice lotion): Treatment of head lice infestations in patients 6 months and older.

Rosacea (Soolantra cream): Treatment of inflammatory lesions of rosacea in adult patients.

Contraindications

There are no contraindications listed in the manufacturer’s labeling.

Dosing: Adult

Head lice: Topical: Lotion: Apply sufficient amount (up to 1 tube) to completely cover dry scalp and hair; for single-dose use only

Rosacea: Topical: Cream: Apply to each affected area (eg, forehead, chin, nose, each cheek) once daily.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Head lice: Children ≥6 months and Adolescents: Topical: Lotion: Refer to adult dosing.

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer’s labeling.

Administration

Topical lotion: For external use only. Apply to dry scalp and hair closest to scalp first, then apply outward towards ends of hair; completely covering scalp and hair. Leave on for 10 minutes (start timing treatment after the scalp and hair have been completely covered). The hair should then be rinsed thoroughly with warm water. Avoid contact with the eyes. Nit combing is not required, although a fine-tooth comb may be used to remove treated lice and nits. Lotion is for one-time use; discard any unused portion. Ivermectin should be a portion of a whole lice removal program, which should include washing or dry cleaning all clothing, hats, bedding, and towels recently worn or used by the patient and washing combs, brushes, and hair accessories in hot soapy water.

Topical cream: For external use only. Not for use in the eye, mouth or vagina. Wash hands with soap and water prior to application and after application. Apply a pea-size amount as a thin layer on each affected area (eg, forehead, chin, nose, each cheek).

Storage

Store at 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C to 30°C (59°F to 86°F). Lotion: do not freeze.

Drug Interactions

There are no known significant interactions.

Adverse Reactions

1% to 10%:

Central nervous system: Localized burning (≤1%)

Dermatologic: Skin irritation (≤1%)

<1% (Limited to important or life-threatening): Conjunctivitis, eye irritation, ocular hyperemia, seborrheic dermatitis of scalp, xeroderma

Warnings/Precautions

Other warnings/precautions:

• Appropriate use:

Topical lotion: For topical use on scalp and scalp hair only; avoid contact with eyes. Wash hands after application.

Topical cream: Not for oral, ophthalmic, or vaginal use; avoid contact with eyes and lips. Wash hands after application.

Monitoring Parameters

Lotion: Monitor scalp for live lice.

Pregnancy Risk Factor

C

Pregnancy Considerations

Adverse events have been observed in animal reproduction studies following oral administration. Although use in pregnancy is likely low risk, other agents are currently recommended for the treatment of pediculosis pubis or scabies in pregnant women (CDC [Workowski 2015]).

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience dry skin or eye irritation. Have patient report immediately to prescriber severe burning or severe skin irritation (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

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