Stromectol (Ivermectin)

Stromectol (Ivermectin): Comprehensive Patient Information

Basic Product Information

Mechanism of Action

For Patients: Ivermectin works by targeting parasites. It binds to specific channels in the nerves and muscle cells of the parasite, causing paralysis and death. Ivermectin does not affect humans in the same way because our nerve channels are different.

For Specialists: Ivermectin selectively binds with high affinity to glutamate-gated chloride ion channels in invertebrate nerve and muscle cells, causing hyperpolarisation and subsequent paralysis. Mammalian CNS is not affected due to the blood-brain barrier.

Pharmacokinetics

• Absorption: Oral bioavailability is approximately 60%, and increases with fatty meals.
• Metabolism: Metabolised primarily in the liver by CYP3A4 (minor: CYP2D6, CYP2E1).
• Elimination: Mainly excreted in the faeces; elimination half-life: 12–36 hours.
• Duration of Action: Effects remain for a few days after a single dose; repeat dosing sometimes required depending on indication.

Use in Everyday Life and Best Practices

Ivermectin tablets should be taken whole, with water. It is prescribed by an Australian GP or specialist and dispensed by pharmacies. It is most often used for treating conditions such as scabies and certain worm infections (like strongyloidiasis).

• Typical Adult Dose: For scabies, a single dose is often 200 micrograms per kilogram of body weight; a second dose may be required after 7–14 days.
• Children: Dosing is weight-based and not recommended for children under 5 years or under 15 kg, except under specialist advice.
• Elderly: Dose adjustments may be necessary for those with liver impairment.

Your doctor or pharmacist will provide clear dosing instructions. If you miss a dose, take it as soon as you remember unless it is almost time for your next dose. Do not double up doses.

Dosing in the Morning vs Evening

• Morning dosing: Allows for observation of side effects during waking hours; less likely to forget a dose.
• Evening dosing: May be preferable if side effects such as drowsiness or dizziness occur.
• Advice: Take at the same time each day for best results. Australians with shift work should discuss optimal timing with their pharmacist or prescriber.

Taking With Food or on an Empty Stomach

• Best practice: Take on an empty stomach (at least 1 hour before or 2 hours after food) for maximum absorption and efficacy.
• Effect of meals: Fatty foods can increase absorption, which may increase the risk of side effects.
• Australian diet: Discuss with your pharmacist if you have a particular dietary pattern (high-fat, vegetarian, etc).

Interaction Warnings

Indications

Dosing According to Clinical Indications

Always follow your doctor's instructions. Dosing may change based on your circumstance and medical supervision.

Safety Profile and Side Effects

If you have a severe or unusual reaction, contact your doctor immediately or go to your nearest emergency department.

Guidelines for Proper Use

• Take Stromectol exactly as prescribed by your doctor or pharmacist.
• Swallow tablets whole with water—do not crush or chew.
• Take on an empty stomach for best results.
• Complete the full course of treatment, even if you feel better before it is finished.
• Practice good hygiene (hand-washing, laundry) to reduce re-infection risks, especially for scabies.
• For households: household contacts may need to be treated concurrently to prevent further spread (follow public health advice).
• Pregnancy and breastfeeding: inform your prescriber if you are pregnant, planning pregnancy, or breastfeeding—Stromectol is not routinely recommended for use in pregnancy in Australia except in special circumstances.
• If you vomit shortly after taking, consult your pharmacist about whether to repeat the dose.

Alternative Treatment Options

• For scabies: Permethrin 5% cream (first-line topical option, widely available and PBS reimbursed), Benzyl benzoate lotion, Sulphur preparations.
• For threadworm infections: Albendazole (widely used and PBS reimbursed), Mebendazole.
• Comparative Pros/Cons:
  • Topical treatments (like permethrin) minimise systemic side-effect risk but may not be suitable for widespread or crusted scabies or in institutional outbreaks.
  • Oral ivermectin may be preferred for severe, resistant, or widespread infestation, or where topical therapy fails or is impractical.
  • Cost and accessibility vary; many oral and topical alternatives are listed on the PBS and available at community pharmacies.

Legal, Registration, and Reimbursement Status in Australia

• Registration: Approved by the Therapeutic Goods Administration (TGA) for human use in Australia.
• Legal Category: Schedule 4 (Prescription Only Medicine) under the Standard for the Uniform Scheduling of Medicines and Poisons (SUSMP).
• Reimbursement: Some indications subsidised by the Pharmaceutical Benefits Scheme (PBS), subject to clinical criteria.
• Supply: Only available with a valid Australian prescription; not available for over-the-counter purchase.

Latest Research and Clinical Guidance (2022–2025)

• Scabies: The Australian Therapeutic Guidelines recommend oral ivermectin for cases refractory to topical therapy and in outbreaks, especially in remote Aboriginal and Torres Strait Islander communities.
• COVID-19: Major Australian and international health authorities (TGA, NHMRC, WHO) do not recommend ivermectin for COVID-19 treatment or prevention outside clinical trials. Recent large trials (e.g., TOGETHER, PRINCIPLE, 2023–24) show no clear benefit for this use.
• Parasitic Infections: Continues as a mainstay for strongyloidiasis and onchocerciasis in Australia and globally, with safety confirmed in atrisk populations (Roberts LJ et al, MJA 2022; Therapeutic Guidelines, 2024).

Availability and Delivery

Frequently Asked Questions (FAQ)

• Q: Do I need a prescription for Stromectol in Australia?
  A: Yes, Stromectol (ivermectin) requires a valid prescription from an Australian healthcare provider.
• Q: Can I take Stromectol if I am pregnant or breastfeeding?
  A: Ivermectin is generally not recommended during pregnancy or breastfeeding except if the potential benefits outweigh the risks. Always consult your doctor.
• Q: Are there foods or drinks I should avoid with Stromectol?
  A: Take on an empty stomach, and avoid excessive alcohol. Fatty meals can increase risks of side effects.
• Q: Can I use Stromectol for COVID-19?
  A: Australian and international authorities do not recommend or approve ivermectin for COVID-19 prevention or treatment, except in clinical trials.
• Q: What should I do if I miss a dose?
  A: Take the missed dose as soon as you remember unless it’s close to the time for your next dose. Do not double up doses.

If you have further questions, consult your Australian healthcare professional or pharmacist.