Are you concerned whether some condition precludes your taking ivermectin?

CONTRAINDICATIONS / PRECAUTIONS General Information Ivermectin is contraindicated in patients with hypersensitivity to any component of the product.

Asthma
Patients with a history of severe asthma should receive ivermectin with caution. Occasionally, systemic ivermectin has been reported to worsen bronchial asthma.

Hepatic disease
Although not extensively studied, due to its extensive hepatic metabolism, ivermectin should be administered with caution in patients with significant hepatic disease.

Human immunodeficiency virus (HIV) infection, immunosuppression In patients with immunosuppression (including those with human immunodeficiency virus (HIV) infection) treated for intestinal strongyloidiasis, repeated ivermectin courses may be necessary. Adequate and well-controlled clinical studies have not been conducted in such patients to determine the optimal dosing regimen. Several treatments (i.e., at 2 week intervals) may be required and a cure may not be achievable. Control of extra-intestinal strongyloidiasis in these patients is difficult, however, suppressive therapy (i.e., once per month) may be helpful.

Pregnancy
Data with oral ivermectin use during pregnancy are insufficient to inform a drug-associated risk. Systemic exposure from topical use of ivermectin is much lower than from oral use. Four published epidemiology studies evaluated the outcomes of a total of 744 women exposed to oral ivermectin in various stages of pregnancy. In the largest study, 397 women in the second trimester of pregnancy were treated open-label with single doses of ivermectin or ivermectin plus albendazole; there was no observed difference in pregnancy outcomes between treated and untreated populations. However, these studies cannot definitely establish or exclude the absence of drug-associated risk during pregnancy, because either the timing of the administration during gestation was not accurately ascertained or the administration only occurred during the second trimester. In animal embyrofetal development studies of oral ivermectin given during organogenesis, adverse developmental outcomes, including cleft palate, exencephaly, wavy ribs, and clubbed forepaws, occurred at or near doses that were maternally toxic. Pre-implantation loss and abortion were also noted.

Breast-feeding
After oral administration, ivermectin is excreted in human breast milk in low concentrations. There is insufficient evidence to determine its effects on the breast-fed infant or milk production. It is estimated that an exclusively breast-fed infant would receive less than 1% of the maternal weight adjusted maternal dose. 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. Previous American Academy of Pediatrics (AAP) recommendations considered oral ivermectin to be usually compatible with breast-feeding. 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. According to the manufacturer, discontinue nursing or discontinue the topical cream, taking into account the importance of the drug to the mother. Consider the developmental and health benefits of breast-feeding along with the mother's clinical need for the topical lotion and any potential adverse effects on the breast-fed infant from the topical lotion or the underlying maternal condition. Women who are breast-feeding while using topical ivermectin should avoid accidental transfer of ivermectin to the breast area where it might be directly ingested while nursing.

Children, infants, neonates
Ivermectin oral tablets are approved for use in children = 15 kg of weight. Safe and effective use has not been established in neonates, infants or children weighing less than 15 kg. 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. The safety and efficacy of ivermectin lotion have not been established in neonates or infants < 6 months. Topical ivermectin lotion is not recommended in pediatric patients < 6 months because of the potential for increased systemic absorption due to a ratio of skin surface area to body mass. There is also a potential increased risk of ivermectin toxicity due to an immature skin barrier. The safety and efficacy of ivermectin cream have not been established in children < 18 years of age.

Loa loa coinfection
Rarely, patients with onchocerciasis and Loa loa coinfection may develop a serious or even fatal encephalopathy either spontaneously or after treatment with an effective microfilaricide. This syndrome has been seen very rarely after the use of ivermectin. In individuals who warrant treatment with ivermectin for any reason and have had significant exposure to Loa loa-endemic areas of West and Central Africa, pretreatment assessment for loiasis and careful posttreatment follow-up is recommended.

Onchodermatitis
Patients with hyperreactive onchodermatitis (i.e., sowda) may be more likely than others to experience severe edema and worsening of onchodermatitis after ivermectin use.

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