Anthelmintic · Antiparasitic
KDIGO 2024 + manufacturer label
254 branded formulations and 468 fixed-dose combinations. Look up specific brands in the Drugs workspace.
Jan Aushadhi — generic available at GoI pharmacies
Ivermectin is a macrocyclic lactone derivative of avermectin B1 that acts as a positive allosteric modulator of glutamate-gated chloride channels (GluCl) in invertebrate nerve and muscle cells. It binds selectively and with high affinity to these channels, increasing chloride ion conductance, causing hyperpolarization of neuronal and muscular membranes, and resulting in flaccid paralysis and death of the parasite. It may also interact with gamma-aminobutyric acid (GABA)-gated chloride channels in nematodes. The selective toxicity is due to the absence of glutamate-gated chloride channels in mammals and the low affinity of ivermectin for mammalian ligand-gated chloride channels. Ivermectin does not readily cross the blood-brain barrier in humans (except in conditions with compromised blood-brain barrier).
FDA PLLR: Safety not established. Animal studies showed teratogenicity at doses toxic to the mother. Avoid in pregnancy unless benefit clearly outweighs risk. Weight >15 kg for pediatric dosing.
Excreted in breast milk in low concentrations. Theoretical risk to nursing infant. AAP recommends suspending breastfeeding for 24 hours after single dose (pump and discard milk).
Concurrent use with ivermectin in patients with high Loa loa microfilarial loads dramatically increases risk of fatal encephalopathy/meningoencephalitis. Both are microfilaricidal.
Do NOT co-administer ivermectin and DEC in Loa loa-endemic areas without first assessing Loa loa microfilarial load. If Loa loa load >30,000/mL, avoid both drugs or pretreat with albendazole to reduce load.
Source: Kimi deep-research + Cla · p1822, p1824
Increased plasma levels of ivermectin.
Source: G&G 14e · p1325-1334
May lead to increased carbamazepine levels and toxicity, or decreased levels and loss of seizure control.
Monitor carbamazepine levels and clinical response closely. Adjust carbamazepine dose as needed.
Increased ivermectin plasma concentrations, potentially leading to increased adverse effects (e.g., neurological toxicity).
Monitor for increased ivermectin side effects. Consider dose reduction of ivermectin if co-administration is necessary.
Source: DDInter
Increased ivermectin plasma concentrations, potentially leading to increased adverse effects.
Monitor for increased ivermectin side effects. Consider dose reduction of ivermectin if co-administration is necessary.
Increased ivermectin plasma concentrations, potentially leading to increased adverse effects.
Advise patients to avoid consuming grapefruit juice while taking ivermectin.
Standard combination for lymphatic filariasis mass drug administration (MDA). No direct pharmacokinetic interaction of concern, but additive adverse effects (hepatotoxicity, GI upset) may occur.
Standard MDA regimen (ivermectin 150-200 mcg/kg + albendazole 400 mg annually). Monitor LFTs and adverse effects.
Source: Kimi deep-research + Cla
CYP3A4 inducers increase ivermectin metabolism, reducing plasma levels and potentially causing treatment failure for parasitic infections.
Monitor for treatment failure (persistent parasites). May need higher ivermectin dose or repeat dosing. Consider alternative antiparasitic if concurrent CYP3A4 inducer cannot be stopped.
Source: Kimi deep-research + Cla
CYP3A4 inhibitors reduce ivermectin metabolism, increasing plasma levels and risk of neurotoxicity (especially in patients with conditions that compromise the blood-brain barrier).
Monitor for CNS side effects (dizziness, ataxia, confusion). Use caution in patients with meningitis or other CNS conditions.
Source: Kimi deep-research + Cla
Increased ivermectin plasma concentrations, potentially leading to increased adverse effects (e.g., neurological toxicity).
Monitor for increased ivermectin side effects. Consider dose reduction of ivermectin if co-administration is necessary.
Source: DDInter
Increased midazolam exposure, potentially leading to enhanced sedation and respiratory depression.
Use with caution. Consider lower doses of midazolam and monitor for increased sedative effects.
Decreased ivermectin plasma concentrations, potentially leading to reduced efficacy.
Monitor for reduced ivermectin efficacy. Consider alternative anti-parasitic agents or increased ivermectin dose if co-administration is unavoidable.
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, Katzung·Verified: 2026-05-18 · House clinical team·Cockpit curated: 2026-05-18