Ivermectin

What it is used for

• As a preventative for heartworm
• For Aelurostrongylus abstrusus
• Ear mites
• For susceptible parasites
• For general control of endo- and ectoparasites in potbellied pigs
• For prevention of heartworm disease
• To treat heartworm disease using the very slow protocol
• For nasal bot infection
• For susceptible parasites
• For adjunctive treatment of meningeal worm (Parelaphostrongylus tenuis)
• Camelids: For susceptible parasites
• Camelids: For GI helminths
• Camelids: For adjunctive treatment of meningeal worm
• For susceptible parasites
• For lice and mange
• As a larvicidal for arterial stages of S. vulgaris
• For ascarids, Capillaria, Knemidocoptes pilae
• For most species
• Budgerigars
• For most species
• Ratites
• Rabbits: For Sarcoptes scabiei, Notoedres cati
• Rabbits: For ear mites (Psoroptes)
• Rabbits: For treatment of ear mites
• Rodents and lagomorphs: For treatment of sarcoptoid and some fur mites
• Mice, Rats, Gerbils, Guinea pigs, Chinchillas
• Hamsters
• Guinea pigs for Trixacarus caviae mites
• For susceptible parasites
• For psoroptic mange
• For susceptible parasites
• For susceptible parasites
• For most nematodes, ectoparasites (Lizards, snakes, alligators)
• As a preventative for heartworm
• As a preventative for heartworm
• As a microfilaricide
• As an adulticide or pre-adulticide for heartworm (with doxycycline)
• For generalized demodicosis
• For demodicosis (alternative protocol)
• As scabicide
• For treatment of parasitic lung disease (Capillaria spp.)
• For Oslerus osleri
• For Eucoleus boehmi
• For Pneumonyssoides caninum

How it is given

Possible side effects

• Horses: Ventral midline swelling and pruritus (hypersensitivity to dying Onchocerca microfilariae)
• Dogs: Shock-like reaction (when used as microfilaricide), depression, hypothermia, vomiting
• Dogs (MDR1/Toxicity): Ataxia, lethargy, hypersalivation, mydriasis, tremors, seizures, blindness, coma
• Cats: Agitation, vocalization, anorexia, mydriasis, rear limb paresis, tremors, disorientation, blindness
• Cattle: Paralysis/staggering or salivation/bloat (if Hypoderma bovis larvae are killed in vital areas), injection site swelling
• Birds: Lethargy, anorexia, death (especially in finches and budgerigars)
• Neurotoxicity (ataxia, tremors, mydriasis, blindness, coma, death) - especially in MDR1-mutant dogs
• Hypersalivation
• Vomiting
• Lethargy
• Bradycardia

Cautions & contraindications

• Foals less than 4 months old (manufacturer recommendation)
• Puppies less than 6 weeks old
• Breeds susceptible to ABCB1-1Δ (MDR1) mutation at high doses (unless tested normal)
• Chelonians (turtles, tortoises)
• Indigo snakes
• Skinks
• Lactating dairy animals (no milk withdrawal established)
• Females of breeding age (cattle/swine, per label)
• Dogs with the MDR1 (ABCB1) gene mutation (unless using strictly at low heartworm preventative doses)
• Chelonians (turtles and tortoises) - causes fatal flaccid paralysis
• Kittens under 16 weeks of age (for topical ear gel)
• Use of concentrated livestock formulations in small animals
• > **MDR1 Gene Mutation Warning:** Ivermectin is actively transported out of the CNS by the P-glycoprotein pump. Dogs with the ABCB1-1Δ (formerly MDR1) mutation have a defective pump, allowing ivermectin to accumulate in the brain, causing severe neurotoxicity. Always test susceptible breeds (Collies, Shelties, Australian Shepherds, Long-haired Whippets, 'white feet' breeds) before using extra-label high doses. Heartworm preventative doses are generally safe. * **Species Sensitivities:** Highly toxic to chelonians (turtles/tortoises), indigo snakes, and skinks. Finches and budgerigars are highly sensitive. * **Cattle Grubs:** Treating cattle for *Hypoderma bovis* when larvae are migrating through the spinal canal or esophagus can cause severe host reactions (paralysis or bloat) due to larval death in vital areas. * **Food Animal Withdrawal:** Strict adherence to slaughter withdrawal times is required. Not approved for lactating dairy animals. * **Administration:** Injectable products for cattle and swine are for **SC use only**; do not administer IM or IV.

Drug interactions

• Benzodiazepines: Effects may be potentiated by ivermectin; concurrent use is not advised.
• Ketamine: Avoid ivermectin in reptiles within 10 days of ketamine administration.
• Spinosad: Increased risk of neurotoxicity; do not use with high extra-label doses of ivermectin.
• Amiodarone: P-glycoprotein inhibitor; increases risk of ivermectin CNS toxicity.
• Carvedilol: P-glycoprotein inhibitor; increases risk of ivermectin CNS toxicity.
• Clarithromycin: P-glycoprotein inhibitor; increases risk of ivermectin CNS toxicity.
• Cyclosporine: P-glycoprotein inhibitor; increases risk of ivermectin CNS toxicity.
• Diltiazem: P-glycoprotein inhibitor; increases risk of ivermectin CNS toxicity.
• Erythromycin: P-glycoprotein inhibitor; increases risk of ivermectin CNS toxicity.
• Itraconazole: P-glycoprotein inhibitor; increases risk of ivermectin CNS toxicity.
• Ketoconazole: Strong P-glycoprotein inhibitor; should never be used with ivermectin in dogs.
• Quinidine: P-glycoprotein inhibitor; increases risk of ivermectin CNS toxicity.
• Spironolactone: P-glycoprotein inhibitor; increases risk of ivermectin CNS toxicity.
• Tamoxifen: P-glycoprotein inhibitor; increases risk of ivermectin CNS toxicity.
• Verapamil: P-glycoprotein inhibitor; increases risk of ivermectin CNS toxicity.

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