Topical ivermectin 0.5% lotion for treatment of head lice

Louise Deeks, Mark NAUNTON, Marian J. Currie, Francis J. Bowden

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective: To investigate the pharmacology, pharmacokinetics, efficacy, adverse effects, and place in therapy of a single application of topical ivermectin 0.5% lotion for head lice treatment. Data Sources: Literature was obtained by searching MEDLINE, PubMed, CINAHL, and Scopus (January 1980 to January 2013). Abstracts were searched for the terms ivermectin AND (head lice or pediculus or pediculosis), topical ivermectin, ivermectin lotion, ivermectin AND (pharmacology OR pharmacokinetics). The New Drug Application filed with the Food and Drug Administration and the product data sheets for ivermectin were obtained. Study Selection and Data Extraction: All English-language articles retrieved from the search were evaluated for relevance to the objective. Data Synthesis: The recommended first-line head lice treatments in the United States are permethrin 1% or pyrethrins, with malathion 0.5% lotion used as a second-line treatment. Significantly more of the 289 head lice–infested participants using topical ivermectin 0.5% lotion were lice-free at day 15 when compared with vehicle control (73.8% vs 17.6%; P < .001) in 2 studies. Although this rate is lower than other third-line treatments (eg, spinosad 0.9% or benzyl alcohol 5%), topical ivermectin 0.5% lotion is well tolerated (pruritus, the most common adverse event, 0.9%) and requires only a single application. Conclusions: Topical ivermectin 0.5% lotion kills head lice by increasing chloride in muscle cells, causing hyperpolarization and paralysis. Only 1 application is required; when the treated eggs hatch, the lice are not viable because they cannot feed as a result of pharyngeal muscle paralysis. Minimal systemic absorption occurs following topical application. Studies have demonstrated that topical ivermectin 0.5% is a safe and efficacious treatment for head lice. Although it has no documented resistance, there is limited clinical experience, it requires a prescription, and it is expensive. Therefore it should be reserved as a third-line treatment for head lice in the United States
Original languageEnglish
Pages (from-to)1161-1167
Number of pages7
JournalAnnals of Pharmacotherapy
Volume47
Issue number9
DOIs
Publication statusPublished - 2013

Fingerprint

Pediculus
Ivermectin
Phthiraptera
Paralysis
Pharmacokinetics
Lice Infestations
Pharyngeal Muscles
Pharmacology
Benzyl Alcohol
Permethrin
Malathion
Pyrethrins
Information Storage and Retrieval
United States Food and Drug Administration
Pruritus
PubMed
MEDLINE
Muscle Cells
Eggs
Prescriptions

Cite this

Deeks, Louise ; NAUNTON, Mark ; Currie, Marian J. ; Bowden, Francis J. / Topical ivermectin 0.5% lotion for treatment of head lice. In: Annals of Pharmacotherapy. 2013 ; Vol. 47, No. 9. pp. 1161-1167.
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abstract = "Objective: To investigate the pharmacology, pharmacokinetics, efficacy, adverse effects, and place in therapy of a single application of topical ivermectin 0.5{\%} lotion for head lice treatment. Data Sources: Literature was obtained by searching MEDLINE, PubMed, CINAHL, and Scopus (January 1980 to January 2013). Abstracts were searched for the terms ivermectin AND (head lice or pediculus or pediculosis), topical ivermectin, ivermectin lotion, ivermectin AND (pharmacology OR pharmacokinetics). The New Drug Application filed with the Food and Drug Administration and the product data sheets for ivermectin were obtained. Study Selection and Data Extraction: All English-language articles retrieved from the search were evaluated for relevance to the objective. Data Synthesis: The recommended first-line head lice treatments in the United States are permethrin 1{\%} or pyrethrins, with malathion 0.5{\%} lotion used as a second-line treatment. Significantly more of the 289 head lice–infested participants using topical ivermectin 0.5{\%} lotion were lice-free at day 15 when compared with vehicle control (73.8{\%} vs 17.6{\%}; P < .001) in 2 studies. Although this rate is lower than other third-line treatments (eg, spinosad 0.9{\%} or benzyl alcohol 5{\%}), topical ivermectin 0.5{\%} lotion is well tolerated (pruritus, the most common adverse event, 0.9{\%}) and requires only a single application. Conclusions: Topical ivermectin 0.5{\%} lotion kills head lice by increasing chloride in muscle cells, causing hyperpolarization and paralysis. Only 1 application is required; when the treated eggs hatch, the lice are not viable because they cannot feed as a result of pharyngeal muscle paralysis. Minimal systemic absorption occurs following topical application. Studies have demonstrated that topical ivermectin 0.5{\%} is a safe and efficacious treatment for head lice. Although it has no documented resistance, there is limited clinical experience, it requires a prescription, and it is expensive. Therefore it should be reserved as a third-line treatment for head lice in the United States",
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Topical ivermectin 0.5% lotion for treatment of head lice. / Deeks, Louise; NAUNTON, Mark; Currie, Marian J.; Bowden, Francis J.

In: Annals of Pharmacotherapy, Vol. 47, No. 9, 2013, p. 1161-1167.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Topical ivermectin 0.5% lotion for treatment of head lice

AU - Deeks, Louise

AU - NAUNTON, Mark

AU - Currie, Marian J.

AU - Bowden, Francis J.

PY - 2013

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N2 - Objective: To investigate the pharmacology, pharmacokinetics, efficacy, adverse effects, and place in therapy of a single application of topical ivermectin 0.5% lotion for head lice treatment. Data Sources: Literature was obtained by searching MEDLINE, PubMed, CINAHL, and Scopus (January 1980 to January 2013). Abstracts were searched for the terms ivermectin AND (head lice or pediculus or pediculosis), topical ivermectin, ivermectin lotion, ivermectin AND (pharmacology OR pharmacokinetics). The New Drug Application filed with the Food and Drug Administration and the product data sheets for ivermectin were obtained. Study Selection and Data Extraction: All English-language articles retrieved from the search were evaluated for relevance to the objective. Data Synthesis: The recommended first-line head lice treatments in the United States are permethrin 1% or pyrethrins, with malathion 0.5% lotion used as a second-line treatment. Significantly more of the 289 head lice–infested participants using topical ivermectin 0.5% lotion were lice-free at day 15 when compared with vehicle control (73.8% vs 17.6%; P < .001) in 2 studies. Although this rate is lower than other third-line treatments (eg, spinosad 0.9% or benzyl alcohol 5%), topical ivermectin 0.5% lotion is well tolerated (pruritus, the most common adverse event, 0.9%) and requires only a single application. Conclusions: Topical ivermectin 0.5% lotion kills head lice by increasing chloride in muscle cells, causing hyperpolarization and paralysis. Only 1 application is required; when the treated eggs hatch, the lice are not viable because they cannot feed as a result of pharyngeal muscle paralysis. Minimal systemic absorption occurs following topical application. Studies have demonstrated that topical ivermectin 0.5% is a safe and efficacious treatment for head lice. Although it has no documented resistance, there is limited clinical experience, it requires a prescription, and it is expensive. Therefore it should be reserved as a third-line treatment for head lice in the United States

AB - Objective: To investigate the pharmacology, pharmacokinetics, efficacy, adverse effects, and place in therapy of a single application of topical ivermectin 0.5% lotion for head lice treatment. Data Sources: Literature was obtained by searching MEDLINE, PubMed, CINAHL, and Scopus (January 1980 to January 2013). Abstracts were searched for the terms ivermectin AND (head lice or pediculus or pediculosis), topical ivermectin, ivermectin lotion, ivermectin AND (pharmacology OR pharmacokinetics). The New Drug Application filed with the Food and Drug Administration and the product data sheets for ivermectin were obtained. Study Selection and Data Extraction: All English-language articles retrieved from the search were evaluated for relevance to the objective. Data Synthesis: The recommended first-line head lice treatments in the United States are permethrin 1% or pyrethrins, with malathion 0.5% lotion used as a second-line treatment. Significantly more of the 289 head lice–infested participants using topical ivermectin 0.5% lotion were lice-free at day 15 when compared with vehicle control (73.8% vs 17.6%; P < .001) in 2 studies. Although this rate is lower than other third-line treatments (eg, spinosad 0.9% or benzyl alcohol 5%), topical ivermectin 0.5% lotion is well tolerated (pruritus, the most common adverse event, 0.9%) and requires only a single application. Conclusions: Topical ivermectin 0.5% lotion kills head lice by increasing chloride in muscle cells, causing hyperpolarization and paralysis. Only 1 application is required; when the treated eggs hatch, the lice are not viable because they cannot feed as a result of pharyngeal muscle paralysis. Minimal systemic absorption occurs following topical application. Studies have demonstrated that topical ivermectin 0.5% is a safe and efficacious treatment for head lice. Although it has no documented resistance, there is limited clinical experience, it requires a prescription, and it is expensive. Therefore it should be reserved as a third-line treatment for head lice in the United States

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KW - Ivermectin

KW - Lotion

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DO - 10.1177/1060028013500645

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