ivermectin + albendazole

Action and Spectrum

Actions and Spectrum: 

• ivermectin works primarily by targeting the nervous systems of parasites. It binds to specific receptors in nerve and muscle cells of parasites, leading to increased permeability of cell membranes to chloride ions. This results in hyperpolarization of the cell membrane and paralysis of the parasites’ neuromuscular system. It causes muscle paralysis and immobilizes the parasites, making it easier for the host’s immune system to clear them. 
• ivermectin is effective against many parasites, including nematode (roundworm) infections and some ectoparasites (external parasites). It is used to treat conditions such as onchocerciasis (river blindness), strongyloidiasis, lymphatic filariasis, and certain mite infestations. 
• albendazole is an antiparasitic medication that works by disrupting the microtubules in parasites. Microtubules are essential for various cellular processes, including nutrient uptake, mobility, and cell division. By interfering with these microtubules, albendazole inhibits the parasites’ ability to function and reproduce. This ultimately leads to the death of the parasites. 
• albendazole is broad-spectrum and effective against various parasitic infections, including intestinal worms (nematodes) like roundworms, hookworms, and tapeworms. 

Drug Interaction

Adverse Reaction

Frequency not defined 

Nausea 

Headache 

Vision problems 

Confusion 

Stomach pain 

Vomiting 

Dizziness 

Weakness 

Black Box Warning

Black box warning: 

None 

Contraindication / Caution

Contraindications/caution: 

• Hypersensitivity or Allergy: Individuals with a known hypersensitivity or allergy to ivermectin, albendazole, or any of their components should not use this combination therapy. Allergic reactions can range from mild skin rashes to severe anaphylactic reactions. 
• Liver Dysfunction: Individuals with significant liver dysfunction or impaired liver function may require dose adjustments or caution when using albendazole, as the medication is metabolized in the liver. 

Pregnancy / Lactation

Pregnancy consideration: N/A 

Lactation: N/A 

Pregnancy category: 

Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 

<b>Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category 

Pharmacology

Pharmacology: 

The combination of ivermectin and albendazole is used in certain situations to simultaneously target both nematode infections (addressed by ivermectin) and intestinal worms (addressed by albendazole). This combination can provide a broader spectrum of antiparasitic activity. 

Pharmacokinetics: 

Absorption 

ivermectin is usually taken orally and is well absorbed from the gastrointestinal tract. It can also be administered topically or intravenously in some instances. albendazole is also administered orally and is poorly absorbed in the gastrointestinal tract. Its absorption is enhanced when taken with fatty meals.  

Distribution  

ivermectin has a high volume of distribution, which means it is extensively distributed throughout the body tissues. It can cross the blood-brain barrier and enter the central nervous system.albendazole and its active metabolite, albendazole sulfoxide (also known as albendazole oxide), are distributed widely in tissues, including the liver, where the metabolite is primarily responsible for its anthelmintic activity.  

Metabolism 

ivermectin is metabolized in the liver by cytochrome P450 enzymes, particularly CYP3A4. It undergoes oxidative and hydrolytic reactions to form inactive metabolites. albendazole undergoes extensive first-pass metabolism in the liver, where it is converted to its active metabolite albendazole sulfoxide. This metabolite is further metabolized to other inactive metabolites.  

Elimination and Excretion 

The elimination half-life of ivermectin varies but is typically around 18 hours. It is mainly excreted in feces, with a smaller proportion excreted in urine. albendazole and its metabolites are mainly excreted in the urine, bile, and feces. The elimination half-life of albendazole sulfoxide is relatively long, ranging from 8 to 12 hours. 

Adminstartion

Administration: 

Oral administration 

Both ivermectin and albendazole are typically administered orally 

Patient Information Leaflet

Patient information leaflet 

Generic Name: ivermectin + albendazole 

Why do we use ivermectin + albendazole? 

The combination of ivermectin and albendazole is used to treat various parasitic infections. Each medication has its spectrum of activity, and when used together, they can be effective against a wide range of parasites.  

• Lymphatic Filariasis: Lymphatic filariasis, also known as elephantiasis, is a parasitic disease caused by thread-like nematode worms. The combination of ivermectin and albendazole is used in mass drug administration programs to treat and prevent this disease. It helps reduce the number of microfilariae (larval forms of the parasite) in the blood, which can decrease disease transmission. 
• Onchocerciasis (River Blindness): Onchocerciasis is caused by the parasite Onchocerca volvulus and is transmitted by black flies. The combination of ivermectin and albendazole is effective in treating onchocerciasis. It helps kill the microfilariae and can reduce skin and eye symptoms associated with the infection. 
• Soil-Transmitted Helminth Infections: albendazole is effective against soil-transmitted helminths like roundworm (Ascaris lumbricoides), whipworm (Trichuris trichiura), and hookworm (Ancylostoma duodenale and Necator americanus). Combined with ivermectin, it can provide broad-spectrum treatment for these parasitic infections. 
• Strongyloidiasis: Strongyloidiasis is an intestinal infection caused by the parasitic nematode Strongyloides stercoralis. Combining ivermectin and albendazole is used to treat this infection, as both drugs are effective against Strongyloides larvae and adult worms. 
• Scabies: ivermectin, when used topically or orally, is effective in treating scabies, which is caused by the Sarcoptes scabiei mite.