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Most likely, people reading these lines have never encountered parasites, especially with roundworms parasitizing on humans, since in countries with a sufficient level of sanitation and medicine, with stable Internet access and a climate other than tropical, such representatives of the fauna can seldom be found. However, this does not mean that numerous terrible diseases caused by these parasites are a thing of the past. On the contrary, diseases such as malaria, elephantiasis, river blindness and many others are more common in the world than ever, due to the rapid growth of the population of poor developing countries who don't have access to qualified medical care. This is exacerbated by the hot, parasite-friendly climates, especially in high humidity conditions.
Photos of the external manifestations of such diseases can terrify even people with very strong nerves, and images of the parasites themselves are disgusting for everyone, except, perhaps, the most stress-resistant doctors. However, fortunately, with timely medical attention, most diseases can be relatively easily cured. Dealing with parasites is much easier than dealing with many other life-threatening conditions, such as malignant tumors. For the treatment of parasitic diseases, various drugs are used, both in injectable and in tablet form. One of them is Stromectol. It is used quite often, although it is not well-known to the common people.
Stromectol is the trade name for the antiparasitic drug Ivermectin, which also has an anti-inflammatory effect. Thus, the active ingredient of Stromectol is Ivermectin. Of course, this medicine also contains other substances in its composition, however, all of them are auxiliary and do not have any effect on the action. This medicine is mainly used in the treatment of parasitic diseases caused by roundworms. It is roundworms, or nematodes, that are responsible for a huge number of parasitic diseases, collectively called helminthiases. It is important to note that not all roundworms are dangerous to humans. We do not know anything about most of them, except that they live in soil, water and in general almost everywhere, being an important part of the biocenosis and not exerting harmful effects on humans and animals in contact with them.
Ivermectin as an active ingredient of Stromectol is a mixture of two semi-synthetic analogs of the fermentation products of Sterptomyces avermitilis. It belongs to the macrocyclic lactone complex.
Initially, the drug Stromectol was used in veterinary medicine, but since 1987 it has also been used to treat humans. Widespread use in human medicine has been observed since the mid-1990s.
For the treatment of parasitic diseases in humans, Stromectol is used in tablets. One tablet contains 3 mg of Ivermectin. Some generics of Stromectol are available as oral capsules, especially those produced in India.
In addition, a topical ointment originally developed for veterinary medicine is used in many poor tropical countries. It is effective against parasites on the skin and in its upper words, and is also used to combat rosacea, a fairly common inflammatory dermatosis, the etiology of which can be different. To date, there is no consensus about the causes of rosacea, but the effectiveness of Stromectol ointment against this disease indirectly proves that in some cases the cause of this disease can be microorganisms Demodex folliculorum, brevis.
Stromectol is widely used in humans to treat diseases such as lymphatic filariasis (elephantiasis), strongyloidosis, onchocerciasis, as well as head lice, scabies and rosacea. Of particular importance is the fact that the medicine is inexpensive to manufacture, making it optimal for introduction into medicine in poor developing countries. In particular, in 1992 and 1995, the Onchocerciasis Elimination Program in the Americas and the African Program for Onchocerciasis Control were launched, the aim of which was to eradicate lymphatic filariasis, a disease caused by the parasitic nematode Brugia malayi, disabling and disfiguring large numbers of people in tropical countries. Within the framework of both programs, Stromectol was used, which showed great clinical efficacy and safety, which is quite a rare case for antiparasitic drugs. Later, this drug was used under the auspices of the Global Program to Eliminate Lymphatic Filariasis.
The control of onchocerciasis and lymphatic filariasis has been the main scope of use of Stromectol for more than 30 years.
TheCurrently, Stromectol is approved for use in humans in several countries such as Australia, France, Japan, The Netherlands, USA, Russia and others.
Most often, adult patients are prescribed 6-12 mg of Ivermectin at a time. The scheme of application is different: for some diseases, a single dose is sufficient, for others it is necessary to repeat it several times. In each case, the required dosage and treatment regimen are determined by the doctor. Self-treatment with Stromectol can be dangerous for the body or simply ineffective.
Ointments based on Ivermectin are applied to the affected skin once a day.
Some doctors prefer to combine Ivermectin with different other drugs employed to control helminthes. For example, to interrupt the transmission of onchocerciasis in humans, the combination of Ivermectin and Doxycycline is more effective than monotherapy with each of these substances. The combination of Ivermectin with other antiparasitic drugs helps to solve the urgent modern problem of parasitology, which is that in recent years there has been an increase in the resistance of helminths to monotherapy.
The medicine in tablet form is recommended to be taken either two hours before meals, or two hours after. This allows it to be more efficiently absorbed into the bloodstream and spread throughout the body.
Stromectol is not used to treat children weighing less than 15 kg. Also, contraindications to the use of this medication in patients of any age is the presence of hepatic and/or renal failure. The safety of the use of Ivermectin in pregnant women has not yet been established, but it has been proven that in low concentrations this substance is found in the breast milk of nursing mothers.
Also among the relative contraindications to the use of this medication can be called an allergy to Ivermectin or to any auxiliary substances contained in the tablet, the presence of more than one parasitic disease in one patient (this can lead to severe side effects), as well as bronchial asthma.
Few people imagine exactly how Stromectol, and other antiparasitic drugs, affect the human body, how exactly they lead to the death of parasites, both roundworms and any others. As it is known, in addition to the direct effect on parasites-causative agents of various diseases, Stromectol also has an anti-inflammatory effect. It appears to be by suppressing the production of inflammatory cytokines induced by lipopolysaccharides. The anti-inflammatory properties of Ivermectin when applied externally have been observed in models of inflammatory skin processes in both animals and humans, and have been proven to be effective in therapeutic practice.
Ivermectin causes the death of parasites mainly through selective binding and high affinity for glutamate-regulated chlorine channels found in the nerve and muscle cells of invertebrates. Parasites are literally killed from the inside, as the medicine affects the very essence of their bodies. The drug disrupts the transmission of nerve impulses of parasites, which leads to their paralysis and death. In addition, by opening the Cl-dependent channels of the muscle cells of the pharynx of roundworms, Stromectol relaxes the muscles of the pharynx, which makes it impossible for the helminth to feed. Stromectol also causes disruption of embryogenesis in female parasites due to intrauterine damage and degeneration of the parasites.
The mechanism of action of Ivermectin in the treatment of inflammatory skin lesions in rosacea is not exactly known, but with a high probability it may be associated with both its anti-inflammatory properties and the ability of Ivermectin to kill Demodex mites, which, in turn, are a factor causing this type of skin inflammation.
Due to the high lipid solubility of Ivermectin, this compound is widely distributed within the body. The compound is present in fat, skin, subcutaneous fascia and nodules as well as in worm fragments. Fat shows the highest and most persistent levels, whilst values for skin, nodular tissues, and worms are comparable, being the lowest concentrations found in the subcutaneous fascia. In the skin, the peak concentration of the drug in squames, sebum and sweat on the forehead and the antithenar is observed 8 hour after a 12 mg oral dose and declines quickly beyond 24 hours.
Despite widespread use of Stromectol, the details of its pharmacokinetic characteristics are still poorly understood and have to be investigated further. Some scientific researches note that people receiving Stromectol in resource‐poor locations can suffer from malnutrition or other concomitant conditions weakening the action of the medicine. It is assumed today that lower amounts of fatty tissue such as in malnourished patients can affect the distribution of Ivermectin, especially into deeper compartments.
Ivermectin, the active substance of Stromectol, is characterized by a fairly low level of severity of side effects. This is unusual for antiparasitic drugs, which are often difficult for the human body to tolerate.
The most common side effect of Ivermectin resembles the Mazotti reaction, which includes fever, headache, dizziness, drowsiness, weakness, skin rash, itching, diarrhea, joint and muscle pain, hypotension, tachycardia, lymphadenitis, lymphangitis, and peripheral edema. Surely, not all the symptoms are present in one patient simultaneously. Mazotti reaction manifests itself to the maximum extent two days after taking the medicine. According to most scientists, this reaction is caused by the mass death of parasites, and not by the toxicity of the drug itself. This is confirmed by the fact that the severity of this reaction is in direct proportion to the level of parasite infestation. Such an adverse reaction is observed in 6-30% of cases, but it is usually mild, short-lived and suppressed by aspirin and antihistamines. Severe reactions occur in about 1% of cases. Therapy for a highly pronounced Mazotti reaction includes the use of steroids.
With Stromectol therapy, after a few days of treatment, a number of patients develop point corneal opacity. Very rare ophthalmic reactions that occur after taking this medication include eyelid edema, conjunctivitis, keratitis, optic neuritis, chorioretinitis, and choroiditis. These conditions do not cause loss of vision, don't require the use of corticosteroids, and are easily treated with topical agents.
The anthelminthic drug Stromectol has recently received attention as it is being repurposed for new indications, among which is mass drug administrations for the treatment of scabies and in malaria vector control.
Ivermectin proposes many potentials effects to treat a range of diseases, with its antimicrobial, antiviral, and anti-cancer properties as a wonder drug. It is highly effective against many microorganisms including some viruses. At the moment, the antiviral properties of Ivermectin in vitro are obvious against several viruses, but scientists do not give an unambiguous definition of the reason for this property of the drug.
Current interest in the potential use of Ivermectin to reduce malaria transmission, envisaged as community-wide campaigns tailored to transmission patterns and as complement of the local vector control program is observed. The development of new Ivermectin regimens will require integrated development of the drug in the context of traditional entomological tools and endpoints.
Medically reviewed by: Dr. Stamatios Lerakis