Kommersiellt obunden läkemedelsinformation riktad till läkare och sjukvårdspersonal

Drugline nr 22350

Publicerat 2005-09-23

Question

What is the documentation about the use of ivermectin during breast feeding?

The questioner wants to update a database, infpreg, concerning treatment of parasite diseases.

Answer

Ivermectin consists of two avermectins, avermectin B1a and avermectin B1b, and has been used against parasites in many animals for thirty years and in humans for two decades. Its mode of action is poorly understood but it alters the transfer of chloride ions across cell membrane ion channels and immobilizes microfiliariae by blocking postsynaptic neurotransmission. This makes it easier for the immune system to eliminate them. It appears to be a GABA-agonist (1).

Ivermectin is used in mass treatment programmes in countries where onchocerciasis, river blindness, is endemic. Those excluded are pregnant women, women who breast feed recently born babies, children weighing less than 15 kg and seriously ill (2). There have been reports of neurotoxicity in some breeds of dogs, though this has not been seen in cattle, horses or humans. Defects in the blood-brain barrier is thought to make some dogs vulnerable to ivermectin, which usually does not penetrate the blood-brain barrier (3). One report implied an increased death rate in elderly patients who were treated for scabies (4), but the statistical method used was afterwards questioned (5).

The concentrations of ivermectin in breast milk is low, and the relative infant dose has been estimated to be 1.8% (6). The American Association of Pediatrics classifies ivermectin as compatible with breast feeding (6). According to an article by an author who treated with ivermectin in a hyperendemic area where 5-10% of the population were lactating mothers for a period of three years, there were no serious adverse effects reported on the nervous system or elsewhere (7). The reason for not treating small children and pregnant mothers is carefulness. There are no data that indicate that it should pose any danger to a foetus or a neonate (8).

Conclusion

The concentration of ivermectin in breast milk is low and there are no data to indicate that treating a lactating mother should pose a risk for the neonate. The practice has been to exclude mothers to recently born babies from treatment, though, and the data are therefore limited.

Bergman U
Sparve E

References

  1. Richard-Lenoble D, Chandenier J, Gaxotte P. Ivermectin and filariasis. Fundam Clin Pharmacol 2003;17:199-203.
  2. Sweetman SC, editor. Martindale, The complete drug reference. 33rd ed. London: Pharmaceutical Press; 2002.
  3. Bredal WP. Deaths associated with ivermectin for scabies. Lancet 1997;350;216.
  4. Barkwell R, Shields S. Deaths associated with ivermectin for scabies. Lancet 1997;349:1144-5.
  5. Coyne PE, Addiss DG. Deaths associated with ivermectin for scabies. Lancet 1997;350;215-216.
  6. Briggs GG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.
  7. Ogbuokiri JE, Ozumba BC, Okonkwo PO. Ivermectin levels in human breastmilk. Eur J Clin Pharmacol 1993;45:389-90.
  8. Maduka CU, Nweke LN, Miri ES, Amazigo U, Emukah EC, Richards FO. Missed treatment opportunities, for pregnant and breast-feeding women, in onchocerciasis mass-treatment programmes in south-eastern Nigeria. Ann Trop Med Parasitol 2004;98(7):697-702.

Senast ändrad 2018-09-20