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No Interaction Expected

_Ivermectin (old primary)

Abacavir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Abacavir is metabolized by alcohol dehydrogenase and UGTs and has no inhibitory or inducing effects on drug metabolizing enzymes. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Acarbose

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. After ingestion of acarbose, the majority of active unchanged drug remains in the lumen of the gastrointestinal tract to exert its pharmacological activity and is metabolized by intestinal enzymes and by the microbial flora.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Acenocoumarol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Acenocoumarol is mainly metabolized by CYP2C9 and to a lesser extent by CYP1A2 and CYP2C19. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp. However, ivermectin is reported to inhibit vitamin-K clotting factors and there are post-marketing reports that coadministration with warfarin can increase INR. Use with caution and monitor INR.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Acetylcysteine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Acetylcysteine is deacetylated before undergoing the normal metabolism of cysteine. Ivermectin does not interfere with this pathway.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Aciclovir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Aciclovir is eliminated renally via glomerular filtration and active renal secretion by OAT1. Ivermectin does not affect this pathway.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Aclidinium bromide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Aclidinium bromide is rapidly and extensively hydrolyzed (non-enzymatic and enzymatic transformation by esterases and butylrylcholineesterases) to its pharmacologically inactive metabolites with only a minor role for CYP metabolism.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Adalimumab

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Adalimumab is a monoclonal IgG antibody. Elimination is similar to endogenous IgG and occurs primarily via proteolytic catabolism throughout the body.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Adrenaline (Epinephrine)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Adrenaline is rapidly inactivated, mostly in the liver by catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO). Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Agomelatine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Agomelatine is metabolized predominantly by CYP1A2. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Albuvirtide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Albuvirtide is a peptide which is eliminated by catabolism to its constituent amino acids and has no inhibitory or inducing effects on drug metabolizing enzymes. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Alcuronium

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Alcuronium is predominantly excreted unchanged via the kidneys possibly via active tubular secretion. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Alendronic acid (Alendronate)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. If taken at the same time, it is likely that food and beverages (including mineral water), calcium supplements, antacids, and some oral medicinal products will interfere with absorption of alendronate. Therefore, ivermectin should be taken at least 30 minutes after alendronic acid. Of note, alendronic acid is contraindicated with the inability of the patient to stand or sit upright for at least 30 minutes.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Alfentanil

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Alfentanil undergoes CYP3A4 metabolism. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Alfuzosin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Alfuzosin is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Aliskiren

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Aliskiren is minimally metabolized by CYP450 and is mainly excreted unchanged in faeces. Aliskiren is a substrate of P-glycoprotein. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Allopurinol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Allopurinol is converted to oxipurinol by xanthine oxidase and aldehyde oxidase. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Alosetron

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. In vitro data indicate that alosetron is metabolized by CYPs 2C9, 3A4 and 1A2, with in vivo data suggesting that CYP1A2 plays a more prominent role. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Alprazolam

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Alprazolam is mainly metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp. However, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents such as benzodiazepines.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ambrisentan

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ambrisentan is mainly glucuronidated by UGT1A9, UGT2B7, UGT1A3 and is metabolized to a lesser extent by CYP3A4. Ambrisentan is also a substrate of P-gp and OATP1B1. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Amikacin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Amikacin is eliminated by glomerular filtration. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Amiloride

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Amiloride is eliminated unchanged by the kidney with in vitro data indicating that it is a substrate of OCT2. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Aminophylline

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Aminophylline is a complex of theophylline and ethylenediamine and is given for its theophylline activity. Theophylline is mainly metabolized by CYP1A2. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Amiodarone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Amiodarone is metabolized by CYPs 3A4 and 2C8 and inhibits P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with a P-gp inhibitor such as amiodarone may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Amisulpride

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Amisulpride is weakly metabolized and is primarily eliminated renally, possibly via OCT. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Amitriptyline

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Amitriptyline is metabolized predominantly by CYP2D6 and CYP2C19. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Amlodipine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Amlodipine is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Amoxicillin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Amoxicillin is mainly excreted in the urine by glomerular filtration and tubular secretion via OAT3. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Amphotericin B

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Amphotericin is not appreciably metabolized and is eliminated to a large extent in the bile. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ampicillin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ampicillin is mainly excreted in the urine by glomerular filtration and tubular secretion. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Anakinra

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ivermectin is a substrate of CYP3A4 and P-gp. Anakinra, per se, has no inhibitory or inducing effects on cytochromes. Patients infected with COVID-19 may experience an elevation of IL-1 which has been shown to suppress expression/activity of CYP3A4, CYP2C19, CYP2C9 and CYP1A2. Anakinra will normalize cytochrome activity (via inhibition of IL-1) thus no a priori dose adjustment of ivermectin is required.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Anidulafungin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Anidulafungin is not metabolized hepatically but undergoes chemical degradation at physiological temperature. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Antacids

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Anti-thymocyte globulin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Thymoglobulins are cleared by the reticuloendothelial system. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Apixaban

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Apixaban is metabolized by CYP3A4 and to a lesser extent CYP1A2, CYP2C8, CYP2C9 and CYP2C19. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Aprepitant

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Aprepitant is mainly metabolized by CYP3A4 and to a lesser extent by CYPs 1A2 and 2C19. Aprepitant is a moderate inhibitor of CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Moderate CYP3A4 inhibitors such as aprepitant are unlikely to cause a clinically significant interaction due to the wide safety margin of ivermectin.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Argatroban

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Argatroban undergoes metabolism in the liver via hydroxylation and aromatization. Drug-drug interaction studies performed with substrates of different cytochromes and P-glycoprotein (i.e., acetaminophen, lidocaine, warfarin, digoxin) indicate that argatroban has a low potential to cause drug-drug interactions. Ivermectin is a substrate of CYP3A4 and P-gp. However, ivermectin is reported to inhibit vitamin-K clotting factors and there are post-marketing reports that coadministration with warfarin can increase INR. Use with caution and monitor INR.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Aripiprazole

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Aripiprazole is metabolized by CYP3A4 and CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Asenapine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Asenapine is metabolized by glucuronidation (UGT1A4) and oxidative metabolism (CYP1A2 (major) and CYP3A4, 2D6 (minor)). Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Aspirin [Acetylsalicylic acid] (Analgesic)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Aspirin is rapidly deacetylated to form salicylic acid which is further glucuronidated by several UGTs (major UGT1A6). Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Aspirin [Acetylsalicylic acid] (Anti-platelet)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ivermectin is a substrate of CYP3A4 and P-gp. Aspirin (acetylsalicylic acid) is rapidly metabolised to salicylic acid, which is further glucuronidated by several UGTs (major UGT1A6). Salicylic acid and its metabolites are predominantly excreted via the kidneys. Aspirin and salicylic acid are extensively bound to plasma proteins, primarily albumin. Interactions with aspirin and substrates, inducers, or inhibitors of CYP enzymes are unlikely.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Atazanavir + ritonavir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Atazanavir/ritonavir is metabolized by CYP3A4. Atazanavir is an inhibitor of CYP3A4 and UGT1A1 and is a strong inhibitor of OATP1B1; ritonavir inhibits CYP3A4. Ritonavir is a strong P-gp inhibitor. Ivermectin is a substrate of CYP3A4 and P-gp. The ivermectin product label advises caution when administering with strong inhibitors of CYP3A4. Moreover, coadministration with a strong P-gp inhibitor such as ritonavir may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Atazanavir alone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Atazanavir is metabolized by CYP3A4. Unboosted atazanavir is a moderate inhibitor of CYP3A4 and P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with a P-gp inhibitor such as atazanavir may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Atazanavir/cobicistat

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Atazanavir/cobicistat is metabolized by CYP3A4. Atazanavir is an inhibitor of CYP3A4 and UGT1A1 and is a strong inhibitor of OATP1B1; cobicistat inhibits CYP3A4 and P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. The ivermectin product label advises caution when administering with strong inhibitors of CYP3A4. Moreover, coadministration with a strong P-gp inhibitor such as cobicistat may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Atenolol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Atenolol is mainly eliminated by the kidney, both by glomerular filtration and active secretion via the renal transporters OCT2 and MATE1. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Atorvastatin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Atorvastatin is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Azathioprine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Azathioprine is converted to 6-mercaptopurine which is metabolized analogously to natural purines. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Bamlanivimab/ Etesevimab

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ivermectin is a substrate of CYP3A4 and P-gp. Bamlanivimab and etesevimab are not metabolized by CYP enzymes. Interactions with concomitant medications that are substrates, inducers, or inhibitors of CYP enzymes are unlikely.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Baricitinib

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Baricitinib is minimally metabolized by CYP3A4 (<10%), and mainly eliminated unchanged in the urine. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Basiliximab

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Basiliximab is a monoclonal IgG antibody. Elimination is similar to endogenous IgG and occurs primarily via proteolytic catabolism throughout the body.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Beclometasone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Beclometasone is a pro-drug which is not metabolized by CYP450 but is hydrolysed via esterase enzymes to the highly active metabolite beclometasone -17-monopropionate. This active metabolite is subsequently converted to inactive metabolites via CYP3A4/5. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Bedaquiline

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bedaquiline is metabolized by CYP3A4 and mainly eliminated in faeces. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Belatacept

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Belatacept is a protein that undergoes non-CYP mediated metabolism in the liver. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Benazepril

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Benazepril is rapidly hydrolyzed to its active metabolite benazeprilat which is eliminated predominantly renally. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Bendroflumethiazide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bendroflumethiazide is eliminated by hepatic metabolism (70%, exact pathway not known) and excreted unchanged in the urine (30%) via OAT1 and OAT3. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Bepridil

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bepridil is metabolized by CYP2D6 (major) and CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Betamethasone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Betamethasone is metabolized by CYP3A4. Betamethasone is a moderate inducer of CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with CYP3A4 inducers such as betamethasone may lead to decreased ivermectin exposure thus further reducing the likelihood for ivermectin to reach efficient concentrations (ivermectin total concentrations are >45 times lower than the in vitro EC50 against SARS-CoV-2).

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Betrixaban

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Betrixaban is largely eliminated unchanged through biliary secretion via P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Bezafibrate

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Half of a bezafibrate dose is eliminated unchanged in the urine. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Bictegravir/ Emtricitabine/ Tenofovir alafenamide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bictegravir is metabolized by CYP3A4 and UGT1A1 whereas emtricitabine and tenofovir alafenamide are eliminated renally. Bictegravir has no inhibitory or inducing effects on drug metabolizing enzymes. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Bisacodyl

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bisacodyl is converted to an active metabolite by intestinal and bacterial enzymes. Absorption from the gastrointestinal tract is minimal and the small amount absorbed is excreted in the urine as the glucuronide.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Bisoprolol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bisoprolol is partly metabolized by CYP3A4 and CYP2D6 and partly eliminated unchanged in the urine. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Bosentan

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Bosentan is metabolized by CYP3A4 and CYP2C9. Bosentan is an inducer of CYP3A4 and CYP2C9. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with CYP3A4 inducers such as bosentan may lead to decreased ivermectin exposure thus further reducing the likelihood for ivermectin to reach efficient concentrations (ivermectin total concentrations are >45 times lower than the in vitro EC50 against SARS-CoV-2).

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Brivaracetam

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Brivaracetam is cleared by multiple pathways including renal excretion and non-CYP-mediated hydrolysis, as well as hydroxylation mediated by CYP2C19. It is also an inhibitor of CYP2C19 and OAT3. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin is unlikely to affect these pathways to a clinically relevant extent.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Bromazepam

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Bromazepam undergoes oxidative biotransformation. Drug-drug interaction studies indicate that CYP3A4 plays a minor role in bromazepam metabolism, but other cytochromes such as CYP2D6 or CYP1A2 may also play a role. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp. However, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents such as benzodiazepines.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Budesonide (inhaled)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ivermectin is a substrate of CYP3A4 and P-gp. Budesonide does not induce or inhibit CYPs.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Budesonide (oral/rectal)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Budesonide is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Bupivacaine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bupivacaine is predominantly metabolized via CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Buprenorphine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Buprenorphine is mainly metabolized by CYP3A4 to form the active metabolite norbuprenorphine but is also glucuronidated by UGT2B7 and UGT1A1. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Bupropion

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bupropion is primarily metabolized by CYP2B6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Buspirone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Buspirone is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

COVID-19 vaccines

Quality of Evidence: Very Low

Summary:

Coadministration has not been formally studied but based on current knowledge of the effect of vaccines on drug disposition a clinically significant interaction is considered unlikely.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Cabotegravir (oral)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cabotegravir is mainly metabolized by UGT1A1 and to a lesser extent by UGT1A9. Ivermectin is a substrate of CYP3A4 and P-gp. Cabotegravir does not inhibit or induce CYP enzymes at clinically relevant concentrations. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Cabotegravir/ rilpivirine (long acting)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cabotegravir is mainly metabolized by UGT1A1 and to a lesser extent by UGT1A9. Rilpivirine is primarily metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Cabotegravir and rilpivirine do not inhibit or induce CYP enzymes at clinically relevant concentrations. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Calcium supplements

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Calcium is eliminated through faeces, urine, and sweat.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Canagliflozin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Canagliflozin is primarily metabolized by UGT1A9 and UGT2B4. Canagliflozin is a weak P-gp inhibitor. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Canakinumab

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Canakinumab is an IL-1 receptor antagonist and is eliminated via intracellular catabolism. Ivermectin is a substrate of CYP3A4 and P-gp. Canakinumab, per se, has no inhibitory or inducing effects on cytochromes. Patients infected with COVID-19 may experience an elevation of IL-1 which has been shown to suppress expression/activity of CYP3A4, CYP2C19, CYP2C9 and CYP1A2. Canakinumab will normalize cytochrome activity (via inhibition of IL-1), but no significant effect on ivermectin is expected and no a priori dose adjustment is required. 

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Candesartan

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Candesartan is mainly eliminated unchanged via urine and bile. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Capreomycin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Capreomycin is predominantly excreted via the kidneys as unchanged drug, partly by glomerular filtration and possibly partly by tubular secretion (renal transporter not identified). Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Captopril

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Captopril is largely excreted in the urine by OAT1 (40-50% as unchanged drug, the rest as disulfide and other metabolites). Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Carbamazepine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Carbamazepine is metabolized by CYP3A4 and UGT2B7. Carbamazepine induces CYP3A4 and P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with CYP3A4 inducers such as carbamazepine may lead to decreased ivermectin exposure thus further reducing the likelihood for ivermectin to reach efficient concentrations (ivermectin total concentrations are >45 times lower than the in vitro EC50 against SARS-CoV-2).

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Carbocisteine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Carbocisteine is metabolized in the liver via acetylation, decarboxylation and sulfoxidation with up to 60% excreted unchanged in the urine. The likelihood of a clinically significant drug interaction is low and no studies have been performed.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Carvedilol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Carvedilol undergoes glucuronidation via UGTs 1A1, 2B4 and 2B7, and additionally metabolism via CYP2D6 and to a lesser extent CYPs 2C9 and 1A2. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Casirivimab/ Imdevimab

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ivermectin is a substrate of CYP3A4 and P-gp. Casirivimab and imdevimab are not metabolized by CYP enzymes. Interactions with concomitant medications that are substrates, inducers, or inhibitors of CYP enzymes are unlikely.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Caspofungin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Caspofungin undergoes spontaneous chemical degradation and metabolism via a non CYP-mediated pathway. In vitro data indicate that caspofungin is a substrate of the hepatic transporter OATP1B1. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Cefalexin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cefalexin is predominantly eliminated unchanged via the kidneys (by glomerular filtration and tubular secretion via OAT1 and MATE1). Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Cefazolin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cefazolin is predominantly excreted unchanged in the urine, mainly by glomerular filtration with some renal tubular secretion via OAT3. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Cefepime

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cefepime is minimally metabolized with 85% of the administered dose is eliminated unchanged. It is renally cleared predominantly by glomerular filtration. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See summary)

No Interaction Expected

_Ivermectin (old primary)

Cefixime

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cefixime is renally excreted predominantly by glomerular filtration. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Cefotaxime

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cefotaxime is partially metabolized by non-specific esterases. Most of a dose of cefotaxime is excreted in the urine (about 60% as unchanged drug and a further 24% as desacetyl-cefotaxime, an active metabolite). In vitro studies indicate that OATs participate to the renal elimination of cefotaxime. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ceftazidime

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ceftazidime is excreted predominantly by renal glomerular filtration. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ceftriaxone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ceftriaxone is eliminated mainly as unchanged drug, approximately 60% of the dose being excreted in the urine predominantly by glomerular filtration and the remainder via the biliary and intestinal tracts. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Celecoxib

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Celecoxib is metabolized mainly by CYP2C9. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Chloramphenicol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Chloramphenicol is predominantly metabolized by glucuronidation via UGT2B7. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Chlordiazepoxide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Chlordiazepoxide is extensively metabolized by hepatic microsomal enzymes. Ivermectin is a substrate of CYP3A4 and P-gp. However, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents such as benzodiazepines.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Chloroquine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Chloroquine undergoes CYP mediated metabolism by CYPs 2C8, 3A4 and 2D6, and is also eliminated unchanged via the kidney (50%). Chloroquine is a moderate inhibitor of CYP3A4 and P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Moderate CYP3A4 inhibitors such as chloroquine are unlikely to cause a clinically significant interaction. However, coadministration with a P-gp inhibitor such as chloroquine may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Chlorpromazine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Chlorpromazine is metabolized mainly by CYP2D6, but also by CYP1A2. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Chlortalidone (Chlorthalidone)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Chlortalidone is mainly excreted unchanged in the urine and faeces. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ciclesonide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ciclesonide is a pro-drug activated by esterases in the lungs to des-ciclesonide which then undergoes CYP3A4 mediated metabolism. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Ciclosporin (Cyclosporine)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Ciclosporin is metabolized by CYP3A4 and is a potent P-gp inhibitor. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with a strong P-gp inhibitor such as ciclosporin may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Cilazapril

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cilazapril is mainly eliminated unchanged by the kidneys. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Cimetidine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cimetidine is primarily eliminated by the kidneys but is a mild CYP3A4 inhibitor. Ivermectin is a substrate of CYP3A4 and P-gp. Weak CYP3A4 inhibitors such as cimetidine are unlikely to cause a clinically significant interaction due to the wide safety margin of ivermectin.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ciprofloxacin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ciprofloxacin is primarily eliminated unchanged through the kidneys (by glomerular filtration and tubular secretion via OAT3). Ciprofloxacin is a moderate CYP3A4 inhibitor. Ivermectin is a substrate of CYP3A4 and P-gp. Moderate CYP3A4 inhibitors such as ciprofloxacin are unlikely to cause a clinically significant interaction due to the wide safety margin of ivermectin.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Cisapride

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cisapride is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Cisatracurium

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cisatracurium undergoes mainly (80% of overall elimination) spontaneous degradation in plasma and tissues at physiological pH and temperature. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Citalopram

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Citalopram is metabolized by CYPs 2C19 (38%), 2D6 (31%) and 3A4 (31%). Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Clarithromycin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Clarithromycin is metabolized by CYP3A4 and is a strong inhibitor of CYP3A4 and P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. The ivermectin product label advises caution when administering with strong inhibitors of CYP3A4. Moreover, coadministration with a strong P-gp inhibitor such as clarithromycin may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Clavulanic acid

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Clavulanic acid is extensively metabolized (likely non-CYP mediated pathway) and excreted in the urine by glomerular filtration. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Clindamycin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Clindamycin is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Clobazam

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Clobazam is metabolized by CYP3A4 (major) and CYP2B6 and CYP2C19 (minor) to the active metabolite N-desmethylclobazam, which is metabolized by CYP2C19. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp. However, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents such as benzodiazepines.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Clobetasol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely with the topical use of clobetasol. Clobetasol is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Clofazimine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Clofazimine is largely excreted unchanged in the faeces, both as unabsorbed drug and via biliary excretion. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Clofibrate

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Clofibrate is hydrolyzed to an active metabolite, clofibric acid. Excretion of clofibric acid glucuronide is possibly performed via OAT1. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Clomipramine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Clomipramine is metabolized by CYPs 3A4, 1A2 and 2C19 to desmethylclomipramine, an active metabolite which has a higher activity than the parent drug. In addition, clomipramine and desmethylclomipramine are metabolized by CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Clonazepam

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Clonazepam is metabolized by CYP3A4 and does not induce metabolizing enzymes. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp. However, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents such as benzodiazepines.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Clonidine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Approximately 70% of administered clonidine is excreted in the urine, mainly in form of the unchanged parent drug (40-60% of the dose). Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Clopidogrel

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Clopidogrel is a prodrug that is converted to its active metabolites via CYPs 3A4, 2B6, 2C19 and 1A2. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Clopidogrel (recently stented patients)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Clopidogrel is a prodrug that is converted to its active metabolites via CYPs 3A4, 2B6, 2C19 and 1A2. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Clorazepate

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Clorazepate is rapidly converted to nordiazepam, which is then metabolized to oxazepam by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp. However, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents such as benzodiazepines.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Cloxacillin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cloxacillin is metabolized to a limited extent, and the unchanged drug and metabolites are excreted via glomerular filtration and tubular secretion. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Clozapine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Clozapine is metabolized by CYPs 1A2, 2C19, 3A4, and to a lesser extent by CYPs 2C9 and 2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Codeine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Codeine undergoes predominantly direct glucuronidation. Codeine is also a substrate of CYP2D6 (major) and CYP3A4 (10-15% of the overall metabolism). Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Colchicine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Colchicine is a CYP3A4 and P-gp substrate. Ivermectin is a substrate of CYP3A4 and P-gp. Colchicine does not affect these pathways.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Convalescent Plasma

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Convalescent plasma is a biological therapy and is unlikely to affect the pharmacokinetics of any coadministered drug.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Cyclizine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. The metabolism of cyclizine has not been fully described but may involve CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Cycloserine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cycloserine is predominantly excreted renally via glomerular filtration. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Dabigatran

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dabigatran is not metabolized by CYP450 enzymes and is mainly cleared by glomerular filtration. The prodrug of dabigatran is a substrate of P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Dalteparin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ivermectin is a substrate of CYP3A4 and P-gp. Dalteparin is excreted largely unchanged by the kidneys and does not induce or inhibit CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Dapagliflozin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dapagliflozin is primarily metabolized by UGT1A9. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Dapsone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dapsone is mainly metabolized by N-acetylation with a component of N-hydroxylation and is via multiple CYP P450 enzymes. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Darunavir + ritonavir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Darunavir/ritonavir is metabolized by CYP3A4. Darunavir/ritonavir is a strong inhibitor of CYP3A4. Ritonavir is a strong P-gp inhibitor. Ivermectin is a substrate of CYP3A4 and P-gp. The ivermectin product label advises caution when administering with strong inhibitors of CYP3A4. Moreover, coadministration with a strong P-gp inhibitor such as ritonavir may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Darunavir/Cobicistat/ Emtricitabine/ Tenofovir alafenamide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Darunavir/cobicistat is metabolized by CYP3A4 whereas emtricitabine and tenofovir alafenamide are eliminated renally. Darunavir/cobicistat is a strong inhibitor of CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. The ivermectin product label advises caution when administering with strong inhibitors of CYP3A4. Moreover, coadministration with a strong P-gp inhibitor such as cobicistat may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Darunavir/cobicistat

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Darunavir/cobicistat is metabolized by CYP3A4. Darunavir/cobicistat is a strong inhibitor of CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. The ivermectin product label advises caution when administering with strong inhibitors of CYP3A4. Moreover, coadministration with a strong P-gp inhibitor such as cobicistat may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Delamanid

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Delamanid is primarily metabolized by albumin to DM-6705; metabolism of DM-6705 to other metabolites is thought to involve pathways mediated by CYP enzymes, including CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Desflurane

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Desflurane is almost exclusively eliminated unchanged by the lungs. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Desipramine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Desipramine is metabolized by CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Desogestrel (COC)

Quality of Evidence: Very Low

Summary:

Coadministration with a desogestrel-containing combined oral contraceptive (COC) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Desogestrel is a prodrug that is activated to etonogestrel by CYP2C9 (and possibly CYP2C19) which is then metabolized by CYP3A4. Ethinylestradiol is metabolized by hydroxylation and glucuronidation. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Desogestrel (POP)

Quality of Evidence: Very Low

Summary:

Coadministration with a desogestrel-containing progestogen-only pill (POP) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Desogestrel is a prodrug that is activated to etonogestrel by CYP2C9 (and possible CYP2C19) which is then metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Dexamethasone (low dose; 16 mg or less)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance, a clinically significant interaction is unlikely. Dexamethasone is a substrate of CYP3A4. Dexamethasone is a moderate CYP3A4 and P-gp inducer.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Dexmedetomidine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dexmedetomidine undergoes extensive hepatic metabolism through direct glucuronidation (mainly via UGTs 1A4 and 2B10) and cytochrome P450 (mainly CYP2A6). Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Dextromethorphan

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dextromethorphan is metabolized by CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Dextropropoxyphene

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dextropropoxyphene has been withdrawn from most European and North American countries due to the risk of arrhythmias and fatalities. Dextropropoxyphene is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Diamorphine (diacetylmorphine)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Diamorphine is rapidly metabolized by sequential deacetylation to morphine which is then mainly glucuronidated to morphine-3-glucuronide (UGT2B7>UGT1A1) and, to a lesser extent, to the pharmacologically active morphine-6-glucuronide (UGT2B7>UGT1A1). Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Diazepam

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Diazepam is metabolized to nordiazepam (by CYPs 3A4 and 2C19) and to temazepam (mainly by CYP3A4). Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp. However, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents such as benzodiazepines.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Diclofenac

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Diclofenac is partly glucuronidated by UGT2B7 and partly oxidized by CYP2C9 (catalyzes the major route of diclofenac oxidative metabolism). Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Digoxin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Digoxin is eliminated unchanged in the kidney via the renal transporters OATP4C1 and P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Dihydrocodeine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dihydrocodeine is converted to dihydromorphine (active metabolite) via CYP2D6, to dihydrocodeine-6-glucuronide via UGT2B7 (major pathway) and to nordihydrocodeine via CYP3A4. The analgesic effect appears to be primarily due to the parent compound. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Diltiazem

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Diltiazem is metabolized by CYP3A4 and CYP2D6. Diltiazem is a moderate inhibitor of CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Moderate CYP3A4 inhibitors such as diltiazem are unlikely to cause a clinically significant interaction due to the wide safety margin of ivermectin. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Dipyridamole

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Dipyridamole is glucuronidated by many UGTs, specifically those of the UGT1A subfamily. Ivermectin is a substrate of CYP3A4 and P-gp. However, ivermectin is reported to inhibit vitamin-K clotting factors and there are post-marketing reports that coadministration with warfarin can increase INR. Use with caution and monitor INR.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Disopyramide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Disopyramide is metabolized by CYP3A4 (25%) whereas 50% of the drug is eliminated unchanged in the urine (possibly via OCT2). Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Dobutamine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dobutamine is metabolized by catechol-O-methyltransferase (COMT) and UGT. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Dofetilide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dofetilide is metabolized to a small degree by CYP3A4 and is mainly excreted unchanged in urine. Renal elimination involves both glomerular filtration and active tubular secretion (via cation transport system). Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Dolasetron

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dolasetron is converted by carbonyl reductase to its active metabolite, hydrodolasetron, which is mainly glucuronidated (60%) and metabolized by CYP2D6 (10-20%) and CYP3A4 (<1%). Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Dolutegravir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dolutegravir is primarily metabolized by UGT1A1, with some contribution from CYP3A. Dolutegravir has no inhibitory or inducing effects on drug metabolizing enzymes. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Dolutegravir/ Lamivudine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dolutegravir is primarily metabolized by UGT1A1, with some contribution from CYP3A whereas lamivudine is eliminated renally. Dolutegravir has no inhibitory or inducing effects on drug metabolizing enzymes. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Dolutegravir/ Rilpivirine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dolutegravir is primarily metabolized by UGT1A1, with some contribution from CYP3A whereas rilpivirine undergoes mainly CYP3A metabolism. Dolutegravir and rilpivirine have no inhibitory or inducing effects on drug metabolizing enzymes. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Dolutegravir/Abacavir/ Lamivudine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dolutegravir is primarily metabolized by UGT1A1, with some contribution from CYP3A, abacavir is metabolized by alcohol dehydrogenase and UGTs whereas lamivudine is eliminated renally. Dolutegravir has no inhibitory or inducing effects on drug metabolizing enzymes. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Domperidone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Domperidone is mainly metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Donepezil

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Donepezil is metabolized by CYP3A4 and CYP2D6 (minor). Ivermectin does not inhibit or induce CYPs.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Dopamine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dopamine is metabolized in the liver, kidneys, and plasma by monoamine oxidase (MAO) and catechol-O-methyltransferase to inactive compounds. About 25% of a dose of dopamine is metabolized to norepinephrine within the adrenergic nerve terminals. There is little potential for drug-drug interactions with dopamine. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Doravirine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Doravirine is primarily metabolized by CYP3A4. Doravirine has no inhibitory or inducing effects on drug metabolizing enzymes. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Doravirine/ Lamivudine/ Tenofovir-DF

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Doravirine is primarily metabolized by CYP3A4 whereas lamivudine and tenofovir disoproxil fumarate are eliminated renally. Doravirine has no inhibitory or inducing effects on drug metabolizing enzymes. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Doxazosin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Doxazosin is metabolized mainly by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Doxepin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Doxepin is metabolized to nordoxepin (a metabolite with comparable pharmacological activity as the parent compound) mainly by CYP2C19. In addition, doxepin and nordoxepin are metabolized by CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Doxycycline

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. No significant metabolism of doxycycline occurs, and it is cleared intact by renal and biliary mechanisms. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Dronabinol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dronabinol is mainly metabolized by CYP2C9 and to a lesser extent by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Drospirenone (COC)

Quality of Evidence: Very Low

Summary:

Coadministration with a drospirenone-containing combined oral contraceptive (COC) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Drospirenone is metabolized to a minor extent via CYP3A4. Ethinylestradiol is metabolized by hydroxylation and glucuronidation. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Drospirenone (HRT)

Quality of Evidence: Very Low

Summary:

Coadministration with drospirenone as hormone replacement therapy (HRT) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Drospirenone is metabolized to a minor extent via CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Dulaglutide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dulaglutide is presumed to be degraded by general protein catabolism pathways. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Duloxetine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Duloxetine is metabolized by CYP2D6 and CYP1A2. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Dydrogesterone (HRT)

Quality of Evidence: Very Low

Summary:

Coadministration with dydrogesterone as hormone replacement therapy (HRT) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dydrogesterone is metabolized to dihydrodydrogesterone (possibly via CYP3A4). Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Edoxaban

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Edoxaban is minimally metabolized by hydrolysis (mediated by carboxylesterase 1), conjugation, or oxidation by CYP3A4/5 (<10%) and is eliminated primarily as unchanged drug in urine. Edoxaban is a substrate for P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Efavirenz

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Efavirenz is metabolized by CYP2B6 and CYP3A4. Efavirenz induces CYP2B6 and CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with CYP3A4 inducers such as efavirenz may lead to decreased ivermectin exposure thus further reducing the likelihood for ivermectin to reach efficient concentrations (ivermectin total concentrations are >45 times lower than the in vitro EC50 against SARS-CoV-2).

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Elbasvir/Grazoprevir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Elbasvir/grazoprevir are substrates of CYP3A4 and P-gp. Elbasvir/grazoprevir is a weak CYP3A4 inhibitor. Ivermectin is a substrate of CYP3A4 and P-gp. Weak CYP3A4 inhibitors such as Elbasvir/grazoprevir are unlikely to cause a clinically significant interaction due to the wide safety margin of ivermectin.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Eltrombopag

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Eltrombopag is metabolized by cleavage conjugation (UGTs 1A1 and 1A3) and oxidation (CYPs 1A2 and 2C8). In vitro data indicate eltrombopag is an inhibitor of UGTs 1A1 and 1A3. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Elvitegravir/Cobicistat/ Emtricitabine/ Tenofovir alafenamide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Elvitegravir/cobicistat is primarily metabolized by CYP3A whereas emtricitabine and tenofovir alafenamide are eliminated renally. Elvitegravir/cobicistat is a strong inhibitor of CYP3A4 and P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. The ivermectin product label advises caution when administering with strong inhibitors of CYP3A4. Moreover, coadministration with a strong P-gp inhibitor such as cobicistat may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Elvitegravir/Cobicistat/ Emtricitabine/ Tenofovir-DF

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Elvitegravir/cobicistat is primarily metabolized by CYP3A whereas emtricitabine and tenofovir disoproxil fumarate are eliminated renally. Elvitegravir/cobicistat is a strong inhibitor of CYP3A4 and P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. The ivermectin product label advises caution when administering with strong inhibitors of CYP3A4. Moreover, coadministration with a strong P-gp inhibitor such as cobicistat may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Empagliflozin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Empagliflozin is mainly glucuronidated by UGTs 1A3, 1A8, 1A9 and 2B7. It is a substrate of P-gp and BCRP, and a substrate of the renal transporter OAT3 and the hepatic transporters OATP1B1 and OATP1B3. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Emtricitabine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Emtricitabine is eliminated renally. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Emtricitabine/ Tenofovir alafenamide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Emtricitabine and tenofovir alafenamide are eliminated renally. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Emtricitabine/ Tenofovir-DF

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Emtricitabine and tenofovir disoproxil fumarate are eliminated renally. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Enalapril

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Enalapril is hydrolysed to enalaprilat which is eliminated renally (possibly via OATs). Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Enflurane

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Enflurane is predominantly metabolized by CYP2E1. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Enoxaparin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ivermectin is a substrate of CYP3A4 and P-gp. Enoxaparin does not undergo cytochrome metabolism but is desulphated and depolymerised in the liver and is excreted predominantly renally. Enoxaparin does not induce or inhibit CYPs or P-gp. 

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Entecavir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Entecavir is eliminated renally via glomerular filtration and active renal secretion by both organic anion and cation transport. Entecavir is eliminated renally via glomerular filtration and active renal secretion by both organic anion and cation transporters

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Enzalutamide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Enzalutamide is primarily metabolized by CYP2C8 and to a lesser extent by CYP3A4. Ivermectin does not inhibit or induce CYPs or P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with an inducer of CYP3A4 and P-gp such as enzalutamide may lead to decreased ivermectin exposure thus further reducing the likelihood for ivermectin to reach efficient concentrations (ivermectin total concentrations are >45 times lower than the in vitro EC50 against SARS-CoV-2).

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ephedrine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ephedrine is predominantly excreted unchanged via renal pathways. There are no available data to determine whether excretion is via active tubular secretion or glomerular filtration. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Eplerenone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Eplerenone is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Epoprostenol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Epoprostenol is rapidly hydrolyzed in the blood. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Eprosartan

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Eprosartan is largely excreted in bile and urine as unchanged drug. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ertapenem

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ertapenem is mainly eliminated through the kidneys by glomerular filtration with tubular secretion playing a minor role. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Erythromycin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Erythromycin is metabolized by CYP3A4 and is a moderate inhibitor of CYP3A4 and a weak inhibitor of P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Moderate CYP3A4 inhibitors such as erythromycin are unlikely to cause a clinically significant interaction due to the wide safety margin of ivermectin.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Escitalopram

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Escitalopram is metabolized by CYPs 2C19 (37%), 2D6 (28%) and 3A4 (35%) to form N-desmethylescitalopram. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Eslicarbazepine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Eslicarbazepine is partly eliminated unchanged renally and partly glucuronidated by UGT2B4. Eslicarbazepine is a CYP3A4 inducer. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with CYP3A4 inducers such as eslicarbazepine may lead to decreased ivermectin exposure thus further reducing the likelihood for ivermectin to reach efficient concentrations (ivermectin total concentrations are >45 times lower than the in vitro EC50 against SARS-CoV-2).

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Esomeprazole

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Esomeprazole is mainly metabolized by CYP2C19 (major) and CYP3A4 (minor). Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Estazolam

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Estazolam is metabolized to its major metabolite 4-hydroxyestazolam via CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp. However, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents such as benzodiazepines.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Estradiol

Quality of Evidence: Very Low

Summary:

Coadministration with estradiol as hormone replacement therapy (HRT) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Estradiol is metabolized by CYP3A4, CYP1A2 and is glucuronidated. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ethambutol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ethambutol is partly metabolized by alcohol dehydrogenase (20%) and partly eliminated unchanged in the faeces (20%) and in the urine (50%). Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ethinylestradiol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ethinylestradiol is metabolized by hydroxylation and glucuronidation. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ethionamide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ethionamide is extensively metabolized in the liver with animal studies suggesting involvement of flavin-containing monooxygenases. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ethosuximide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ethosuximide is mainly metabolized by CYP3A4 and does not induce metabolizing enzymes. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Etidocaine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Etidocaine is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Etonogestrel (implant)

Quality of Evidence: Very Low

Summary:

Coadministration with an etonogestrel-containing progestogen-only implant has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Etonogestrel is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Etonogestrel (vaginal ring)

Quality of Evidence: Very Low

Summary:

Coadministration with etonogestrel as a combined vaginal ring (CVR) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Etonogestrel is metabolized by CYP3A4. Ethinylestradiol is metabolized by hydroxylation and glucuronidation. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Etravirine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Etravirine is metabolized by CYP3A4, CYP2C19, CYP2C9. Etravirine induces CYP3A4 and UGT1A1. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with CYP3A4 inducers such as etravirine may lead to decreased ivermectin exposure thus further reducing the likelihood for ivermectin to reach efficient concentrations (ivermectin total concentrations are >45 times lower than the in vitro EC50 against SARS-CoV-2).

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Everolimus

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Everolimus is metabolized by CYP3A4 which is not affected by ivermectin. Ivermectin is a substrate of CYP3A4 and P-gp. Everolimus is thought to be a weak inhibitor of intestinal CYP3A4. However, a clinically relevant interaction is unlikely.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Evolocumab

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Evolocumab is a monoclonal IgG antibody. Elimination is similar to endogenous IgG and occurs primarily via proteolytic catabolism throughout the body.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Exenatide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Exenatide is cleared mainly by glomerular filtration. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ezetimibe

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ezetimibe is glucuronidated by UGTs 1A1 and 1A3 and to a lesser extent by UGTs 2B15 and 2B7. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Famotidine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Famotidine is eliminated by renal excretion via OAT3 (65-70%) and by metabolic routes (30-35%). Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Favipiravir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Favipiravir is mainly metabolized by aldehyde oxidase and undergoes no CYP-mediated metabolism. Favipiravir inhibits CYP2C8 and is a moderate inhibitor of OAT1 and OAT3. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Felodipine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Felodipine is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Fenofibrate

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Fenofibrate is hydrolyzed to an active metabolite, fenofibric acid. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Fentanyl

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Fentanyl undergoes extensive CYP3A4 metabolism. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Finasteride (1 mg)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Finasteride is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Fish oils

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Flecainide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Flecainide is metabolized mainly via CYP2D6, with a proportion of the parent drug also eliminated unchanged renally. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Flucloxacillin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Flucloxacillin is mainly eliminated renally partly by glomerular filtration and partly by active secretion via OAT1. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Fluconazole

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Fluconazole is mainly eliminated renally by glomerular filtration and is a moderate inhibitor of CYP3A4 and CYP2C9. Ivermectin is a substrate of CYP3A4 and P-gp. Moderate CYP3A4 inhibitors such as fluconazole are unlikely to cause a clinically significant interaction due to the wide safety margin of ivermectin.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Flucytosine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Flucytosine is metabolized to 5-flurouracil which is further metabolized by dihydropyrimidine dehydrogenase. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Fludrocortisone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Fludrocortisone is metabolized in the liver to inactive metabolites, possibly via CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Flunisolide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Flunisolide is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Flunitrazepam

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Flunitrazepam is metabolized mainly via CYPs 3A4 and 2C19. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp. However, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents such as benzodiazepines.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Fluocinolone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely with the topical use of fluocinolone. Fluocinolone undergoes hepatic metabolism. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Fluoxetine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Fluoxetine is metabolized by CYPs 2D6 and 2C9 and to a lesser extent by CYPs 2C19 and 3A4 to form norfluoxetine. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Fluphenazine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Fluphenazine is metabolized by CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Flurazepam

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. The metabolism of flurazepam is most likely CYP-mediated. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp. However, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents such as benzodiazepines.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Fluticasone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Fluticasone is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Fluvastatin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Fluvastatin is mainly metabolized by CYP2C9. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Fluvoxamine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Fluvoxamine is extensively metabolized, mainly by CYP2D6 and to a lesser extent by CYP1A2. Ivermectin does not inhibit or induce CYPs. Ivermectin is a substrate of CYP3A4 and P-gp. The ivermectin product label advises caution when administering with strong inhibitors of CYP3A4. Fluvoxamine is a moderate inhibitor of CYP3A4 and may increase ivermectin concentrations to a limited extent. Caution is advised and monitor for adverse effects.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Folic acid

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Folic acid is metabolized to dihydrofolic acid and tetrahydrofolic acid with the aid of reduced diphosphopyridine nucleotide and folate reductases. Ivermectin does not interfere with this metabolic pathway.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Fondaparinux

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Fondaparinux does not undergo cytochrome metabolism but is eliminated predominantly renally. Ivermectin is a substrate of CYP3A4 and P-gp. However, ivermectin is reported to inhibit vitamin-K clotting factors and there are post-marketing reports that coadministration with warfarin can increase INR. Use with caution and monitor INR.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Formoterol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Formoterol is eliminated primarily by direct glucuronidation, with O-demethylation (by CYPs 2D6, 2C19, 2C9, and 2A6) followed by further glucuronidation being another pathway. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Fosinopril

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Fosinopril is hydrolysed by esterases in the GI mucosa and liver. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Fostemsavir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Fostemsavir is a prodrug and is hydrolysed to the active compound temsavir in the small intestine. Temsavir is mainly metabolized by esterase-mediated hydrolysis with a small contribution of CYP3A4. Temsavir does not inhibit or induce CYP enzymes. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Furosemide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Furosemide is glucuronidated mainly in the kidney (UGT1A9) and to a lesser extent in the liver (UGT1A1). A large proportion of furosemide is also eliminated unchanged renally (via OATs). Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Gabapentin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Gabapentin is cleared mainly by glomerular filtration. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Gemfibrozil

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Gemfibrozil is mainly glucuronidated by UGT2B7.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Gentamicin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Gentamicin is eliminated unchanged predominantly via glomerular filtration. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Gestodene (COC)

Quality of Evidence: Very Low

Summary:

Coadministration with a gestodene-containing combined oral contraceptive (COC) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Gestodene is metabolized by CYP3A4 and to a lesser extent by CYP2C9 and CYP2C19. Ethinylestradiol is metabolized by hydroxylation and glucuronidation. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Glecaprevir/Pibrentasvir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Glecaprevir and pibrentasvir are mainly eliminated by biliary/faecal excretion. Glecaprevir/pibrentasvir is a weak CYP3A4 inhibitor and a strong P-gp inhibitor. Ivermectin is a substrate of CYP3A4 and P-gp. Weak CYP3A4 inhibitors such as glecaprevir/pibrentasvir are unlikely to cause a clinically significant interaction due to the wide safety margin of ivermectin. However, coadministration with a strong P-gp inhibitor such as glecaprevir/pibrentasvir may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Glibenclamide (Glyburide)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Glibenclamide is mainly metabolized by CYP3A4 and to a lesser extent by CYP2C9. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Gliclazide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Gliclazide is metabolized mainly by CYP2C9 and to a lesser extent by CYP2C19. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Glimepiride

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Glimepiride is metabolized by CYP2C9. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Glipizide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Glipizide is metabolized mainly by CYP2C9. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Glycopyrronium bromide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Glycopyrronium bromide is mainly eliminated renally (active secretion via organic cation transporter) and is also partly hydroxylated via multiple CYPs. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Granisetron

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Granisetron is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Griseofulvin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Griseofulvin is metabolized by CYP3A4 and glucuronidation. Less than 1% of a griseofulvin dose is excreted unchanged via the kidneys. Griseofulvin is a moderate CYP3A4 inducer. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with CYP3A4 inducers such as griseofulvin may lead to decreased ivermectin exposure thus further reducing the likelihood for ivermectin to reach efficient concentrations (ivermectin total concentrations are >45 times lower than the in vitro EC50 against SARS-CoV-2).

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Guaifenesin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Guaifenesin undergoes oxidation and demethylation. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Haloperidol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Haloperidol has a complex metabolism as it undergoes glucuronidation (UGT2B7>1A4, 1A9), carbonyl reduction as well as oxidative metabolism (CYP3A4, CYP2D6). Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Halothane

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. In vitro data indicate that halothane undergoes oxidation (mainly via CYP2E1 and to a lesser extent CYP2A6) and reduction (via CYP2A6 and CYP3A4). Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Heparin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Heparin is thought to be eliminated via the reticuloendothelial system. Ivermectin is a substrate of CYP3A4 and P-gp. However, ivermectin is reported to inhibit vitamin-K clotting factors and there are post-marketing reports that coadministration with warfarin can increase INR. Use with caution and monitor INR.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Hydralazine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Hydralazine is metabolized via primary oxidative metabolism and acetylation. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Hydrochlorothiazide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Hydrochlorothiazide is not metabolized and is cleared by the kidneys via OAT1. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Hydrocodone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Hydrocodone is metabolized by CYP2D6 to hydromorphone and by CYP3A4 to norhydrocodone, both of which have analgesic effects. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Hydrocortisone (oral or IV)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ivermectin is a substrate of CYP3A4 and P-gp. Hydrocortisone neither induces nor inhibits CYPs.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Hydrocortisone (topical)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely with the topical use of hydrocortisone. Hydrocortisone is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Hydromorphone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Hydromorphone is eliminated via glucuronidation, mainly by UGT2B7. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Hydroxychloroquine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Hydroxychloroquine undergoes CYP mediated metabolism by CYPs 2C8, 3A4 and 2D6. Elimination is mainly via the urine, with 3% of the administered dose recovered over 24 hours. Hydroxychloroquine is a moderate inhibitor of CYP3A4 and P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Moderate CYP3A4 inhibitors such as hydroxychloroquine are unlikely to cause a clinically significant interaction. However, coadministration with a P-gp inhibitor such as hydroxychloroquine may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Hydroxyzine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Hydroxyzine is partly metabolized by alcohol dehydrogenase and partly by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ibalizumab-uiyk

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. No drug interaction studies have been conducted with ibalizumab: based on ibalizumab’s mechanism of action and target-mediated drug disposition, drug-drug interactions are not expected.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ibuprofen

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ibuprofen is metabolized mainly by CYP2C9 and to a lesser extent by CYP2C8 and direct glucuronidation. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Iloperidone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Iloperidone is metabolized by CYP3A4 and CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Iloprost

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Iloprost is extensively metabolized via beta oxidation of the carboxyl side chain with only a minor role for CYP metabolism. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Imipenem/Cilastatin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Imipenem/cilastatin are eliminated by glomerular filtration and, to a lesser extent, by active tubular secretion. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Imipramine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Imipramine is metabolized by CYPs 3A4, 2C19 and 1A2 to desipramine. Imipramine and desipramine are both metabolized by CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Indacaterol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Indacaterol is eliminated partly unchanged (33%) and partly metabolized by CYP3A4 and UGT1A1. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Indapamide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Indapamide is extensively metabolized by CYP450. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Infliximab

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Infliximab is a TNF-alpha inhibitor and undergoes via binding to its target antigen. Ivermectin is a substrate of CYP3A4 and P-gp. Infliximab, per se, has no inhibitory or inducing effects on cytochromes. Patients infected with COVID-19 may experience an elevation of IL-6 which has been shown to suppress expression/activity of CYP3A4, CYP2C19, CYP2C9 and CYP1A2. Infliximab will normalize cytochrome activity (via reduction of IL-6) but no significant effect on ivermectin is expected and no a priori dose adjustment is required.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Insulin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Interferon beta

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ivermectin is a substrate of CYP3A4 and P-gp. Interferon beta is unlikely to affect this pathway to a clinically relevant extent.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ipratropium bromide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. A small proportion of an inhaled ipratropium dose is systemically absorbed (6.9%). Metabolism is via ester hydrolysis and conjugation. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Irbesartan

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Irbesartan is metabolized by glucuronidation and oxidation (mainly CYP2C9). Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Isavuconazole

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Isavuconazole is metabolized by CYP3A4/5 and UGTs. Isavuconazole is a moderate inhibitor of CYP3A4/5, a mild inducer of CYP2B6, and a mild inhibitor of P-gp, BCRP, OCT2 and UGT. Ivermectin is a substrate of CYP3A4 and P-gp. Moderate CYP3A4 inhibitors such as isavuconazole are unlikely to cause a clinically significant interaction due to the wide safety margin of ivermectin.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Isoflurane

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Isoflurane is almost exclusively eliminated unchanged by the lungs. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Isoniazid

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Isoniazid is acetylated in the liver to form acetylisoniazid which is then hydrolysed to isonicotinic acid and acetylhydrazine. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Isosorbide dinitrate

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Isosorbide dinitrate undergoes extensive first past metabolism, predominantly in the liver, with less than 30% of a dose undergoing subsequent glucuronidation. In vitro studies suggest that CYP3A4 has a role in nitric oxide formation from isosorbide dinitrate. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Itraconazole

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Itraconazole is metabolized by CYP3A4. Itraconazole is a strong inhibitor of CYP3A4 and P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. The ivermectin product label advises caution when administering with strong inhibitors of CYP3A4. Coadministration with a strong P-gp inhibitor such as itraconazole may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ivabradine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ivabradine is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Kanamycin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Kanamycin is eliminated unchanged predominantly via glomerular filtration. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ketamine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ketamine is mainly metabolized by CYP3A4 and to a lesser extent by CYPs 2B6 and 2C9 in the range of concentrations used in anaesthesia. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Ketoconazole

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Ketoconazole is metabolized by CYP3A4. Ketoconazole is a strong inhibitor of CYP3A4 and P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. The ivermectin product label advises caution when administering with strong inhibitors of CYP3A4. Coadministration with a strong P-gp inhibitor such as ketoconazole may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Labetalol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Labetalol is mainly glucuronidated by UGTs 1A1 and 2B7. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Lacidipine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Lacidipine is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Lacosamide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Lacosamide is metabolized to O-desmethyl-lacosamide mainly by CYP2C19 (approximatively 30% of the dose) and is eliminated unchanged through the kidneys (approximately 40% of the dose). Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Lactulose

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Metabolism of lactulose to lactic acid occurs via gastro-intestinal microbial flora only.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Lamivudine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Lamivudine is eliminated renally. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Lamotrigine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Lamotrigine is mainly glucuronidated by UGT1A4. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Lansoprazole

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Lansoprazole is mainly metabolized by CYP2C19 (major) and CYP3A4 (minor). Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ledipasvir/Sofosbuvir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Biliary excretion of unchanged ledipasvir is a major route of elimination. Sofosbuvir is a prodrug and formation of its active metabolite is unlikely to be affected by comedications. Ledipasvir/sofosbuvir is a weak CYP3A4 and P-gp inhibitor. Ivermectin is a substrate of CYP3A4 and P-gp. Weak CYP3A4 inhibitors such as ledipasvir/sofosbuvir are unlikely to cause a clinically significant interaction due to the wide safety margin of ivermectin.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Lercanidipine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Lercanidipine is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Levetiracetam

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Levetiracetam undergoes enzymatic hydrolysis (non CYP) and is eliminated unchanged in the urine by glomerular filtration. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Levodopa

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. In the presence of a peripheral dopa-decarboxylase inhibitor (carbidopa or benserazide) levodopa is metabolised mainly to 3-O-methyldopa by catechol-O-methyltransferase.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Levofloxacin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Levofloxacin is eliminated renally mainly by glomerular filtration and active secretion (possibly OCT2). Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Levomepromazine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Levomepromazine is metabolized by CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Levonorgestrel (COC)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Levonorgestrel is metabolized by CYP3A4 and is glucuronidated to a minor extent. Ethinylestradiol is metabolized by hydroxylation and glucuronidation. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Levonorgestrel (Emergency Contraception)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Levonorgestrel is metabolized by CYP3A4 and is glucuronidated to a minor extent. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Levonorgestrel (HRT)

Quality of Evidence: Very Low

Summary:

Coadministration with levonorgestrel as hormone replacement therapy (HRT) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Levonorgestrel is metabolized by CYP3A4 and is glucuronidated to a minor extent. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Levonorgestrel (IUD)

Quality of Evidence: Very Low

Summary:

Coadministration with a levonorgestrel intra-uterine device (IUD) has not been studied but there is little potential for an interaction given the local mechanism of action of levonorgestrel.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Levonorgestrel (POP)

Quality of Evidence: Very Low

Summary:

Coadministration with a levonorgestrel progestogen-only pill (POP) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Levonorgestrel is metabolized by CYP3A4 and is glucuronidated to a minor extent. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Levonorgestrel (implant)

Quality of Evidence: Very Low

Summary:

Coadministration with a levonorgestrel progestogen-only implant has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Levonorgestrel is metabolized by CYP3A4 and is glucuronidated to a minor extent. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Levothyroxine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ivermectin is a substrate of CYP3A4 and P-gp. Levothyroxine is metabolized by deiodination (by enzymes of deiodinase family) and glucuronidation.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Lidocaine (Lignocaine)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. CYP1A2 is the predominant enzyme involved in lidocaine metabolism in the range of therapeutic concentrations with a minor contribution from CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Linagliptin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Linagliptin is mainly eliminated as parent compound in faeces, with metabolism by CYP3A4 representing a minor elimination pathway. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Linezolid

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Linezolid undergoes non-CYP mediated metabolism. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Liraglutide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Liraglutide is degraded by endogenous endopeptidases. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Lisinopril

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Lisinopril is eliminated unchanged renally via glomerular filtration. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Lithium

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Lithium is mainly eliminated unchanged through the kidneys and is freely filtered at a rate that is dependent upon the glomerular filtration rate. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Loperamide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Loperamide is metabolized by CYP2C8 and CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Lopinavir/ritonavir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Lopinavir/ritonavir is metabolized by CYP3A and is a strong inhibitor of this enzyme. Lopinavir/ritonavir is a strong P-gp inhibitor. Ivermectin is a substrate of CYP3A4 and P-gp. The ivermectin product label advises caution when administering with strong inhibitors of CYP3A4. Moreover, coadministration with a strong P-gp inhibitor such as lopinavir/ritonavir may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Lorazepam

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Lorazepam is mainly glucuronidated (by UGTs 2B15, 2B4, 2B7, 1A7, 1A10). Ivermectin is a substrate of CYP3A4 and P-gp. However, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents such as benzodiazepines.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Lormetazepam

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Lormetazepam is mainly glucuronidated (possibly by UGTs 2B15, 1A9 and 2B7). Ivermectin is a substrate of CYP3A4 and P-gp. However, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents such as benzodiazepines.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Losartan

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Losartan is converted to its active metabolite mainly by CYP2C9. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Lovastatin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Lovastatin is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Macitentan

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Macitentan is metabolized mainly by CYP3A4 and to a lesser extent by CYPs 2C19, 2C9 and 2C8. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Magnesium salts (oral)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Oral magnesium salts have the properties of antacids and the product labels recommend that they are not taken within two to four hours of any other medicinal products to minimise interactions. However, absorption of ivermectin is unlikely to be influenced by changes in gastric pH and a clinically significant interaction is not expected.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Magnesium sulfate (IV)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Magnesium is eliminated in the kidney, mainly by glomerular filtration. Ivermectin does not affect this pathway.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Maprotiline

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Maprotiline is mainly metabolized by CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Maraviroc

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Maraviroc is primarily metabolized by CYP3A4. Maraviroc has no inhibitory or inducing effects on drug metabolizing enzymes. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Medroxyprogesterone (depot injection)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Medroxyprogesterone is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Medroxyprogesterone (oral)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Medroxyprogesterone is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Mefenamic acid

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Mefenamic acid is metabolized by CYP2C9 and additionally glucuronidated by UGT2B7 and UGT1A9. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Megestrol acetate

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Megestrol acetate is mainly eliminated in the urine. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Melatonin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Melatonin is metabolized by CYP1A2 and CYP1A1. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Memantine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Memantine is eliminated by active renal secretion via the organic cationic transport system (OCT2). Ivermectin does not affect this pathway.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Meropenem

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Meropenem is primarily eliminated by the kidney and in vitro data suggest that it is a substrate of the renal transporters OAT3/OAT1. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Metamizole

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Metamizole is a pro-drug that undergoes hydrolysis to 4-methylaminoantipyrine (MAA) which is then metabolised by CYPs 3A4, 2B6, 2C8 and 2C9. Metamizole is a moderate inducer of CYP3A4 and a strong inducer of CYP2B6 in vitro. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with CYP3A4 inducers such as metamizole may lead to decreased ivermectin exposure thus further reducing the likelihood for ivermectin to reach efficient concentrations (ivermectin total concentrations are >45 times lower than the in vitro EC50 against SARS-CoV-2).

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Metformin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Metformin is mainly eliminated unchanged in the urine via OCT2 and MATE1. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Methadone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Methadone is metabolized by CYP2B6 and CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Methotrexate (immunosuppressant)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Methotrexate is mainly eliminated renally via glomerular filtration and active renal secretion whereas ivermectin is metabolized by CYP3A4.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Methyldopa

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Methyldopa is excreted in urine largely by glomerular filtration, primarily unchanged, and as the mono-O-sulfate conjugate. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Methylprednisolone (oral or IV)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ivermectin is a substrate of CYP3A4 and P-gp. Methylprednisolone neither induces nor inhibits CYPs.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Methylprednisolone (topical)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely with the topical use of methylprednisolone. Methylprednisolone is metabolized by CYP3A4, but neither induces nor inhibits CYPs. Ivermectin is a substrate of CYP3A4 and P-gp, but does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Metoclopramide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Metoclopramide is partially metabolized by CYP450 system (mainly CYP2D6). Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Metolazone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Metolazone is largely excreted unchanged in the urine. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Metoprolol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Metoprolol is mainly metabolized by CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Metronidazole

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Metronidazole is eliminated via glomerular filtration. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Mexiletine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Mexiletine is metabolized mainly by CYP2D6 and to a lesser extent CYP1A2. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Mianserin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Mianserin is metabolized by CYPs 2D6 and 1A2, and to a lesser extent by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Micafungin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Micafungin has a low potential for CYP3A-mediated interactions as CYP3A is not a major pathway for micafungin metabolism in vivo. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Miconazole

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Miconazole is largely metabolized and less than 1% of an administered dose is excreted unchanged in the urine. Miconazole is a moderate inhibitor of both CYP2C9 and CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Weak CYP3A4 inhibitors such as miconazole are unlikely to cause a clinically significant interaction due to the wide safety margin of ivermectin.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Midazolam (oral)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Midazolam is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp. However, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents such as benzodiazepines.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Midazolam (parenteral)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Midazolam is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp. However, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents such as benzodiazepines.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Milnacipran

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Milnacipran is mainly eliminated unchanged (50%), and as glucuronides (30%) and oxidative metabolites (20%). Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Mirabegron

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Mirabegron is metabolized by multiple pathways including hydrolysis, glucuronidation, and oxidation by CYP2D6 and CYP3A4. It is also a substrate of P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Mirtazapine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Mirtazapine is metabolized to 8-hydroxymirtazapine by CYP2D6 and CYP1A2, and to N-desmethylmirtazapine mainly by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Molnupiravir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ivermectin is a substrate of CYP3A4 and P-gp. Molnupiravir does not inhibit or induce CYPs and is unlikely to have significant drug-drug interactions with other therapies. Molnupiravir is rapidly metabolized by esterases to a nucleoside metabolite which is phosphorylated to an active triphosphate.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Mometasone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Mometasone is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Montelukast

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Montelukast is mainly metabolized by CYP2C8 and to a lesser extent by CYPs 3A4 and 2C9. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Morphine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Morphine is mainly glucuronidated to morphine-3-glucuronide (UGT2B7>UGT1A1) and, to a lesser extent, to the pharmacologically active morphine-6-glucuronide (UGT2B7>UGT1A1). Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Moxifloxacin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Moxifloxacin is predominantly glucuronidated by UGT1A1. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Moxonidine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Moxonidine is only minimally metabolized and is eliminated renally, mainly as unchanged moxonidine. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Mycophenolate

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Mycophenolate is mainly glucuronidated by UGTs 1A9 and 2B7. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Nandrolone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Nandrolone is metabolized in the liver by alpha-reductase. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Naproxen

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Naproxen is mainly glucuronidated by UGT2B7 (major) and demethylated to desmethylnaproxen by CYP2C9 (major) and CYP1A. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Nateglinide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Nateglinide is mainly metabolized by CYP2C9 (70%) and to a lesser extent CYP3A4 (30%). Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Nebivolol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Nebivolol metabolism involves CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Weak Interaction

_Ivermectin (old primary)

Nefazodone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Nefazodone is metabolized mainly by CYP3A4 and is a strong inhibitor of CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. The ivermectin product label advises caution when administering with strong inhibitors of CYP3A4. However, unlike P-gp inhibitors, CYP3A4 inhibitors are not expected to increase ivermectin transfer across the blood-brain barrier.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Nevirapine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Nevirapine is metabolized by CYP3A4. Nevirapine induces CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with CYP3A4 inducers such as nevirapine may lead to decreased ivermectin exposure thus further reducing the likelihood for ivermectin to reach efficient concentrations (ivermectin total concentrations are >45 times lower than the in vitro EC50 against SARS-CoV-2).

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Nicardipine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Nicardipine is metabolized mainly by CYP3A4 and to a lesser extent by CYP2D6 and CYP2C8. Nicardipine is a moderate inhibitor of CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Moderate CYP3A4 inhibitors such as nicardipine are unlikely to cause a clinically significant interaction due to the wide safety margin of ivermectin. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Niclosamide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ivermectin is a substrate of CYP3A4 and P-gp. Niclosamide does not inhibit or induce CYPs.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Nifedipine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Nifedipine is metabolized mainly by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Nimesulide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Nimesulide is extensively metabolized in the liver following multiple pathways including CYP2C9. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Nirmatrelvir/ritonavir (5 days)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Nirmatrelvir/ritonavir is metabolized by CYP3A and is a strong inhibitor of this enzyme, and a strong P-gp inhibitor. Ivermectin is a substrate of CYP3A4 and P-gp. The ivermectin product label advises caution when administering with strong inhibitors of CYP3A4. Moreover, coadministration with a strong P-gp inhibitor such as ritonavir, may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Nisoldipine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Nisoldipine is metabolized mainly by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Nitazoxanide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Nitazoxanide is rapidly hydrolyzed to an active metabolite, tizoxanide. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Nitrendipine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Nitrendipine is extensively metabolized mainly by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Nitrofurantoin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Nitrofurantoin is partly metabolized in the liver via glucuronidation and N-acetylation and partly eliminated in the urine as unchanged drug. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Nitrous oxide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Most inhaled nitrous oxide is rapidly eliminated unchanged through the lungs. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Noradrenaline (Norepinephrine)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Noradrenaline is metabolized by catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO), with up to 16% of an intravenous dose is excreted unchanged in the urine. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Norelgestromin (patch)

Quality of Evidence: Very Low

Summary:

Coadministration with transdermally delivered norelgestromin/ethinylestradiol has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Norelgestromin is metabolized to norgestrel (possibly by CYP3A4). Ethinylestradiol is mainly metabolized by hydroxylation and glucuronidation. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Norethisterone [Norethindrone] (COC)

Quality of Evidence: Very Low

Summary:

Coadministration of a combined oral contraceptive (COC) containing norethisterone and ethinylestradiol has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Norethisterone is metabolized by CYP3A4 and is also glucuronidated. Ethinylestradiol is metabolized by hydroxylation and glucuronidation. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Norethisterone [Norethindrone] (HRT)

Quality of Evidence: Very Low

Summary:

Coadministration with norethisterone as hormone replacement therapy (HRT) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Norethisterone is metabolized by CYP3A4 and is also glucuronidated. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Norethisterone [Norethindrone] (IM depot injection)

Quality of Evidence: Very Low

Summary:

Coadministration of a norethisterone IM depot injection has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Norethisterone is metabolized by CYP3A4 and is also glucuronidated. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Norethisterone [Norethindrone] (POP)

Quality of Evidence: Very Low

Summary:

Coadministration with a norethisterone progestogen-only pill (POP) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Norethisterone is metabolized by CYP3A4 and is also glucuronidated. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Norgestimate (COC)

Quality of Evidence: Very Low

Summary:

Coadministration of a combined oral contraceptive (COC) containing norgestimate has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Norgestimate is deacetylated to the active metabolite norelgestromin which is then metabolized to norgestrel, possibly by CYP3A4. Ethinylestradiol is metabolized by hydroxylation and glucuronidation. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Norgestrel (COC)

Quality of Evidence: Very Low

Summary:

Coadministration of a combined oral contraceptive (COC) containing norgestrel/ethinylestradiol has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Norgestrel is a racemic mixture with levonorgestrel being biologically active. Levonorgestrel is metabolized by CYP3A4 and is glucuronidated to a minor extent. Ethinylestradiol is metabolized by hydroxylation and glucuronidation.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Norgestrel (HRT)

Quality of Evidence: Very Low

Summary:

Coadministration with norgestrel as hormone replacement therapy (HRT) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Norgestrel is a racemic mixture with levonorgestrel being biologically active. Levonorgestrel is metabolized by CYP3A4 and is glucuronidated to a minor extent. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Nortriptyline

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Nortriptyline is metabolized mainly by CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Nystatin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Systemic absorption of nystatin from oral or topical dosage forms is not significant, therefore no drug interactions are expected.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ofloxacin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ofloxacin is eliminated unchanged in the kidneys by glomerular filtration and active tubular secretion via both cationic and anionic transport systems. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Olanzapine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Olanzapine is metabolized mainly by CYP1A2, but also by glucuronidation (UGT1A4). Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Olmesartan

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Olmesartan medoxomil is de-esterified to the active metabolite olmesartan, which is eliminated in the faeces and urine. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Olodaterol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Olodaterol is metabolized by CYP2C8, CYP2C9, is glucuronidated via several UGTs, and is a substrate of P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Ombitasvir/Paritaprevir/r

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Ombitasvir is primarily metabolized by amide hydrolysis followed by oxidative metabolism, with only a minor contribution from CYP enzymes. Paritaprevir is metabolized by CYP3A4 and CYP3A5. Ritonavir is metabolized by CYP3A and CYP2D6 and is a strong CYP3A4 and P-gp inhibitor. Ivermectin is a substrate of CYP3A4 and P-gp. The ivermectin product label advises caution when administering with strong inhibitors of CYP3A4. Moreover, coadministration with a strong P-gp inhibitor such as ritonavir may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Ombitasvir/Paritaprevir/r + Dasabuvir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Ombitasvir is primarily metabolized by amide hydrolysis followed by oxidative metabolism, with only a minor contribution from CYP enzymes. Paritaprevir is metabolized by CYP3A4 and CYP3A5. Ritonavir is metabolized by CYP3A and CYP2D6 and is a stronger CYP3A4 and P-gp inhibitor. Dasabuvir is metabolized by CYP2C8 and CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. The ivermectin product label advises caution when administering with strong inhibitors of CYP3A4. Moreover, coadministration with a strong P-gp inhibitor such as ritonavir may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Omeprazole

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Omeprazole is mainly metabolized by CYP2C19 (major) and CYP3A4 (minor). Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ondansetron

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ondansetron is metabolized mainly by CYP1A2 and CYP3A4 and to a lesser extent by CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Oseltamivir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Oseltamivir is converted to oseltamivir carboxylate by esterases. The latter is excreted in the urine by glomerular filtration and tubular secretion by OAT1. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Oxandrolone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Oxandrolone is mainly eliminated renally. Ivermectin is a substrate of CYP3A4 and P-gp

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Oxazepam

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Oxazepam is mainly glucuronidated (by UGTs 2B15, 1A9 and 2B7). Ivermectin is a substrate of CYP3A4 and P-gp. However, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents such as benzodiazepines.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Oxcarbazepine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Oxcarbazepine is rapidly reduced by cytosolic arylketone reductases to its active metabolite, 10-hydroxycarbazepine. Oxcarbazepine is a CYP3A4 and P-gp inducer. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with CYP3A4 inducers such as oxcarbazepine may lead to decreased ivermectin exposure thus further reducing the likelihood for ivermectin to reach efficient concentrations (ivermectin total concentrations are >45 times lower than the in vitro EC50 against SARS-CoV-2).

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Oxprenolol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Oxprenolol is largely metabolized by glucuronidation. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Oxycodone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Oxycodone is metabolized principally by CYP3A and CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Paliperidone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Paliperidone is primarily eliminated renally (possibly OCT), with minimal metabolism occurring via CYPs 2D6 and 3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Pantoprazole

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Pantoprazole is mainly metabolized by CYP2C19 (major) and CYP3A4 (minor).

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Para-aminosalicylic acid

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Para-aminosalicylic acid and its acetylated metabolite are mainly excreted in the urine by glomerular filtration and tubular secretion. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Paracetamol (Acetaminophen)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Paracetamol is mainly metabolized by glucuronidation (via UGT1A9 (major), UGT1A6, UGT1A1, UGT2B15) and sulfation and, to a lesser extent, by oxidation. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Paroxetine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Paroxetine is mainly metabolized by CYPs 2D6 and 3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Penicillins

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Penicillins are mainly eliminated in the urine (20% by glomerular filtration and 80% by tubular secretion via OAT). Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Perampanel

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Perampanel is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Perazine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Perazine is demethylated by CYP3A4 and to a lesser extent by CYP2C9, and oxidated by FMO3. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Periciazine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. The metabolism of periciazine has not been well characterized but is likely to involve CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Perindopril

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Perindopril is hydrolysed to the active metabolite perindoprilat and is metabolized to other inactive metabolites. Elimination occurs predominantly via the urine. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Perphenazine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Perphenazine is metabolized by CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Pethidine (Meperidine)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Pethidine is metabolized mainly by CYP2B6 and to a lesser extent by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Phenelzine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Phenelzine is primarily metabolized by oxidation via monoamine oxidase and to a lesser extent by acetylation. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Phenobarbital (Phenobarbitone)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Phenobarbital is metabolized by CYP2C19 and CYP2C9 (major), and to a lesser extent by CYP2E1. Phenobarbital is a CYP3A4 and P-gp inducer. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with CYP3A4 inducers such as phenobarbital may lead to decreased ivermectin exposure thus further reducing the likelihood for ivermectin to reach efficient concentrations (ivermectin total concentrations are >45 times lower than the in vitro EC50 against SARS-CoV-2). In addition, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents such as barbiturates.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Phenprocoumon

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Phenprocoumon is metabolized by CYP2C9 and CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp. However, ivermectin is reported to inhibit vitamin-K clotting factors and there are post-marketing reports that coadministration with warfarin can increase INR. Use with caution and monitor INR.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Phenytoin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Phenytoin is mainly metabolized by CYP2C9 and to a lesser extent by CYP2C19. Phenytoin is a CYP3A4 and P-gp inducer. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with CYP3A4 inducers such as phenytoin may lead to decreased ivermectin exposure thus further reducing the likelihood for ivermectin to reach efficient concentrations (ivermectin total concentrations are >45 times lower than the in vitro EC50 against SARS-CoV-2).

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Pimozide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Pimozide is metabolized mainly by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Pindolol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Pindolol is partly metabolized to hydroxymetabolites (possibly by CYP2D6) and partly eliminated unchanged in the urine. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Pioglitazone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Pioglitazone is metabolized by mainly CYP2C8 and to a lesser extent by CYPs 3A4, 1A2 and 2C9. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Piperacillin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Piperacillin is eliminated renally via glomerular filtration and active secretion by OAT1/3. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Pipotiazine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. The metabolism of pipotiazine has not been well described but may involve CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Pirfenidone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Pirfenidone is mainly metabolized by CYP1A2 (70-80%) with minor contributions from CYPs 2C9, 2C19, 2D6, and 2E1. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Piroxicam

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Piroxicam is primarily metabolized by CYP2C9. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Pitavastatin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Pitavastatin is metabolized by UGTs 1A3 and 2B7 with minimal metabolism by CYPs 2C9 and 2C8. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Weak Interaction

_Ivermectin (old primary)

Posaconazole

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Posaconazole is eliminated mainly unchanged in the faeces and only a minimal amount undergoes biotransformation (mainly glucuronidation by UGT1A4). Posaconazole is a strong inhibitor of CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. The ivermectin product label advises caution when administering with strong inhibitors of CYP3A4. However, unlike P-gp inhibitors, CYP3A4 inhibitors are not expected to increase ivermectin transfer across the blood-brain barrier.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Potassium

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as potassium is eliminated renally.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Pramipexole

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Pramipexole undergoes minimal metabolism and is primarily eliminated by the kidney. In vitro data suggest that it is a substrate of the renal transporter OCT2.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Prasugrel

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Prasugrel is a prodrug and is converted to its active metabolite mainly by CYP3A4 and CYP2B6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Pravastatin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. The metabolism of pravastatin is not dependent on CYP3A. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Prazosin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Prazosin undergoes extensive hepatic metabolism primarily by demethylation and conjugation. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Prednisolone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Prednisolone is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Prednisone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Prednisone is converted to the active metabolite prednisolone by 11-B-hydroxydehydrogenase. Prednisolone is then metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Pregabalin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Pregabalin is cleared mainly by glomerular filtration. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Primidone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Primidone is metabolized by CYP3A4 to the active metabolite phenobarbital. Primidone is a CYP3A4 and P-gp inducer. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with CYP3A4 inducers such as primidone may lead to decreased ivermectin exposure thus further reducing the likelihood for ivermectin to reach efficient concentrations (ivermectin total concentrations are >45 times lower than the in vitro EC50 against SARS-CoV-2). In addition, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents such as barbiturates.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Prochlorperazine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Prochlorperazine is metabolized by CYP2D6 and CYP2C19. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Propafenone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Propafenone is metabolized mainly by CYP2D6 and to a lesser extent CYP1A2 and CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Propofol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Propofol is glucuronidated via UGT1A9 and UGT1A8 and is oxidized mainly via CYP2B6.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Propranolol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Propranolol is metabolized by 3 routes (aromatic hydroxylation by CYP2D6, N-dealkylation followed by side chain hydroxylation via CYPs 1A2, 2C19, 2D6, and direct glucuronidation). Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Prucalopride

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Prucalopride is minimally metabolized and mainly eliminated renally, partly by active secretion by renal transporters. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Pyrazinamide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Pyrazinamide is mainly metabolized by xanthine oxidase. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Pyridostigmine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Pyridostigmine is mainly eliminated unchanged by the kidney with up to 74% of renal clearance attributed to active tubular secretion. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Quetiapine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Quetiapine is metabolized mainly by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Quinapril

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Quinapril is de-esterified to the active metabolite quinaprilat, which is eliminated primarily by renal excretion via OAT3. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Quinidine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Quinidine is metabolized by CYP3A4. Quinidine is an inhibitor of P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp. Coadministration with a strong P-gp inhibitor such as quinidine may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Rabeprazole

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Rabeprazole is mainly metabolized by CYP2C19 (major) and CYP3A4 (minor).

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Raltegravir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Raltegravir is primarily metabolized by UGT1A1 and has no inhibitory or inducing effects on drug metabolizing enzymes. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ramipril

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ramipril is hydrolysed to the active metabolite ramiprilat, and is metabolized to the diketopiperazine ester, diketopiperazine acid and the glucuronides of ramipril and ramiprilat. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ranitidine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ranitidine is excreted via the kidney, partially by the cationic system but is a mild CYP3A4 inhibitor. Ivermectin is a substrate of CYP3A4 and P-gp. Weak CYP3A4 inhibitors such as ranitidine are unlikely to cause a clinically significant interaction due to the wide safety margin of ivermectin.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Ranolazine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Ranolazine is primarily metabolized by CYP3A4 and is a mild CYP3A4 inhibitor and a moderate-strong P-gp inhibitor. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with a P-gp inhibitor such as ranolazine may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Reboxetine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Reboxetine is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Remdesivir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Remdesivir is a substrate of CYP2C8, CY2D6, CYP3A4, OATP1B1 and P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Remifentanil

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Remifentanil is metabolized by non-specific blood and tissue esterases. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Repaglinide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Repaglinide is metabolized by CYPs 2C8 and 3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Retigabine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Retigabine is metabolized primarily by glucuronidation (mainly UGT1A4, with contributions from UGTs 1A1, 1A3 and 1A9) and acetylation (mainly by NAT2). There is no evidence of CYP-mediated metabolism. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ribavirin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ribavirin is partly metabolized (non CYP mediated) and partly excreted in the urine. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Rifabutin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Rifabutin is mainly metabolized by CYP3A4 and cholinesterase and is a CYP3A4 and P-gp inducer. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with CYP3A4 inducers such as rifabutin may lead to decreased ivermectin exposure thus further reducing the likelihood for ivermectin to reach efficient concentrations (ivermectin total concentrations are >45 times lower than the in vitro EC50 against SARS-CoV-2).

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Rifampicin (Rifampin)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Rifampicin is metabolized via deacetylation. Rifampicin induces CYP3A4 and P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with CYP3A4 inducers such as rifampicin may lead to decreased ivermectin exposure thus further reducing the likelihood for ivermectin to reach efficient concentrations (ivermectin total concentrations are >45 times lower than the in vitro EC50 against SARS-CoV-2).

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Rifapentine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Rifapentine is deacetylated. Rifapentine induces CYP3A4 and P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with CYP3A4 inducers such as rifapentine may lead to decreased ivermectin exposure thus further reducing the likelihood for ivermectin to reach efficient concentrations (ivermectin total concentrations are >45 times lower than the in vitro EC50 against SARS-CoV-2).

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Rifaximin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Rifaximin is mainly excreted in faeces, almost entirely as unchanged drug. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Rilpivirine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Rilpivirine is primarily metabolized by CYP3A4. Rilpivirine has no inhibitory or inducing effects on drug metabolizing enzymes. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Rilpivirine/ Emtricitabine/ Tenofovir alafenamide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Rilpivirine is primarily metabolized by CYP3A4 whereas emtricitabine and tenofovir alafenamide are eliminated renally. Rilpivirine has no inhibitory or inducing effects on drug metabolizing enzymes. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Rilpivirine/ Emtricitabine/ Tenofovir-DF

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Rilpivirine is primarily metabolized by CYP3A4 whereas emtricitabine and tenofovir-DF are eliminated renally. Rilpivirine has no inhibitory or inducing effects on drug metabolizing enzymes. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Riociguat

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Riociguat is metabolized by CYP1A1, CYP3A4, CYP2C8, CYP2J2 and is also eliminated unchanged in the bile and renally. Riociguat is a substrate of P-gp and BCRP. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Risperidone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Risperidone is metabolized by CYP2D6 and to a lesser extent by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Rivaroxaban

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Rivaroxaban is partly metabolized in the liver (by CYP3A4, CYP2J2 and hydrolytic enzymes) and partly eliminated unchanged in urine (by P-gp and BCRP). Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Rocuronium

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Rocuronium is mostly cleared in the bile although up to 30% may be excreted renally. P-gp was shown to mediate biliary excretion of rocuronium in a rat model. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Roflumilast

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Roflumilast is metabolized by CYP3A4 and CYP1A2 to form roflumilast N-oxide, with both roflumilast and roflumilast N-oxide having PDE4 inhibitory activity. Roflumilast N-oxide is subsequently dealkylated by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Rosiglitazone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Rosiglitazone is metabolized mainly by CYP2C8 and to a lesser extent by CYP2C9. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Rosuvastatin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Rosuvastatin is largely excreted unchanged via the faeces. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Rufinamide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Rufinamide is metabolized by hydrolysis and does not undergo significant CYP-mediated metabolism. However, rufinamide is a moderate CYP3A4 inducer. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with CYP3A4 inducers such as rufinamide may lead to decreased ivermectin exposure thus further reducing the likelihood for ivermectin to reach efficient concentrations (ivermectin total concentrations are >45 times lower than the in vitro EC50 against SARS-CoV-2).

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Ruxolitinib

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Ruxolitinib is metabolized by CYP3A4 (major) and CYP2D9 (minor). Ruxolitinib is a P-gp inhibitor. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with a P-gp inhibitor such as ruxolitinib may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Sacubitril

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Sacubitril is rapidly converted to LBQ657 (active metabolite) by carboxylesterases and the active metabolite is not further metabolized to a significant extent. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Salbutamol (Albuterol)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Salbutamol is metabolized to the inactive salbutamol-O-sulphate. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Salmeterol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Salmeterol is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Sarilumab

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Sarilumab, per se, has no inhibitory or inducing effects on cytochromes. Patients infected with COVID-19 may experience an elevation of IL-6 which has been shown to suppress expression/activity of CYP3A4, CYP2C19, CYP2C9 and CYP1A2. Sarilumab will normalize cytochrome activity (via inhibition of IL-6) thus no a priori dose adjustment of ivermectin is required.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Saxagliptin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Saxagliptin is mainly metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Selexipag

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Selexipag is hydrolysed to its active metabolite by carboxylesterase 1 (CES1). Both selexipag and its active metabolite undergo oxidative metabolism by CYP2C8 and CYP3A4. The active metabolite is also glucuronidated by UGT1A3 and UGT2B7. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Senna

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Senna glycosides are hydrolysed by colonic bacteria in the intestinal tract and the active anthraquinones liberated into the colon. Excretion occurs in the urine and the faeces and in other secretions. No clinically significant drug interactions are known.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Sertraline

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Sertraline is mainly metabolized by CYP2B6 and to a lesser extent by CYPs 2C9, 2C19, 2D6 and 3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Sevoflurane

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Sevoflurane is almost exclusively eliminated unchanged by the lungs. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Sildenafil (Pulmonary Arterial Hypertension)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Sildenafil is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Simvastatin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Simvastatin is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Sirolimus

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Sirolimus is metabolized by CYP3A4 and is a substrate of P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Sitagliptin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Sitagliptin is primarily eliminated in urine as unchanged drug (active secretion by OAT3, OATP4C1, P-gp), with metabolism by CYP3A4 representing a minor elimination pathway. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Sodium nitroprusside

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Sodium nitroprusside is rapidly metabolized, likely by interaction with sulfhydryl groups in the erythrocytes and tissues. Cyanogen (cyanide radical) is produced which is converted to thiocyanate in the liver by the enzyme thiosulfate sulfurtransferase. There is little potential for drug-drug interactions with sodium nitroprusside. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Sofosbuvir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Sofosbuvir is a prodrug and formation of its active metabolite is unlikely to be affected by comedications. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Sofosbuvir/Velpatasvir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Sofosbuvir is a prodrug and formation of its active metabolite is unlikely to be affected by comedications. Velpatasvir is metabolized by CYPs 2B6, 2C8 and 3A4. Sofosbuvir/velpatasvir is a weak P-gp inhibitor. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Sofosbuvir/Velpatasvir/Voxilaprevir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Sofosbuvir is a prodrug and formation of its active metabolite is unlikely to be affected by comedications. Velpatasvir is metabolized by CYPs 2B6, 2C8 and 3A4; voxilaprevir is metabolized by CYPs 3A4, 1A2 and 2C8. Sofosbuvir/velpatasvir/voxilaprevir is a weak P-gp inhibitor. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Sotrovimab

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ivermectin is a substrate of CYP3A4 and P-gp. Sotrovimab is not metabolized by CYP enzymes. Interactions with concomitant medications that are substrates, inducers, or inhibitors of CYP enzymes are unlikely.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Spectinomycin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Spectinomycin is predominantly eliminated unchanged by the kidneys via glomerular filtration. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Spironolactone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Spironolactone is partly metabolized by the flavin containing monooxygenases. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

St John's Wort

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. St John’s wort is an inducer of CYP3A4 and P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with CYP3A4 inducers such as St John’s Wort may lead to decreased ivermectin exposure thus further reducing the likelihood for ivermectin to reach efficient concentrations (ivermectin total concentrations are >45 times lower than the in vitro EC50 against SARS-CoV-2).

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Stanozolol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Stanozolol is extensively hydroxylated and conjugated followed by renal excretion. Ivermectin does not affect these pathways.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Streptokinase

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Like other proteins, streptokinase is metabolized proteolytically in the liver and eliminated via the kidneys. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Streptomycin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Streptomycin is excreted rapidly in the urine by glomerular filtration. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Sufentanil

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Sufentanil undergoes extensive CYP3A4 metabolism. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Sulfadiazine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. In vitro studies suggest that sulfadiazine is metabolized in part by CYP2C9. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Sulpiride

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Sulpiride is mainly excreted in the urine and faeces as unchanged drug. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Sultiame

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. The metabolism of sultiame has been poorly characterised but it is thought to undergo moderate metabolism in the liver. Sultiame is an inhibitor of CYP2C9 and CYP2C19. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Suxamethonium (Succinylcholine)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Suxamethonium is hydrolysed by plasma cholinesterase. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Tacrolimus

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Tacrolimus is metabolized by CYP3A4 and is a substrate of P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Tadalafil (Pulmonary Arterial Hypertension)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Tadalafil is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Tamsulosin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Tamsulosin is metabolized mainly by CYP3A4 and to a lesser extent by CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Tapentadol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Tapentadol is mainly glucuronidated by UGT1A6, UGT1A9 and UGT2B7. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Tazobactam

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Tazobactam is only minimally metabolized and is eliminated renally via glomerular filtration and active secretion by OAT1/3. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

Potential Weak Interaction

_Ivermectin (old primary)

Telithromycin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Telithromycin is metabolized by CYP3A4 and is a strong inhibitor of CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. The ivermectin product label advises caution when administering with strong inhibitors of CYP3A4. However, unlike P-gp inhibitors, CYP3A4 inhibitors are not expected to increase ivermectin transfer across the blood-brain barrier.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Telmisartan

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Telmisartan is mainly glucuronidated by UGT1A3. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Temazepam

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Temazepam is mainly glucuronidated. Ivermectin is a substrate of CYP3A4 and P-gp. However, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents such as benzodiazepines.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Tenofovir-DF

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Tenofovir disoproxil fumarate is eliminated renally. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Terazosin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Terazosin is extensively metabolized in the liver possibly via CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Terbinafine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Terbinafine is metabolized by CYPs 1A2, 2C9, 3A4 and to a lesser extent by CYPs 2C8 and 2C19. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Testosterone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Testosterone is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Tetracaine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Absorbed tetracaine is predominantly metabolized by pseudocholinesterases in the plasma. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Tetracyclines

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Tetracyclines are eliminated unchanged primarily by glomerular filtration. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Theophylline

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Theophylline is mainly metabolized by CYP1A2. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Thiopental

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. The isoenzymes involved in thiopental metabolism have not been identified. Although pentobarbital (a potent inducer of hepatic microsomal drug metabolism) is formed during thiopental metabolism, levels do not reach the therapeutic range. Ivermectin is a substrate of CYP3A4 and P-gp. However, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents such as barbiturates.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Thioridazine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Thioridazine is metabolized by CYP2D6 and to a lesser extent by CYP3A4. Thioridazine is a moderate inducer of CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Coadministration with CYP3A4 inducers such as thioridazine may lead to decreased ivermectin exposure thus further reducing the likelihood for ivermectin to reach efficient concentrations (ivermectin total concentrations are >45 times lower than the in vitro EC50 against SARS-CoV-2).

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Tiagabine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Tiagabine is metabolized by CYP3A4/5. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Tiapride

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Tiapride is excreted largely unchanged in the urine. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ticagrelor

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ticagrelor undergoes extensive CYP3A4 metabolism and is a mild CYP3A4 inhibitor. Ivermectin is a substrate of CYP3A4 and P-gp. Weak CYP3A4 inhibitors such as ticagrelor are unlikely to cause a clinically significant interaction due to the wide safety margin of ivermectin.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Timolol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Timolol is predominantly metabolized by CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Tinidazole

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Tinidazole is partly metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Tinzaparin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Tinzaparin is partially metabolized by desulfation and depolymerization and then renally excreted. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Tiotropium bromide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Tiotropium bromide is predominantly excreted unchanged in the urine. Metabolism by CYP2D6 and CYP3A4 is only a minor role in its elimination. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Tixagevimab/ Cilgavimab

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ivermectin is a substrate of CYP3A4 and P-gp. Tixagevimab and cilgavimab are not metabolized by CYP enzymes. Interactions with concomitant medications that are substrates, inducers, or inhibitors of CYP enzymes are unlikely.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Tizanidine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Tizanidine is metabolized by CYP1A2. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Tocilizumab

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Tocilizumab, per se, has no inhibitory or inducing effects on cytochromes. Patients infected with COVID-19 may experience an elevation of IL-6 which has been shown to suppress expression/activity of CYP3A4, CYP2C19, CYP2C9 and CYP1A2. Tocilizumab will normalize cytochrome activity (via inhibition of IL-6) thus no a priori dose adjustment of ivermectin is required.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Tolbutamide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Tolbutamide is mainly metabolized by CYP2C9, and to a lesser extent by CYPs 2C8 and 2C19. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Topiramate

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Topiramate is mainly eliminated by renal elimination in unchanged form (up to 60% of the dose) and partly by oxidation. Weak induction of CYP isozymes has been observed, but only with higher doses of topiramate. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Torasemide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Torasemide is metabolized mainly by CYP2C9. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Tramadol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Tramadol is metabolized by CYPs 3A4, 2B6, and 2D6. Metabolism by CYP2D6 is to a metabolite more potent than the parent compound. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Trandolapril

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Trandolapril is hydrolysed to trandolaprilat. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Tranylcypromine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Tranylcypromine is hydroxylated and acetylated. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Trazodone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Trazodone is primarily metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Treprostinil

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Treprostinil is mainly metabolized by CYP2C8 and to a lesser extent by CYP2C9. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Triamcinolone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Triamcinolone is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Triazolam

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Triazolam is metabolized by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp. However, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents such as benzodiazepines.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Trimethoprim/Sulfamethoxazole (Co-trimoxazole)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Trimethoprim is primarily eliminated by the kidneys through glomerular filtration and tubular secretion. Approximately 30% of trimethoprim is metabolized by CYPs (in vitro data suggest CYPs 3A4, 1A2 and 2C9). Sulfamethoxazole is metabolized by CYP2C9. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Trimipramine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Trimipramine is metabolized mainly by CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ulipristal

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ulipristal is metabolized mainly by CYP3A4 and to a lesser extent by CYPs 1A2 and 2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Umeclidinium bromide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Umeclidinium bromide is mainly metabolized by CYP2D6 and is a substrate of P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Valsartan

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Valsartan is eliminated unchanged mostly through biliary excretion. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Vancomycin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Vancomycin is excreted unchanged via renal glomerular filtration. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Vasopressin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Vasopressin is predominantly metabolized in the liver and kidney by serine protease, carboxipeptidase and disulfide oxido-reductase. Only about 6% of the dose is excreted unchanged in urine. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Vecuronium

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Vecuronium is partly deacetylated and partly cleared in the bile as parent compound. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Venlafaxine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Venlafaxine is mainly metabolized by CYP2D6 and to a lesser extent by CYPs 3A4, 2C19 and 2C9. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Verapamil

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Verapamil is metabolized mainly by CYP3A4 and to a lesser extent by CYPs 1A2, 2C8 and 2C9. Verapamil is a moderate inhibitor of CYP3A4 and P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Moderate CYP3A4 inhibitors such as verapamil are unlikely to cause a clinically significant interaction. However, coadministration with a P-gp inhibitor such as verapamil may increase ivermectin transfer across the blood-brain barrier leading to higher concentrations in the brain and increased risk of neurotoxicity. Use with caution and monitor for signs and symptoms of neurotoxicity.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Vigabatrin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Vigabatrin is cleared mainly by glomerular filtration. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Vilanterol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Vilanterol is metabolized by CYP3A4 and is a substrate of P-gp. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Vildagliptin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Vildagliptin is inactivated via non-CYP mediated hydrolysis. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

Potential Weak Interaction

_Ivermectin (old primary)

Voriconazole

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Voriconazole is metabolized by CYPs 2C19, 2C9 and 3A4. Voriconazole is a strong inhibitor of CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. The ivermectin product label advises caution when administering with strong inhibitors of CYP3A4. However, unlike P-gp inhibitors, CYP3A4 inhibitors are not expected to increase ivermectin transfer across the blood-brain barrier.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Vortioxetine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Vortioxetine is mainly metabolized by CYP2D6 and to a lesser extent by CYP2C9 and CYP3A4/5. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Warfarin

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Warfarin is a mixture of enantiomers which are metabolized by different cytochromes. R-warfarin is primarily metabolized by CYP1A2 and 3A4. S-warfarin (more potent) is metabolized by CYP2C9. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp. However, ivermectin is reported to inhibit vitamin-K clotting factors and there are post-marketing reports that coadministration with warfarin can increase INR. Use with caution and monitor INR.

Description:

A sixty-eight-year-old man on chronic warfarin treatment who was prescribed ivermectin for scabies presented to the emergency department with a massive hematoma under his tongue. Previous INR checks prior to initiation of ivermectin had been stable. One week before the first dose of ivermectin, his INR was 3.1, on 5 mg warfarin. One week after a single dose of 3 mg ivermectin, his INR rose to 4.2. He was told to withhold 2 doses of warfarin, and his INR decreased to 2.7 after a week. One month after the initial ivermectin dose, he took a second 3 mg dose of ivermectin as his scabies symptoms had not resolved. The following morning, he had developed the hematoma and could not swallow, and on investigation, his INR was >20. He was given 10 mg of vitamin K. The authors hypothesize a drug interaction occured between warfarin and ivermectin, which inhibits clotting factors II, VII, IX, and X in vitro.
A case of ivermectin-induced warfarin toxicity: first published report. Gilbert B & Slechta J. Hosp Pharm, 2018, 53(6):393-394.

No Interaction Expected

_Ivermectin (old primary)

Xipamide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Approximately 90% of xipamide is excreted in the urine, mainly as unchanged drug (50%) and glucuronides (30%). Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Zaleplon

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Zaleplon is mainly metabolized by aldehyde oxidase and to a lesser extent by CYP3A4. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp. However, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Zidovudine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Zidovudine is metabolized by UGT2B7 and UGT1A9. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Ziprasidone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Approximately two thirds of ziprasidone metabolic clearance is by reduction, with less than one third by CYP enzymes (mainly CYP3A4). Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Zolpidem

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Zolpidem is metabolized mainly by CYP3A4 and to a lesser extent by CYP2C9 and CYP1A2. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp. However, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Zonisamide

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Zonisamide is metabolized partly by CYP3A4 and by N-acetyltransferases and conjugation. Zonisamide is a weak inhibitor of P-gp. Ivermectin is a substrate of CYP3A4 and P-gp.

Description:

(See Summary)

Potential Interaction

_Ivermectin (old primary)

Zopiclone

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Zopiclone is metabolized mainly by CYP3A4 and to a lesser extent by CYP2C8. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp. However, caution is required as ivermectin may act as an agonist of GABA and toxic effects may be increased when combined with other gabanergic agents.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Zotepine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Zotepine is mainly metabolized by CYP3A4 and to a lesser extent by CYP1A2 and CYP2D6. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

No Interaction Expected

_Ivermectin (old primary)

Zuclopenthixol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Zuclopenthixol is metabolized by sulphoxidation, N-dealkylation (by CYP2D6 and CYP3A4) and glucuronidation. Ivermectin is a substrate of CYP3A4 and P-gp. Ivermectin does not inhibit or induce CYPs or P-gp.

Description:

(See Summary)

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