Ivermectin 0.5% lotion is FDA-approved for head lice (Pediculus humanus capitis) in patients six months and older. It is applied once, left on for ten minutes and rinsed out, and unlike older treatments it does not require nit combing or a second application. Widespread resistance to permethrin and pyrethrin has made it an increasingly important option.
Most older pediculicides kill live lice but not eggs, which is why they demand a second application 7 to 9 days later plus laborious nit combing. Ivermectin lotion behaves differently: lice that hatch from treated eggs are unable to feed and die of starvation, because ivermectin paralyses the pharyngeal pump they use to take blood.
This is what allows a single ten-minute application to succeed where older agents needed a repeat course.
In two pivotal randomised, vehicle-controlled trials, roughly 74 to 76 percent of patients treated with a single application of ivermectin 0.5% lotion were louse-free at day 15, against about 18 percent with vehicle. Notably, participants were instructed not to nit comb, so the result reflects the lotion alone.
Surveys across North America and Europe have found very high frequencies of knockdown-resistance mutations in head lice, which confer resistance to permethrin and pyrethrins. In many regions the great majority of lice now carry them. This is the practical reason ivermectin and other newer agents have moved up the treatment order.
Oral ivermectin at 200 to 400 micrograms per kilogram, repeated after 7 to 10 days, is used off-label for difficult or repeatedly failed cases. A trial in patients who had already failed topical therapy found oral ivermectin superior to malathion lotion. It is generally reserved for treatment failures rather than first-line use.
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View products and pricingYes. Ivermectin 0.5% lotion is FDA-approved for head lice in patients six months and older, as a single ten-minute application.
No. The pivotal trials specifically instructed participants not to nit comb, and still showed roughly 74 to 76 percent louse-free at day 15. Lice hatching from treated eggs cannot feed and die.
Head lice across North America and Europe now carry knockdown-resistance mutations at very high frequency, which confer resistance to permethrin and pyrethrins. This is why newer agents including ivermectin have become more important.