Soolantra (Topical Ivermectin) is primarily used as an antihelminthic drug used in the treatment of lice infestation. It is also used to treat the inflammatory lesions of adults with rosacea (a type of adult acne).

Soolantra (Topical Ivermectin) Uses:

• Head lice (Pediculus capitis) (Sklice lotion):

  • Topical ivermectin can be used to treat head lice infestations in patients older than six months.

• Rosacea (Soolantra cream):

  • It is approved for the treatment of adult patients with rosacea. 

Details and uses of oral ivermectin tablets (including its use in the treatment of COVID-19 and FDA-alert) is discussed here: Ivermectin Tablets - Uses, Dose, Side effects

Soolantra (Topical Ivermectin) Dose in Adults:

How much Soolantra (Topical Ivermectin) is used to treat head lice

• Topical: Lotion:
  • Apply enough lotion (up to one tube) to the dry scalp and hair to completely cover them. 
  • A single dose is adequate.

Soolantra (Topical Ivermectin) Dose in the treatment of Rosacea:

• Topical: Cream:
  • Once a day, apply the lotion to the cheeks, nose, chin, and forehead that are affected.

Soolantra (Topical Ivermectin) Dose in Children:

Soolantra (Topical Ivermectin) Dose in the treatment of Head lice:

• Topical: Lotion (Sklice):

  • Infants and toddlers older than six months, kids, and teenagers:
    • To properly cover your dry hair and scalp, apply enough of the lotion (up to one tube). 
    • It only takes one application.

Pregnancy Risk Factor C

• Animal reproduction studies have shown adverse outcomes for fetuses following oral administration.
• Manufacturers recommend the use of other preferred agents during pregnancy.

Ivermectin use during breastfeeding:

• When the drug is administered as an oral tablet, a low amount of the drug is excreted in breastmilk.
• It is recommended that breastfeeding mothers avoid it. Women should consider other options for the treatment or prevention of pediculosis pubis and scabies while breastfeeding.

Topical Ivermectin Dose in Kidney Disease:

The manufacturer has not provided any recommendations on dose adjustment in patients with kidney disease.

Topical Ivermectin Dose in Liver disease:

The manufacturer has not provided any adjustments in the dose in patients with liver disease.

Side Effects of Soolantra (Topical Ivermectin):

• Dermatologic:

  • Skin irritation

• Central nervous system:

  • Localized burning

Contraindications to Soolantra (Topical Ivermectin):

Allergy to any ingredient in the mix, including ivermectin.

Monitoring parameters:

Lotion: Monitor for live lice when applied over the scalp.

How to administer Soolantra (Topical Ivermectin)?

Topical lotion:

• Only to be used externally
• Apply thoroughly to dry scalp and hair, starting with the areas closest to the scalp and working your way toward the ends. 
• Keep running for ten minutes (start timing treatment after the scalp and hair have been completely covered). 
• After that, properly rinse the hair with warm water. 
• Avoid making eye contact. 
• Although a fine-tooth comb can be used to remove treated lice and nits, nit combing is not necessary. 
• Use the lotion only once, and then throw away any leftovers. 
• Ivermectin should only be used as a small part of a comprehensive lice eradication programme that also includes washing or dry cleaning all clothing, hats, beds, and towels that the patient has recently used or worn, as well as washing combs, brushes, and hair accessories in hot, soapy water.

Topical cream:

• only for external usage. 
• Not to be applied to the mouth, vagina, or eyes. 
• Before and after application, wash hands with soap and water. 
• Apply a thin layer of a pea-sized amount to each affected area (eg, forehead, chin, nose, each cheek)

Mechanism of action of Soolantra (Topical Ivermectin):

• Ivermectin, a semi-synthetic anti-helminthic compound, binds to glutamate-gated channels in invertebrates' nerves and muscles with strong affinity.
• This makes cell membranes more permeable to chloride ions, leading to the hyperpolarization of nerve and muscle cells and ultimately the parasite's demise.
• It is unknown what the mechanism of action of rosacea treatment is.

Protein binding:

• >99%

Metabolism:

• Metabolized in the liver by CYP3A4

Half-life elimination:

• Cream: about 6.5 days

Time to peak:

• Cream: about 10 hours after application

International Brands of Topical Ivermectin:

• Sklice
• Soolantra
• Rosiver
• Abti-Lice Lotion
• Iverzine
• Licend
• Quanox Locion
• Soolantra

Topical Ivermectin Brand Names in Pakistan:

Topical Ivermectin is not available in Pakistan.