STROMECTOL (ivermectin)

STROMECTOL (ivermectin) 

Diagnosis considered for coverage:

• Strongyloides stercoralis: treatment of intestinal (i.e., nondisseminated) strongyloidiasis due to the nematode parasite Strongyloides stercoralis.
• Onchocerca volvulus: treatment of onchocerciasis due to the nematode parasite Onchocerca volvulus.

Coverage Criteria:

For diagnosis of strongyloidiasis of the intestinal tract:

• Requested dose is approximately 0.2 mg/kg given as a single dose; AND
• Medical records document a diagnosis of intestinal (i.e., nondisseminated) strongyloidiasis due to the nematode parasite Strongyloides stercoralis.

For diagnosis of onchocerciasis:

• Requested dose is approximately 0.15 mg/kg given as a single dose; AND
• Medical records document a diagnosis of onchocerciasis due to the nematode parasite Onchocerca volvulus.

Coverage Duration:

• Strongyloidiasis of the intestinal tract: one time.
• Onchocerciasis: one time.

Authorization is not covered for the following:

The following conditions, and other uses of this drug for indications not listed in this policy, do not meet the coverage criteria established by the Western Health Advantage (WHA) Pharmacy and Therapeutics Committee.

• Requests for ivermectin for the treatment or prevention of COVID-19 infection is not authorized and will not be approved.

Additional Information:

• Dosing: Dosage Guidelines for Ivermectin 3 MG Tablets for Strongyloidiasis
  • 15-24 kg: 1 tablet; 25-35 kg: 2 tablets; 36-50 kg: 3 tablets; 51-65 kg: 4 tablets; 66-79 kg: 5 tablets; 80 kg and up: 0.2 mg/kg.
  • Additional doses are not necessary.  However, follow-up stool examinations should be performed to verify eradication of infection with Strongyloides stercoralis.
• Dosing: Dosage Guidelines for Ivermectin 3 MG Tablets for Onchocerciasis
  • 15-25 kg: 1 tablet; 26-44 kg: 2 tablets; 45-64 kg: 3 tablets; 65-84 kg: 4 tablets; 85 kg and up: 0.15 mg/kg.
  • The patient should be reminded that treatment with ivermectin does not kill the adult Onchocerca parasites, and therefore repeated follow-up and retreatment is usually required.
  • In mass distribution campaigns in international treatment programs, the most commonly used dose interval is 12 months.  For the treatment of individual patients, retreatment may be considered at intervals as short as 3 months.
• Stromectol (ivermectin) has no activity against adult Onchocerca volvulus parasites.  The adult parasites reside in subcutaneous nodules which are infrequently palpable.  Surgical excision of these nodules (nodulectomy) may be considered in the management of patients with onchocerciasis, since this procedure will eliminate the microfilariae-producing adult parasites.

Policy Updates:

• 09/15/2021 – New policy approved by P&T

References:

• COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. Available at https://www.covid19treatmentguidelines.nih.gov/. Accessed Sep 13, 2021.
• Stromectol prescribing information. Merck & Co., Inc., Whitehouse Station, NJ. November 2020.