The latest issue of NPS RADAR features reviews of ivermectin (Stromectol) for typical and crusted scabies, ferric carboxymaltose (Ferinject) for iron-deficiency anaemia, and tapentadol sustained release (Palexia SR) for chronic severe disabling pain. All three treatments are now listed on the Pharmaceutical Benefits Scheme (PBS).
Ivermectin is an oral avermectin acaricide — a class of broad spectrum antiparastic agents. It is a second line treatment for typical scabies but topical treatments (permethrin 5% cream or benzyl benzonate 25% lotion) remain the first line treatment. Ivermectin in conjunction with topical treatment is the only treatment option indicated for crusted scabies.
Oral ivermectin has been shown to be superior to placebo and has been used successfully in the community management of endemic scabies. Despite significant heterogeneity across clinical trials in studies comparing ivermectin with topical treatments, guidelines recommend ivermectin as an alternative after failure of both permethrin and benzyl benzoate or in people for whom topical treatment is contraindicated.
Ivermectin is well tolerated with a low number of adverse effects. It is not recommended for use in pregnancy as safety has not been established and there are limited safety data in the very old, very young and patients with liver impairment. Patients should take ivermectin with food to enhance its bioavailability. Prescribers should ensure that patients know how to take ivermectin (dose frequency and interval). To ensure successful treatment and to minimise the risk of mite resistance, two doses are recommended — a single dose may be inadequate to eradicate the parasite.
Invermectin is listed authority required (streamlined) for the treatment of:
- Typical scabies where the patient has completed and failed sequential treatment with topical permethrin and benzyl benzoate and the most recent course of topical treatment at least four weeks prior has failed, or when topical therapy is contraindicated
- Crusted scabies in conjunction with topical therapy (except for when topical therapy is contraindicated).
The condition must be diagnosed by clinical and/or parasitological examination.
The latest issue of RADAR also includes In Brief articles on aclidinium (Bretaris Genuair) for chronic obstructive pulmonary disease and a further enhancement to the RADAR evidence appraisal in the form of the GRADE systematic evaluation of the quality of evidence.
To read and download RADAR visit www.nps.org.au/radar or look for RADAR reviews in your prescribing software.