Combination therapy (premethrin + ive...

Combination therapy (premethrin + ivermectin)

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itchy and scratchy

UK

#1 Nov 21, 2006
In an effort to make things easier to find, I have seperated out slomo's information from another post.

Perhaps we can try and keep discussion in this thread specific to premethrin + ivermectin.

A combined therapy ( permethrin topical + ivermectin oral)is probably a good idea. Say, 3 doses of Ivermectin, 5 days apart, with 2 doses of permetrin cream in between .
This would effectively give you continuous coverage for 15 days, which should prevent reinfection from your environment.

day1: Ivermectin.

day 3: permethrin cream

day 5: Ivermectin

day 8: permethrin

day 10 : Ivermectin.

day 13: Permethtin
itchy and scratchy

UK

#2 Nov 21, 2006
Questions:

1. What about days 4 and 9? Won't there be minimal protection? or is it assumed the ivermectin will still be effective?

2. Ivermectin is to be taken on an empty stomach with a full glass of water. What is the best time of day to take it? First thing in the morning? Is it then ok to sleep in unwashed sheets that night under the assumption the ivermectin is still fully effective?
If taken before bed I wouldn't have an empty stomach.

3. How long after administation does it take until the Ivermectin is effective?

Thanks to anyone who can answer these queries.
Scabies in Phoenix

Phoenix, AZ

#3 Nov 21, 2006
Ivermectin kicks in pretty quick, but I think the half-life is something like 12 hours?

The combination therapy is highly recommended by me (10 month battle).

Need lots of different doctors and MAKE SURE THEY GIVE YOU REFILLS... or write one down yourself...
Been there

United States

#4 Nov 21, 2006
2 Therapeutic dosage
4.2.1 Adults
Oral: 3 to 12 mg as a single dose per os (about 150 to
200 g/kg bodyweight) for onchocerciasis and other
parasitic infections.

http://www.inchem.org/documents/pims/pharm/iv...

6.3 Biological half-life by route of exposure
From plasma analyses in humans and in laboratory animals,
after oral and/or parenteral administration of ivermectin, the
following half-lives have been calculated (MSD, 1988).

SPECIES ROUTE T1/2

Human Oral 10 - 12 hours
Rat I.V. 1 day
Cattle Oral 2.7 days
S.C. 2.9 days
Topical 15.9 days
Been there

United States

#5 Nov 21, 2006
itchy and scratchy wrote:
Questions:
1. What about days 4 and 9? Won't there be minimal protection? or is it assumed the ivermectin will still be effective?
2. Ivermectin is to be taken on an empty stomach with a full glass of water. What is the best time of day to take it? First thing in the morning? Is it then ok to sleep in unwashed sheets that night under the assumption the ivermectin is still fully effective?
If taken before bed I wouldn't have an empty stomach.
3. How long after administation does it take until the Ivermectin is effective?
Thanks to anyone who can answer these queries.
In the morning on an empty stomach with large glass of water.
Dogs and cats are treated(usually injectable) three times at 10-14 days. Since we are pretty certain Ivermetin does not kill eggs or young mites, using the vet method(without any topical)would mean waiting it out the 10-14 days while eggs hatch and hatchlings turn into adults. If a human suppliments Permethrin with the Ivermectin, treatments at 6th or 7th days should be kill all stages. What about Ivermectin only? It's bad enough they get to grow up on the dog.
Slomo

Assonet, MA

#6 Nov 21, 2006
itchy and scratchy wrote:
Questions:
1. What about days 4 and 9? Won't there be minimal protection? or is it assumed the ivermectin will still be effective?
2. Ivermectin is to be taken on an empty stomach with a full glass of water. What is the best time of day to take it? First thing in the morning? Is it then ok to sleep in unwashed sheets that night under the assumption the ivermectin is still fully effective?
If taken before bed I wouldn't have an empty stomach.
3. How long after administation does it take until the Ivermectin is effective?
Thanks to anyone who can answer these queries.
1) The rationale for the schedule:
a) Should not take Ivermectin more frequently than 5 days, unless you want to experiment with higher than the recommended dose. Also, some Australian clinics use a 5 day interval to treat crusted scabies, when using multiple doses. You could stretch it out to 2 weeks, but then you are risking allowing a full life cycle for the mite (a bit on the sort side but there may be some variance depending on temperature, etc.)
b) There are several half life values for ivermectin.
Blood half life & serum half life for the drug, and its metabolites. The one affecting mites is the serum half life, because they are not blood borne. The drug's metabolites stick around the longest.

There is no significant rationale to figuring out when to use the topical. It is probably a bad idea to overuse permethrin, hence the suggested timing at the mid-point between Ivermectin treatments. This is probably better than simultaneous use of the 2 drugs.

2) First thing early morning, at least 1 hour before breakfast. Also, perhaps avoid greasy foods until lunch.
From my experience, the drug is clearly effective for a few days, say, 2to 4.
So, taken in the morning, it is fine to sleep in an infested bed that evening. Let the mites bite (the dust).

Rationale: The drug's package insert recommends 1 hour before breakfast, with a glass of water. You do not want the drug to mix with food in your stomach, this is why:
There was a toxicology study, where giving a similar drug in sesame oil instead of water significantly potentiated the drug. I think it was Doramectin , and the LD ( Lethal Dose) decreased by a factor of 10.

3) Works fast, kicks in in a few hours
Slomo

Assonet, MA

#7 Nov 21, 2006
Been there wrote:
2 Therapeutic dosage
4.2.1 Adults
Oral: 3 to 12 mg as a single dose per os (about 150 to
200 g/kg bodyweight) for onchocerciasis and other
parasitic infections.
The common one-time recommended oral dose is 200mcg per kilogramm of body wgt.
1 mcg = 0.001 mg. So, for a 90kg (200lbs) person, that works out to 18g.

Be aware, that there is no studies on any interaction between permethrin and ivermectin taken concurrently. Every person is different, and something that works for someone may not be safe for you. You should run this idea by a health care professional to see if they pee their pants when hearing about it. Permethrin and Ivermectin are both work by interfering with CNS neuro-transmitters there may very well be some unexpected interaction.

Come to think of it, pushing out the permethrin timing to perhaps 24 hours before taking the ivermectin may be a bette way to go. This way the permetrin is washed off before the next ivermectin dose is taken.
Been there

United States

#8 Nov 22, 2006
Slomo wrote:
<quoted text>
The common one-time recommended oral dose is 200mcg per kilogramm of body wgt.
1 mcg = 0.001 mg. So, for a 90kg (200lbs) person, that works out to 18g.
Be aware, that there is no studies on any interaction between permethrin and ivermectin taken concurrently. Every person is different, and something that works for someone may not be safe for you. You should run this idea by a health care professional to see if they pee their pants when hearing about it. Permethrin and Ivermectin are both work by interfering with CNS neuro-transmitters there may very well be some unexpected interaction.
Come to think of it, pushing out the permethrin timing to perhaps 24 hours before taking the ivermectin may be a bette way to go. This way the permetrin is washed off before the next ivermectin dose is taken.
The dosing on the above post is a cut and paste from the article link.

Personally
Day 1 ..4 3 mg tabs Plus permethrin 5%
Day 7 ..4 3 mg tabs
Day 6...Ivercare paste measured for my body weight 125.

If I need more treatments Ill use the Stomectol and Permethrin on separate days. Hopefully effective in killing all stages.

Worried about my dog infecting me since he is on the 10 day Iver treatment plan. He is not a candidate for topical.

My MD gave me prescriptions for Stromectol and Permethrin same visit. No instructions on spacing them out. This is pioneer territory, even for the doc, perhaps only a handful of docs using this method, in this country anyway.

Call me a risk taker but I do lots of research and think it out and ask questions before jumping in. The Ivercare paste took some deep thought but I feel confident its ok if properly dosed.
Been there

United States

#9 Nov 22, 2006
Corection. Day 13 Ivercare Paste.
Slomo

Assonet, MA

#10 Nov 22, 2006
I am not saying there IS a known interaction, just pointing out the possibility. I am naturally paranoid.
The fear is an unexpected boost in the effect of the ivermectin. It would be very useful to ask a doctor, if there is any rational basis for such concern.
BTW: Signs of a dangerous overdose are: salivating, mydriasis, tachycardia, tremors, lethargy..
Been there

United States

#11 Nov 22, 2006
Don't think my doc gave interaction a thought, she had never prescribed Ivermectin before. Probably best to be on the side of caution. I think it would be wise to seperate the two treatments for two reasons. Possiblily of interaction and more effective treatment.
BTW, my dog is going to start on doramectin injections, vet just ordered a bottle from Pzizer(sp).
itchy and scratchy

UK

#12 Nov 22, 2006
I was reading the article at hhttp://www.journals.uchicago. edu/CID/journal/issues/v39n1/3 2835/32835.html
(which I posted in another thread).
There were 2 points to note which relate to what we are dicussing here:
- they mention a treatment regime using ivermectin on days 1,2,15,16,29. I wonder what the rationale of the dose on consecutive days is? As there will still be a large amount of the ivermectin in the system from the day before...
- The following gives an answer to my original question about how long ivermectin is effective for:
"a study of experimental scabies challenge in pigs showed efficacy of ivermectin persisting for only 9 days after administration of a single dose [30]."
itchy and scratchy

UK

#13 Nov 22, 2006
unfortunately the line breaks were removed from my post above.
Slomo

Assonet, MA

#14 Nov 22, 2006
itchy and scratchy wrote:
Ithey mention a treatment regime using ivermectin on days 1,2,15,16,29. I wonder what the rationale of the dose on consecutive days is?
hmmm. Someone should write to them and ask. While at it, ask them how long the mites can survive and reinfect from fomites.
Further: what is the best disinfectant to use on furniture and hard surface objects? Further, how long do the mites survive under water?
Any volunteers?
I have done this before, usually posing as a nurse. I ask for reprints of articles, and throw in a few questions.
Been there

United States

#15 Nov 22, 2006
Jefferslivestock.com
All info on these products plus price on website. These can be used deluted as a surface spray for porches, kennels. Tells you in product discription.
Very Toxic to Bees and Fish.
30 day residual effects.

Permectrin II 10% Emulsifiable Insecticide
(Anchor) Contains 10% Permethrin to kill flies, lice, mites, ticks (including ticks that carry Lyme disease), fleas, spiders, mosquitoes & cockroaches on horses, beef & dairy cattle, swine, sheep, poultry, dogs & their premises. Apply as a pour-on, spray, dip or on a back-rubber. Offers a 30 day residual effect. Premise spray: 8 oz makes 6.25 gals, 1 qt makes 25 gals. Animal use: 8 oz makes 50 gals, 1 qt makes 200 gals. Easily mixes with water or mineral oil. 5-day slaughter withdrawal for swine. Do not use on puppies under 3 months of age.

GardStar 40% EC
(Y-Tex) Livestock and emulsifiable concentrate premise insecticide with 40% Permethrin. Highly effective against horse, face, stable, house and black flies, mosquitoes, eye gnats, mange mites, scabies mites, ticks, lice and fleas. On horses and livestock mix 1/4 oz to 1 pt of water then apply 1 to 2 oz per animal. Mix 4 oz with 10 gals of water for a premise spray. 4 oz bottle come with 1/2 oz measuring chamber.
Note: This product cannot be shipped via postal service or air. This product cannot be shipped to Hawaii, Alaska, Canada or the Virgin Islands.
DO NOT USE ON CATS!!

Martin's Permethrin 10%
(Control Solutions) For use on cattle, lactating dairy cattle horses, swine, poultry and pets. Controls horn flies, face flies, lice, ticks and deer ticks. Long-lasting, up to 28 days of residual activity. One pint makes 100 gallons of cattle spray and up to 25 gallons of dog dip. Can be used as indoor flea control and as a perimeter spray. Contains no petroleum-based solvent. Contains: 10% Permethrin.
Been there

United States

#16 Nov 23, 2006
Martin's is the one I'll use. I'm not going to use this on surfaces such as tables or furniture. Probably will spray it into the carpet because the mites target my feet. I will spray the porch and kennel area.

I'm returning the Permectrin II because it contains the petroleum distillates which are a health hazard.

Gardstar, don't think so.
Mary

United States

#17 Nov 23, 2006
Been There: I have been using the Permethrin II and spraying it on my bites. As it says that you can use it on dogs. What is the health hazard? Thanks, Mary
Been there wrote:
Martin's is the one I'll use. I'm not going to use this on surfaces such as tables or furniture. Probably will spray it into the carpet because the mites target my feet. I will spray the porch and kennel area.
I'm returning the Permectrin II because it contains the petroleum distillates which are a health hazard.
Gardstar, don't think so.
Been there

Del Mar, CA

#18 Nov 24, 2006
Mary wrote:
Been There: I have been using the Permethrin II and spraying it on my bites. As it says that you can use it on dogs. What is the health hazard? Thanks, Mary
<quoted text>
Mary,

The product name Permectrin II contains petroleum distillates.
The website listed has some info.
http://www.scorecard.org/chemical-profiles/su...

Following product instructions very carefully, using it as a spray to treat the porch and kennel area is considered ok.

This product is intended for large animals and probably for working dogs living in kennels.
No vet has ever mentioned using Permethrin either as a spray or as a dip or bath for a dog.

You are in uncharted territory.

I've read the insert about what delution strength to use for treatment for dogs. Personlly, I wouldn't use any of the Permethrin liquid products as a spray on my dog or myself. What strength have you deluted it to? What brand name are you using? How long have you been using this?
Slomo

Assonet, MA

#19 Nov 24, 2006
I have found some info on another board asserting that:

1) Ivermectin causes a worsening of symptoms, typically the next 3 days.

2) Causes a multitude of small red dots. I have seen this on my leg the next day after my first dose. Cleared up within a couple of days.
Been there

United States

#20 Nov 25, 2006
Slomo wrote:
I have found some info on another board asserting that:
1) Ivermectin causes a worsening of symptoms, typically the next 3 days.
2) Causes a multitude of small red dots. I have seen this on my leg the next day after my first dose. Cleared up within a couple of days.
could it be mite activity as they die?

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