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What's With Ivermectin?

Cautious Optimism for Possible Role in Lice and Scabies Wars


The following is a letter received via e-mail from Michael W. Skoien, R.Ph., MBA, Senior Director of Marketing for Merck & Co., Inc. directed to Deborah Z. Altschuler, NPA President, commenting on the use of ivermectin (currently utilized in veterinary medicine as a cow wormer and to combat the disease know as River Blindness) for treatment of head lice and scabies:

I am the director of the marketing Unit at Merck [& Co., Inc.] who has U.S. responsibility for marketing oral ivermectin, brand name STROMECTOL.

We do not have an FDA approved indication for the treatment of scabies or head lice. However, as one of your links points out, health care professionals have studied this product for use in this area.

The Medical Letter and Dermatology Times have recently commented on the unapproved use of STROMECTOL for scabies and lice. We do not advocate this use until such time as we receive an approved indication. When customers and consumers call for information, we send them prescribing information, and refer them to published articles in the medical literature if it is germane to their request. (Most requests are for use in scabies in immuno-compromised patients such as HIV/AIDS patients who get afflicted with scabies due to the Norwegian scabies which I understand to be more difficult to treat.)

We also explicitly state that STROMECTOL is not approved for use in treating scabies and head lice.

You have an informative and interesting site.

Thank you


Altschuler responded as follows:

Thank you for your detailed message about ivermectin* and your well-taken comments. We agree that it is premature to suggest ivermectin at this time.

We are working to help others "appreciate" the broader implications of pediculosis -- and the urgent need to establish a standardized public health strategy. Otherwise, we risk taking what might be a better and safer treatment and setting it up for extinction through the predictable misuse that will occur.

For the record -- the NPA is not anti-chemical (as some might choose to portray us), and the issues aren't just about pesticides. They are about the children on the receiving end of them. There are growing numbers of children vulnerable to even the most appropriately used chemical product.

Many children have already had more than their fair share of repeated head lice infestations, beds sprayed with permethrin, flea bombs ("just to be sure"). . . antibiotics for ear infections, Ritalin for attention problems -- and you know the rest.

We want to discourage the "system" from painting this problem with one big brush or one new pill. Each kid must be looked at as an individual, bringing his or her own unnatural history to the head lice treatment decision.

If Merck does have something safer and more effective for lice in the fast lane, we will be the first to sing its praises. We will also be the first to promote its prudent use. Anything less would underestimate the ability of the head louse to zig when we zag.

As it is, we sit with a population of children endemically infested with a blood-obligate parasite that is winning.

Deborah Z. Altschuler
NPA President

* The NPA also strongly discourages the use of the antibiotic Bactrim for similar reasons.



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