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second rise in plasma levels (mostly occurring between 6 and 12 h after the dose) suggesting an enterohepatic recycling of the drug

Ivermectin is exceptionally potent, with effective dosages levels that are unusually low.

the optimal dose of ivermectin is 150 μg/kg, but the frequency of administration is still controversial, ranging from 150 μg/kg once to three times yearly.

high lipid solubility of ivermectin, this compound is widely distributed within the body.

To interrupt the transmission of onchocerciasis in humans, the combination of ivermectin and doxycycline is highly effective as, in infested patients, the ingestion of the anthelmintic (200 μg/kg, single dose) and the antibacterial (100 mg/kg, daily for 6 weeks)

ivermectin interactions with another concurrently administered drugs can occur.

This issue becames important, as combination chemotherapy is being used with increasing frequency as resistance to antiparasitic agents is becoming more widespread.

haematomatous swellings

prothrombin times were significantly above baseline by one week to one month after drug ingestion, suggesting an antagonist effect against vitamin K

bleeding disorders were not found in 15,000 patients treated with ivermectin (150 μg/kg)

prolonged prothrombin ratios were observed in 148 subjects given ivermectin orally. Although no patients suffered bleeding complications, factor II and VII levels were reduced in most of them, suggesting interference with vitamin K metabolism

Ivermectin has a minimal effect on coagulation and concern about mass treatment for this reason appears to be unjustified