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Abstracts were searched for the terms ivermectin AND (head lice or pediculus or pediculosis), topical ivermectin, ivermectin lotion, ivermectin AND (pharmacology OR pharmacokinetics). The New Drug Application filed with the Food and Drug Administration and the product data sheets for ivermectin were obtained. Study Selection and Data Extraction: All English-language articles retrieved from the search were evaluated for relevance to the objective. Data Synthesis: The recommended first-line head lice treatments in the United States are permethrin 1% or pyrethrins, with malathion 0.5% lotion used as a second-line treatment. Significantly more of the 289 head lice\u2013infested participants using topical ivermectin 0.5% lotion were lice-free at day 15 when compared with vehicle control (73.8% vs 17.6%; P &lt; .001) in 2 studies. Although this rate is lower than other third-line treatments (eg, spinosad 0.9% or benzyl alcohol 5%), topical ivermectin 0.5% lotion is well tolerated (pruritus, the most common adverse event, 0.9%) and requires only a single application. Conclusions: Topical ivermectin 0.5% lotion kills head lice by increasing chloride in muscle cells, causing hyperpolarization and paralysis. Only 1 application is required; when the treated eggs hatch, the lice are not viable because they cannot feed as a result of pharyngeal muscle paralysis. Minimal systemic absorption occurs following topical application. Studies have demonstrated that topical ivermectin 0.5% is a safe and efficacious treatment for head lice. Although it has no documented resistance, there is limited clinical experience, it requires a prescription, and it is expensive. Therefore it should be reserved as a third-line treatment for head lice in the United States.<\/jats:p>","DOI":"10.1177\/1060028013500645","type":"journal-article","created":{"date-parts":[[2014,7,15]],"date-time":"2014-07-15T13:56:59Z","timestamp":1405432619000},"page":"1161-1167","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":24,"title":["Topical Ivermectin 0.5% Lotion for Treatment of Head Lice"],"prefix":"10.1177","volume":"47","author":[{"given":"Louise S.","family":"Deeks","sequence":"first","affiliation":[{"name":"University of Canberra, Canberra, Australia"},{"name":"Canberra Hospital, Canberra, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Naunton","sequence":"additional","affiliation":[{"name":"University of Canberra, Canberra, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marian J.","family":"Currie","sequence":"additional","affiliation":[{"name":"Canberra Hospital, Canberra, Australia"},{"name":"The Australian National University Medical School, Canberra, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis J.","family":"Bowden","sequence":"additional","affiliation":[{"name":"Canberra Hospital, Canberra, Australia"},{"name":"The Australian National University Medical School, Canberra, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2013,9,1]]},"reference":[{"key":"bibr1-1060028013500645","first-page":"1703","volume":"105","author":"Burgess IF","year":"2011","journal-title":"Clin Evid"},{"key":"bibr2-1060028013500645","doi-asserted-by":"publisher","DOI":"10.3201\/eid1409.080368"},{"key":"bibr3-1060028013500645","doi-asserted-by":"publisher","DOI":"10.1111\/j.1529-8019.2009.01242.x"},{"key":"bibr4-1060028013500645","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-4632.2006.02827.x"},{"key":"bibr5-1060028013500645","doi-asserted-by":"publisher","DOI":"10.1517\/14740338.5.1.169"},{"key":"bibr6-1060028013500645","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2012.03806.x"},{"issue":"10","key":"bibr7-1060028013500645","first-page":"CD009321","author":"van der Wouden JC","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"bibr8-1060028013500645","doi-asserted-by":"publisher","DOI":"10.2183\/pjab.87.13"},{"key":"bibr9-1060028013500645","first-page":"985","volume":"8","author":"Nofal A","year":"2010","journal-title":"J Dtcsh Dermatol Ges"},{"key":"bibr10-1060028013500645","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0905471"},{"key":"bibr11-1060028013500645","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMe1211124"},{"key":"bibr12-1060028013500645","doi-asserted-by":"publisher","DOI":"10.1021\/jm00184a014"},{"key":"bibr13-1060028013500645","unstructured":"Stromectol (ivermectin) [package insert]. 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