permethrin + ivermectin

Permethrin + ivermectin is a combination therapy consisting of topical permethrin (usually 5% cream) and oral ivermectin, used primarily for the treatment of scabies, especially severe or crusted (Norwegian) scabies. Permethrin is a synthetic pyrethroid that acts as a neurotoxin to mites by disrupting sodium channel function in nerve cell membranes, leading to paralysis and death of the parasite. Ivermectin is an oral antiparasitic agent that binds selectively to glutamate-gated chloride ion channels in nerve and muscle cells of parasites, causing hyperpolarization, paralysis, and death. The combination approach leverages both topical and systemic mechanisms to increase efficacy—particularly important in cases where monotherapy may be insufficient due to high mite burden or compromised skin integrity[2][3][5][7]. Clinical studies indicate that this combination can achieve higher cure rates than either agent alone for severe forms of scabies[2][5][7].