From the Research
Ivermectin generally does not require dose adjustment for patients with impaired renal function, as it is primarily eliminated through feces, with less than 1% excreted unchanged in urine 1. The drug is extensively metabolized by the liver, making hepatic function more relevant to its clearance than kidney function. However, patients with severe kidney disease should still be monitored closely when taking ivermectin, as they may have altered drug distribution or protein binding that could theoretically affect drug levels.
Some key points to consider when prescribing ivermectin to patients with impaired renal function include:
- Standard dosing for most parasitic infections is typically 200 micrograms per kilogram as a single oral dose, though specific regimens vary by indication.
- For patients on dialysis, no supplemental doses are needed after dialysis sessions.
- The pharmacokinetic profile of ivermectin explains this renal-independent elimination - it is highly lipophilic and binds extensively to plasma proteins, limiting glomerular filtration.
- While kidney function doesn't significantly impact ivermectin clearance, patients with renal impairment often have multiple comorbidities that may affect medication tolerance, so clinical monitoring remains important 2, 3, 4.
It's also worth noting that ivermectin has been studied for its potential anticancer effects, particularly in the treatment of renal cell carcinoma, where it has been shown to induce mitochondrial dysfunction and oxidative damage in cancer cells 2. However, this does not directly impact its use in patients with impaired renal function. Overall, ivermectin can be safely used in patients with impaired renal function, but close monitoring is still necessary to ensure optimal treatment outcomes.