From the Research
Ivermectin is generally considered safe for patients with impaired kidney function, but caution is still warranted due to limited clinical data specifically studying these populations. The medication is primarily metabolized in the liver and eliminated through feces, with minimal renal excretion (less than 1% of the dose is excreted unchanged in urine) 1, 2. This pharmacokinetic profile makes ivermectin relatively safe for patients with kidney disease, including those with reduced glomerular filtration rates or on dialysis. However, some studies suggest that ivermectin may cause glomerular and tubular disturbances in patients with onchocerciasis, although these effects are minor and do not seem to be clinically relevant 1.
Key Points to Consider
- Ivermectin's extensive hepatic metabolism through cytochrome P450 enzymes and its primary elimination through the biliary/fecal route rather than through the kidneys explains its safety profile in patients with renal impairment 3, 4.
- Patients with both kidney and liver impairment may need closer monitoring due to potential drug accumulation 5.
- The standard oral dosing of ivermectin (typically 200 mcg/kg) can usually be maintained in patients with renal impairment, but caution is still necessary due to the limited clinical data available 2.
- Some studies have investigated the effects of ivermectin on kidney function, including a study that found ivermectin to cause attenuation in kidney function and increase in matrix metalloproteinase-9 activity in rats 2.
Recommendations for Clinical Practice
- Monitor patients with severe kidney impairment closely when administering ivermectin, as there is limited clinical data specifically studying these populations 1, 2.
- Consider the potential for drug accumulation in patients with both kidney and liver impairment, and adjust the dosing regimen accordingly 5.
- Use the standard oral dosing of ivermectin (typically 200 mcg/kg) in patients with renal impairment, but exercise caution and monitor for any adverse effects 2, 3.