Recommended Ivermectin Dosing for Parasitic Infections
The recommended dose of ivermectin for parasitic infections is 200 mcg/kg as a single oral dose for strongyloidiasis and 150 mcg/kg as a single oral dose for onchocerciasis, taken on an empty stomach with water. 1
FDA-Approved Indications and Dosing
Ivermectin is FDA-approved for the following parasitic infections:
Strongyloidiasis
- Dose: 200 mcg/kg as a single oral dose 1
- Administration: Take tablets on an empty stomach with water
- Follow-up: Stool examinations should be performed to verify eradication
Onchocerciasis (River Blindness)
- Dose: 150 mcg/kg as a single oral dose 1
- Administration: Take tablets on an empty stomach with water
- Retreatment: May be considered at intervals as short as 3 months for individual patients; 12-month intervals are common in mass distribution campaigns 1
Weight-Based Dosing Guide for 3mg Tablets
| Body Weight (kg) | Strongyloidiasis (200 mcg/kg) | Onchocerciasis (150 mcg/kg) |
|---|---|---|
| 15-24 | 1 tablet | 1 tablet |
| 25-35 | 2 tablets | - |
| 26-44 | - | 2 tablets |
| 36-50 | 3 tablets | - |
| 45-64 | - | 3 tablets |
| 51-65 | 4 tablets | - |
| 65-84 | - | 4 tablets |
| 66-79 | 5 tablets | - |
| ≥80 | Calculate: 200 mcg/kg | - |
| ≥85 | - | Calculate: 150 mcg/kg |
Other Parasitic Conditions with Clinical Evidence
Cutaneous Larva Migrans
- Dose: 200 μg/kg as a single oral dose 2
- Alternative: Albendazole 400 mg once daily for 3 days
Scabies
- Dose: 200 μg/kg orally, repeated in 2 weeks 2
- Note: Permethrin 5% cream is considered effective, safe, and less expensive than ivermectin 2
Lymphatic Filariasis
- Treatment: Specialist input advised; typically involves combination therapy with diethylcarbamazine plus doxycycline 2
- Important: Exclude onchocerciasis and loiasis before treatment if patient has traveled to co-endemic areas
Important Considerations
Safety Profile
- Ivermectin is generally well-tolerated at parasitic treatment doses 2, 3
- Common adverse effects include edema, rash, headache, and ocular complaints 3
- Severe reactions can occur in patients with high microfilarial loads 4
Contraindications
- Infants and young children should be treated with permethrin for scabies rather than ivermectin 2
- Use caution in patients with liver disease as safety of multiple doses is not established 2
Pregnancy
- Classified as "human data suggest low risk" in pregnancy and probably compatible with breastfeeding 2
Important Caution
- Ivermectin is NOT recommended for COVID-19 treatment. Multiple randomized controlled trials have shown no proven effect on mortality in hospitalized or ambulatory patients with COVID-19 2, 3
- The FDA has only approved ivermectin for specific parasitic infections, not for viral infections 3
Clinical Pearls
- Ivermectin should be taken on an empty stomach with water to ensure proper absorption
- For strongyloidiasis, follow-up stool examinations are essential to verify eradication
- Ivermectin has shown efficacy against Ascaris lumbricoides but limited effectiveness against Trichuris trichiura and is ineffective against hookworms 5
- Side effects are significantly correlated with pretreatment microfilarial counts in onchocerciasis patients 4