Should ivermectin be taken with or without food?

Ivermectin Should Be Taken on an Empty Stomach with Water

Ivermectin should be taken on an empty stomach with water to ensure proper absorption and effectiveness, as explicitly stated in the FDA drug label. 1

Administration Guidelines

Proper Administration

• Take ivermectin tablets on an empty stomach with water 1
• Avoid taking with food, particularly high-fat meals, as this can significantly alter drug bioavailability
• High-fat food increases ivermectin bioavailability by 2.5 times 2

Pharmacokinetic Considerations

• When taken with a high-fat meal, ivermectin's bioavailability increases significantly:
  • Geometric mean AUC can be 2.6 times higher when administered with food 3
  • This altered bioavailability may lead to unpredictable therapeutic effects and potential side effects

Clinical Implications

Disease-Specific Considerations

• For strongyloidiasis:
  • The FDA-approved dosage is a single oral dose providing approximately 200 mcg/kg of body weight 1
  • Follow-up stool examinations should be performed to verify eradication of infection
  • In some cases, particularly with immunocompromised patients, repeated courses may be necessary

Safety Considerations

• Taking ivermectin as directed (on an empty stomach) helps ensure consistent absorption and reduces variability in drug levels
• Consistent administration improves predictability of therapeutic effects and minimizes risk of adverse events
• Common side effects include:
  • Dizziness, nausea, fever, headache, muscle/joint pain 2
  • In patients with onchocerciasis: tender lymphadenopathy, headache, bone/joint pain 2

Special Populations

Drug Interactions

• Azithromycin can significantly increase serum ivermectin concentration 2
• Use with caution in patients with reduced hepatic function 2
• Post-marketing reports indicate rare interactions with warfarin, potentially increasing INR 1

Pregnancy and Breastfeeding

• Ivermectin should be used with caution during pregnancy and breastfeeding
• The drug is excreted in human milk in low concentrations 1
• Treatment of breastfeeding mothers should only be undertaken when the risk of delayed treatment outweighs potential risk to the newborn 1

Monitoring and Follow-up

• For strongyloidiasis: Follow-up stool examinations should be performed to verify eradication of infection 1
• For onchocerciasis: Repeated follow-up and retreatment is usually required as ivermectin does not kill adult Onchocerca parasites 1

By following these administration guidelines, patients can maximize the effectiveness of ivermectin treatment while minimizing potential adverse effects and ensuring consistent therapeutic outcomes.