Treatment for Ivermectin Toxicity
For ivermectin toxicity, supportive care is the mainstay of treatment, with activated charcoal administration recommended for recent ingestions and close monitoring of neurological symptoms. 1, 2
Clinical Presentation of Ivermectin Toxicity
- Neurological symptoms are predominant, including somnolence, altered mental status, kinetic ataxia, increased tendon reflexes, and visual disturbances 3, 1
- Gastrointestinal symptoms such as nausea, vomiting, and abdominal pain 2, 4
- Musculoskeletal complaints may also occur 2
- Severity of symptoms correlates with dosage and formulation (veterinary vs. human) 2
Treatment Algorithm
Immediate Management
- Administer activated charcoal for recent ingestions (within 1-2 hours) to reduce absorption 1
- Monitor vital signs and hemodynamic parameters closely 3
- Assess neurological status frequently 3, 2
Supportive Care
- Provide symptomatic treatment for neurological manifestations 3
- Manage gastrointestinal symptoms as needed 2
- For severe cases with respiratory compromise, provide respiratory support 1
Special Considerations
- Patients who have ingested veterinary formulations typically require more intensive monitoring due to higher doses and increased risk of altered mental status 2
- Chronic ingestion cases may present with milder symptoms but require the same supportive approach 2
- Patients with severe liver disease may be at higher risk for toxicity as the safety of ivermectin in this population is not well established 5, 6
Monitoring and Follow-up
- Continue monitoring hemodynamic parameters until clinical improvement 3
- Most patients show significant improvement in neurological symptoms within 24 hours with appropriate supportive care 1
- In severe cases, particularly with transdermal exposure or extremely high doses, more aggressive interventions including hemoperfusion may be considered, though evidence is limited 7
Prognosis
- Most cases of ivermectin toxicity have favorable outcomes with appropriate supportive care 3, 1
- Even in cases of extremely high doses (up to 100 times the standard dose), patients have recovered with supportive management 3
- Fatal outcomes are rare but have been reported, particularly with very high exposures or delayed treatment 7
Prevention of Recurrence
- Educate patients about proper dosing of ivermectin for approved indications 6
- Standard dosing for approved parasitic infections is typically 200-250 μg/kg 6
- Warn against self-medication or use of veterinary formulations 2
- Emphasize that ivermectin is not recommended for COVID-19 prevention or treatment due to insufficient evidence and risk of adverse effects 4, 7