From the FDA Drug Label
DOSAGE AND ADMINISTRATION Strongyloidiasis The recommended dosage of STROMECTOL for the treatment of strongyloidiasis is a single oral dose designed to provide approximately 200 mcg of ivermectin per kg of body weight. Table 1: Dosage Guidelines for STROMECTOL for Strongyloidiasis Body Weight (kg) Single Oral Dose Number of 3-mg Tablets 15-24 1 tablet 25-35 2 tablets 36-50 3 tablets 51-65 4 tablets 66-79 5 tablets ≥80 200 mcg/kg Onchocerciasis The recommended dosage of STROMECTOL for the treatment of onchocerciasis is a single oral dose designed to provide approximately 150 mcg of ivermectin per kg of body weight Table 2: Dosage Guidelines for STROMECTOL for Onchocerciasis Body Weight (kg) Single Oral Dose Number of 3-mg Tablets 15-25 1 tablet 26-44 2 tablets 45-64 3 tablets 65-84 4 tablets ≥85 150 mcg/kg
The recommended dosing of ivermectin is as follows:
- For strongyloidiasis: a single oral dose of approximately 200 mcg/kg of body weight.
- For onchocerciasis: a single oral dose of approximately 150 mcg/kg of body weight. The dosage guidelines are provided in Table 1 for strongyloidiasis and Table 2 for onchocerciasis, based on the patient's body weight 1.
From the Research
Ivermectin dosing should be based on the specific indication, with standard doses ranging from 150 mcg/kg to 200 mcg/kg, and its use for COVID-19 treatment or prevention is not supported by high-quality evidence outside of clinical trials. The dosing of ivermectin varies by indication, with the standard dose for parasitic infections like strongyloidiasis being 200 mcg/kg (0.2 mg/kg) as a single oral dose, while scabies treatment requires the same dose but repeated after 1-2 weeks 2. For onchocerciasis (river blindness), 150 mcg/kg (0.15 mg/kg) is given once every 6-12 months.
Key Considerations
- The medication should be taken on an empty stomach with water.
- Side effects are generally mild and may include headache, dizziness, muscle pain, or gastrointestinal symptoms.
- Ivermectin works by paralyzing and killing parasites by enhancing inhibitory neurotransmission.
- It's essential to note that ivermectin is not FDA-approved for viral infections, including COVID-19, despite some off-label use 3, 4, 5.
- Patients with certain neurological conditions or who are pregnant should use ivermectin cautiously.
- Weight-based dosing is crucial for effectiveness and safety, so accurate weight measurement is necessary before administration.
COVID-19 Considerations
- The current evidence on the efficacy and safety of ivermectin for the prevention and treatment of COVID-19 is conflicting and of very low to low certainty 3.
- Some studies suggest that ivermectin may have antiviral and anti-inflammatory properties, but the evidence is not strong enough to support its use for COVID-19 treatment or prevention outside of clinical trials 4, 5, 6.
- The FDA-approved drug ivermectin has been shown to inhibit the replication of SARS-CoV-2 in vitro, but this does not necessarily translate to clinical efficacy 6.
Recommendation
Given the lack of high-quality evidence supporting the use of ivermectin for COVID-19 treatment or prevention, its use should be limited to clinical trials or specific situations where the benefits outweigh the risks, and always under the guidance of a healthcare professional. For parasitic infections, ivermectin dosing should follow established guidelines, with careful consideration of the patient's weight, medical history, and potential interactions with other medications.