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Ivermectin is a macrocyclic lactone antiparasitic used for strongyloidiasis, onchocerciasis, and refractory ectoparasites in children.
Standard dose is 200 mcg/kg; administer on an empty stomach with water.
Repeat dosing may be needed for strongyloidiasis, scabies, or lice based on life cycle timing.
Monitor for Mazzotti reactions in onchocerciasis (fever, rash, hypotension) and manage supportively.
Use caution in children under 15 kg—off-label use should involve specialist guidance.
Limited hepatic metabolism means dose adjustment is rarely necessary, but data are sparse in severe hepatic impairment.
Ivermectin treats intestinal nematodes and ectoparasites with weight-based dosing.
Use is common for strongyloidiasis, onchocerciasis, and refractory scabies.
| Condition | Age Range | First Line? | Notes |
|---|---|---|---|
| Strongyloidiasis | Children and adolescents | Yes | Single 200 mcg/kg oral dose on an empty stomach with repeat dosing in two weeks for persistent infection. |
| Refractory or crusted scabies | Children ≥15 kg | Yes | Administer with topical permethrin and repeat in 7–14 days; ensure household contacts are treated simultaneously. |
| Onchocerciasis | Children in endemic regions | Yes | Weight-based dosing every 6–12 months under public health programs to suppress microfilariae. |
| Pediculosis capitis resistant to topical therapy | Children and adolescents | No | Use 200 mcg/kg orally with a repeat dose after 7 days when permethrin and malathion fail. |
| Topical therapy for inflammatory rosacea | Adolescents | No | Ivermectin 1% cream decreases Demodex density and improves papulopustular lesions. |
FDA-approved primary uses with Level A evidence
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Ivermectin is generally well tolerated. Dizziness, nausea, and mild rash are most common.
Reactions from parasite kill (Mazotti) can occur in heavy onchocerciasis infections.
Dizziness
Common • mild
Headache
Common • mild
Rash
Common in onchocerciasis • mild
Pruritus
Common • mild
Mazotti reaction
Uncommon • moderate
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Administration guidance for oral ivermectin in pediatrics.
Dose by weight. Give the full oral dose with water on an empty stomach at least 1 hour before or 2 hours after meals unless otherwise directed.
For strongyloidiasis, a single dose is typical; some children need a repeat dose at 2 weeks. For scabies, treat close contacts and follow topical instructions.
Emergency contact: Seek urgent medical care for trouble breathing, swelling of the face or lips, severe rash, confusion, or signs of severe infection.
Adhering to the timing instructions and treating household contacts reduces reinfection and helps ivermectin work effectively.
Different formulations and concentrations
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Storage guidelines and safety tips
Expert pearls and evidence-based tips
Selectively targets parasite glutamate-gated chloride channels with minimal mammalian CNS penetration.
Ivermectin opens parasite chloride channels leading to paralysis.
Simple explanations and helpful analogies
Receptors, enzymes, and cellular targets
Absorption, metabolism, and elimination
Age-related differences and special populations
Pearls to optimize ivermectin therapy.
Emphasize dosing timing, co-therapy, and follow-up.
Give ivermectin on an empty stomach to improve absorption.
Schedule repeat dosing at 7-14 days when treating scabies or strongyloidiasis.
Ask about travel to Central Africa to avoid severe adverse events.
Core insights every provider should know
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Understanding your child's medication is important. We've created comprehensive guides to help you safely administer Ivermectin and monitor your child's response to treatment.
Food can decrease absorption. Giving it on an empty stomach ensures the dose works properly.
Often, yes, but many children need a second dose 7 to 14 days later plus topical therapy for full eradication.
When parasites die quickly (especially onchocerciasis), fever, rash, or low blood pressure can occur. Seek medical guidance if symptoms appear.
Children under 15 kg usually need alternative therapies. Follow the clinician's recommendations for each family member.