What are emergency treatments for ivermectin overdose in humans and pets?
Executive summary
Ivermectin overdose in humans and animals causes primarily neurologic depression (ataxia, somnolence, seizures), respiratory compromise and occasionally death; human reports show hospitalization is common and one death was recorded in a poison‑center series (Oregon Poison Center: 21 hospitalized, 1 death) [1]. Treatment is largely supportive—airway/respiratory support, cardiovascular monitoring, and symptomatic care—with no broadly accepted human antidote; veterinary literature and case reports document decontamination (activated charcoal, emesis when appropriate), intensive supportive care, and growing use of intravenous lipid emulsion (ILE) as a rescue therapy in animals [2] [3] [4] [5].
1. What the overdose looks like on arrival: clear neurologic and systemic danger signs
Ivermectin toxidrome presents with central‑nervous‑system depression (drowsiness, ataxia, altered consciousness, seizures), visual disturbances and gastrointestinal symptoms; severe cases can progress to respiratory failure and death (human case series note neurologic symptoms in older patients and at least one fatality) [1] [6] [7]. Veterinary reports emphasize similar neurologic signs in dogs, cats and even large species after large overdoses (ataxia, blindness, seizures) [8] [9] [10].
2. Immediate emergency steps for people: supportive care, monitoring, and poison‑center guidance
Human management documented in clinical series is primarily supportive: airway protection, oxygen and ventilatory support when needed, hemodynamic monitoring, and symptomatic treatment for seizures or hypotension, with close observation because patients often require hospitalization [1] [6] [7]. A review of human literature cited by emergency‑medicine sources found “no reports of any specific antidotal therapy” in humans and recommends supportive care as the backbone of treatment [2].
3. Decontamination and early measures used in animals — emesis, activated charcoal, fluids
Veterinary guidance routinely recommends decontamination if exposure is recent: induce vomiting and administer activated charcoal within the typical 4–6 hour window to reduce gastrointestinal absorption, and provide intravenous fluids and metabolic support as indicated [3] [9]. Case series of poisoned animals describe IV isotonic fluids and symptomatic care (including glucose/electrolyte management) as standard components of early therapy [9].
4. Intravenous lipid emulsion (ILE): a veterinary rescue therapy with accumulating case evidence
Veterinary case reports and reviews increasingly report successful reversal of severe ivermectin toxicosis using intravenous lipid emulsion (ILE). Examples include a dog treated after a 2.2 mg/kg overdose (3.5× standard) who recovered after standard‑dose ILE and an African lion whose blindness resolved with ILE administration [5] [8]. Clinical reviews and practitioners note ILE use as an emerging option in animals, though these are case‑based reports rather than randomized trials [4] [8].
5. Antidote status and evidence limits: humans vs. animals
Available human literature and emergency‑medicine reviews state there is no specific antidote for ivermectin poisoning in humans and emphasize supportive care [2]. Veterinary literature documents off‑label therapies (decontamination, repeated charcoal, ILE) with positive outcomes in case reports, but randomized evidence and standardized protocols are lacking; many reports are individual cases or small series [4] [5] [8].
6. Practical takeaways for clinicians, veterinarians and pet owners
For humans: treat airway and breathing first, control seizures, provide ICU monitoring as necessary, consult a poison center, and do not expect a proven antidote—management is supportive [2] [6]. For pets: if ingestion was recent, veterinarians often induce emesis and give activated charcoal, start IV fluids and supportive care, and consider ILE in severe cases based on case reports and veterinary consultation [3] [4] [5]. Owners should avoid giving veterinary formulations to people and keep large‑animal products away from small pets [6] [10].
7. Conflicting views and hidden agendas to watch
Public interest in ivermectin for COVID‑19 drove increased off‑label human use and veterinary‑product ingestion; reporting shows more prescriptions and poison‑center calls during the pandemic [11] [1]. Emergency medicine sources and regulatory agencies stress that ivermectin is not authorized for COVID‑19 and warn against high doses, while some veterinary case reports highlight experimental use of ILE — an intervention promoted in veterinary toxicology but not established as a human antidote [6] [5] [2].
Limitations: available sources do not provide randomized controlled trials proving ILE efficacy in ivermectin overdose in humans, and many veterinary successes are case reports or small series (not found in current reporting). Always consult local poison‑control (human) or a veterinarian/animal‑poison hotline for case‑specific guidance [1] [3].