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Fact check: What are the risks and reported adverse events from off-label ivermectin use for COVID-19, including veterinary formulations?
Executive Summary
Off-label use of ivermectin for COVID-19 has been repeatedly linked to acute toxic effects ranging from gastrointestinal upset and hypotension to neurologic disturbances including confusion, ataxia, seizures, coma, and death, especially when users take overdoses or veterinary formulations. Multiple poison center reports, a CDC advisory, hospital case series, and published case reports spanning 2021–2025 document rising poison control calls, hospitalizations, and at least one fatality temporally attributed to ivermectin toxicity, underscoring that self-treatment with ivermectin is unsafe and not supported by regulatory authorities [1] [2] [3] [4] [5].
1. The pattern that alarms clinicians: poison-center spikes and severe neurologic events
Poison control centers and toxicologists reported a clear signal of harm after ivermectin gained attention for COVID-19: calls to U.S. poison centers increased substantially in 2021, and case series documented clusters of exposures with neurologic symptoms such as confusion, ataxia, seizures, and hypotension leading to hospitalization. The Oregon Poison Center documented 21 calls in August 2021 with six hospitalizations for severe toxic effects, and national surveillance described a threefold increase in poison center calls prompting a CDC advisory that highlighted gastrointestinal, cardiovascular, and serious neurologic outcomes including decreased consciousness and death [2] [5]. These reports frame ivermectin toxicity not as isolated mishaps but as a reproducible clinical pattern linked to off-label use during the pandemic.
2. Veterinary formulations magnify risk: dose, formulation, and outcomes
Multiple analyses show greater harm when people ingest veterinary ivermectin, which is concentrated for large animals and often contains excipients not intended for humans. A 2022 clinical toxicology study and additional poison center reports found that patients who used veterinary products tended to ingest larger doses and presented with more severe altered mental status and higher rates of hospitalization compared with those who used human formulations at lower doses [4] [2]. The Georgia Poison Center reiterated that ivermectin is not FDA-approved for COVID-19 and warned that intentional overdoses with human or veterinary products can result in seizures, coma, and respiratory failure, emphasizing that dose escalation and incorrect formulation are central drivers of adverse outcomes [6].
3. Individual tragic cases underscore worst-case outcomes, including death
Case reports and series provide granular clinical detail that complements aggregate surveillance. A documented 2023 case of a 34-year-old man who developed status epilepticus with acute respiratory distress syndrome and died after ivermectin toxicity illustrates that fatal outcomes can occur, particularly when seizures complicate a toxic exposure [3]. While larger series have not uniformly reported deaths, multiple hospitalized cases with severe neurologic compromise and hemodynamic instability demonstrate that ivermectin toxicity can progress rapidly and require intensive care. These case-level data show the plausible biological pathway from overdose to life-threatening neurologic and respiratory failure.
4. Who is most affected and why — demographics, dosing, and misinformation
Studies and poison center surveillance indicate that toxicity has occurred across ages but was notably reported in older male patients ingesting higher-than-recommended doses, and in those turning to veterinary formulations for perceived preventive or therapeutic benefit [4]. The CDC and regional poison centers linked the surge in exposures to public interest and misinformation about ivermectin as a COVID-19 remedy, driving intentional self-treatment and dose escalation [5] [1]. These trends suggest that public messaging, social media amplification, and limited access to medical care or trusted guidance contributed to risk-taking behavior that translated into measurable clinical harm.
5. What experts and public-health agencies recommend — prevention and clinical response
Public-health and toxicology bodies consistently advise that ivermectin is not approved to prevent or treat COVID-19 and that clinicians should warn patients about the risks; poison centers recommend contacting health professionals before self-medication [6] [5]. Clinical toxicology literature describes supportive care and symptomatic management as primary treatments for ivermectin toxicity, with hospitalization warranted for severe neurologic or cardiopulmonary compromise [4] [2]. The evidence assembled from 2021 through 2025 shows a recurring message: prevention through accurate public information and avoidance of veterinary or unprescribed human formulations is the most effective strategy to avert the documented harms [1] [5].