Do standard therapeutic doses of ivermectin alter creatinine, BUN, or glomerular filtration rate in adults?
Executive summary
Standard, single therapeutic oral doses of ivermectin used in humans have not been consistently shown to raise serum creatinine, blood urea nitrogen (BUN), or to reduce glomerular filtration rate (GFR) in adults in the clinical literature available here; guidance from major drug information sources notes minimal renal excretion and calls for caution in patients with existing kidney disease or advanced age because of limited data and potential for altered pharmacokinetics [1] [2] [3]. Animal studies and some small or context-specific human observations report kidney‑related laboratory changes after repeated or high doses or in vulnerable populations, so vigilance and monitoring are advised when treating people with renal impairment or when using repeated mass‑drug administration strategies [4] [5] [6] [7].
1. What the mainstream drug references say about renal effects
Authoritative drug summaries emphasize that ivermectin is mainly metabolized by the liver and is excreted only minimally unchanged in urine, which physiologically argues against direct major effects on creatinine, BUN or GFR at standard doses; clinical dosing guidance therefore does not list routine nephrotoxicity for single, weight‑based treatments in otherwise healthy adults, while advising caution and dose review in elderly patients with preexisting liver or kidney disease [3] [1] [2].
2. Clinical human data and population programs: little consistent signal
Large community‑level ivermectin programs that have delivered annual mass treatment for onchocerciasis have monitored liver and kidney markers; available programmatic reporting and cross‑sectional studies emphasize surveillance but do not establish a reproducible, clinically significant rise in creatinine or BUN or a drop in GFR attributable to standard annual therapy in adults, though authors stress the need for ongoing monitoring as part of public‑health campaigns [7].
3. Animal and experimental studies show nephrotoxic signals at higher or repeated doses
Multiple preclinical studies in rodents document elevations in serum creatinine and BUN and histopathological kidney changes after repeated or supra‑therapeutic ivermectin dosing, and some experiments show partial mitigation with antioxidants like vitamin C—findings that establish biological plausibility for renal injury under certain exposure patterns but cannot be directly extrapolated to standard human dosing without caution [4] [5] [6].
4. Pharmacokinetic caveats for patients with kidney disease
Because ivermectin relies largely on hepatic metabolism with minimal urinary excretion, standard guidance suggests the drug can often be used without major dose adjustment in renal impairment; however, multiple sources note that pharmacokinetics can be altered in patients who have both liver and kidney dysfunction, and that limited clinical data warrant closer monitoring and individualized clinical judgment in those populations [2] [8].
5. Where the debate and misinformation intersect
Some clinics, blogs, and secondary summaries assert that ivermectin commonly elevates creatinine or BUN; these claims draw primarily on animal work, small case reports, or misuse/overdose incidents with veterinary formulations rather than on randomized clinical trials in adults taking approved human doses—an important distinction that has driven polarized public discussion during off‑label use debates [9] [3] [6].
6. Practical takeaway and gaps in evidence
For otherwise healthy adults given a standard single, weight‑based oral dose of ivermectin, current mainstream clinical resources and population studies do not support a consistent effect on creatinine, BUN or GFR, but the evidence base is limited for repeated high‑frequency dosing, for combinations with other drugs (e.g., albendazole), and for people with preexisting hepatic or renal disease—areas flagged by animal data and by drug information sources as requiring monitoring and more rigorous human study [1] [4] [5] [7].