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Are there any known interactions between ivermectin and over-the-counter medications like acetaminophen?
Executive summary
Available reporting and drug-reference checks show no established direct pharmacologic interaction between ivermectin and acetaminophen/paracetamol in standard references such as Drugs.com (no interactions found) and related interaction tools [1] [2]. Case reports and pharmacokinetic reviews emphasize ivermectin’s interactions mainly with anticoagulants, P‑glycoprotein substrates, and certain CYP/P‑gp pathways, not routine OTC analgesics; randomized trials have combined ivermectin with acetaminophen for symptom control without flagging a safety signal [3] [4].
1. What the main interaction databases report: “no interactions found”
Major consumer-facing interaction checks list acetaminophen (Tylenol/paracetamol) as having no identified drug–drug interaction with ivermectin: Drugs.com shows “no interactions found” for ivermectin with Tylenol and with paracetamol [1] [2]. Professional interaction reports generated for combination products (acetaminophen/hydrocodone) likewise report no interactions with ivermectin [5] [6].
2. Clinical-trial and real-world usage: combined use has been documented
A randomized, double‑blind trial of ivermectin in mild COVID‑19 explicitly gave both study arms acetaminophen (500 mg four times daily) while randomizing ivermectin versus placebo and did not report an acetaminophen‑ivermectin safety interaction as a study exclusion or outcome [4]. This trial documents that co‑administration has occurred in a clinical-research setting [4].
3. Pharmacology and known interaction mechanisms — why acetaminophen isn’t flagged
Reviews of ivermectin pharmacokinetics and interaction mechanisms highlight ivermectin’s interactions via P‑glycoprotein (MDR1/ABCG2) transporters and potential effects on hepatic enzymes and coagulation—mechanisms that explain interactions with medications like warfarin or certain P‑gp substrates, rather than simple analgesics such as acetaminophen [3] [7]. DrugBank and other references emphasize transporter and CYP‑related considerations rather than acetaminophen‑type metabolism as a primary concern [7].
4. Signals from surveillance and lower‑quality data: small reports exist but aren’t definitive
Aggregate post‑marketing analyses and registries can report co‑occurrence of adverse events among people taking both drugs; for example, an eHealthMe analysis of FDA data identified reports where patients took ivermectin and acetaminophen [8]. Such signal‑detection findings show co‑use but do not establish causality or a mechanistic interaction and are less definitive than controlled pharmacologic data [8].
5. Where interactions do exist — the important cautions clinicians emphasize
Professional references and review articles highlight interactions clinicians should watch with ivermectin: increased effects with warfarin or other anticoagulants and interactions mediated by P‑glycoprotein/CYP pathways, and alcohol‑related CNS effects [9] [3] [10]. Consumer sites also warn that absence of a listed interaction does not guarantee none exist and encourage discussion with providers [7] [10].
6. Practical guidance and limitations of current reporting
If you plan to take ivermectin and acetaminophen together, current references do not list a direct interaction [1] [2]. However, limitations remain: interaction databases disclaim “no known interaction” is not proof of absence, observational signal reports exist [8], and ivermectin’s interaction profile centers on transporters and anticoagulants more than OTC analgesics [3] [7]. Always tell your clinician about all medications, and seek medical attention for unexpected symptoms [10] [7].
7. Competing perspectives and hidden agendas to watch for
Consumer tools and trial reports document co‑use without identified problems [1] [4], while pharmacokinetic reviews emphasize unknowns and rare case observations [3]. Some signal‑detection services present raw co‑use counts that can be interpreted alarmingly without causality [8]. Be aware that web summaries can reflect different aims—patient education, pharmacology review, or automated signal mining—and each frames risk differently [1] [3] [8].
Summary takeaway: authoritative interaction checkers and a clinical trial report list no known interaction between ivermectin and acetaminophen/paracetamol, though pharmacology reviews highlight other, clinically important interactions for ivermectin and surveillance datasets report co‑use events that don’t prove causation [1] [2] [4] [3] [8]. If you have specific health issues (liver disease, anticoagulant use, heavy alcohol use) or are taking other prescription drugs, consult a clinician before combining medications [6] [10].