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What are the clinical signs and timeline of ivermectin poisoning in adults and children?
Executive summary
Ivermectin overdose causes a predictable cluster of gastrointestinal, cardiovascular and neurological signs that typically develop within hours to days after excess ingestion; reported features include nausea, vomiting, diarrhea, hypotension, tachycardia, dizziness, ataxia, visual disturbance, hallucinations, seizures, coma and — rarely — death [1] [2] [3]. Public‑health alerts during the COVID‑19 era documented sharp increases in poison‑center calls and hospitalizations for ivermectin exposures, most often in adults taking excessive or veterinary formulations [3] [4].
1. What clinicians and poison centers list as the characteristic symptoms
Clinical descriptions from the U.S. Centers for Disease Control and Prevention (CDC) health alert and the FDA emphasize a triad: gastrointestinal upset (nausea, vomiting, diarrhea), cardiovascular effects (hypotension, tachycardia), and neurologic/psychiatric effects (dizziness, ataxia/loss of coordination, visual symptoms, hallucinations, altered mental status, seizures, coma). The FDA’s consumer guidance explicitly names nausea, vomiting, diarrhea, hypotension, allergic reactions, dizziness, ataxia, seizures, coma and death [1] [2].
2. Typical timeline after an overdose or inappropriate use
Available guidance and poison‑center reporting describe onset within hours to a few days after ingestion or exposure. The CDC’s health advisory warns of rapid increases in reports and lists acute symptoms such as GI upset and neurologic changes that prompt immediate calls to poison centers, implying a short latency to clinically relevant toxicity [1]. The FDA likewise frames overdose effects (including severe neurologic depression) as acute outcomes of excessive dosing [2]. Exact median times to each sign are not provided in the current materials; available sources do not mention precise hour‑by‑hour timelines or median onset intervals for individual symptoms.
3. Severity, risk factors and special populations (adults vs children)
Adults accounted for most poison‑center reports and hospitalizations referenced in the literature and health alerts during the COVID‑19 period; many were older adults using human or veterinary preparations at higher than recommended doses [3] [4]. Ivermectin is approved for specific doses in adults and children ≥15 kg, but pharmacokinetic studies show children generally have different drug exposures (e.g., lower AUC and Cmax at the same weight‑based dose), complicating extrapolation of toxicity thresholds between age groups [5] [6]. Available sources do not list pediatric‑specific symptom timelines or a clear pediatric dose threshold for severe poisoning; they do note that ivermectin is not licensed for use in children <15 kg in many jurisdictions and that safety data are limited in that group [6] [7].
4. Mechanisms and why neurologic effects occur
Case reports and pharmacovigilance reviews suggest ivermectin can penetrate the central nervous system in some circumstances and has been found in brain tissue in at least one report of neurologic adverse events; mechanistic reviews connect such penetration to serious neurological events including encephalopathy and seizures [8]. The CDC and FDA emphasize that ivermectin can potentiate sedation when combined with other CNS depressants (e.g., benzodiazepines, barbiturates), which increases the risk of respiratory and CNS depression [1] [2].
5. Real‑world signal during COVID‑19 and implications for clinicians
During the pandemic, the number of prescriptions and poison‑center calls linked to ivermectin rose sharply, prompting CDC and FDA alerts and peer‑reviewed reporting of clusters of toxic exposures — often tied to self‑medication or use of veterinary products — and several hospitalizations [3] [4] [1]. Clinicians should view acute gastrointestinal symptoms plus new neurologic signs in a patient with known or possible excess ivermectin exposure as red flags warranting poison‑control consultation and possible hospitalization [1] [2].
6. What the sources say about management and gaps in reporting
Authoritative sources advise contacting poison control for management and emphasize supportive care; however, the provided materials do not give a unified, detailed treatment algorithm (antidote, decontamination timelines, or evidence‑based interventions) in the excerpts supplied — they instead list symptoms and urge prompt medical advice [1] [2]. Precise quantitative thresholds for “overdose” versus therapeutic dosing, and exact pediatric versus adult toxicity curves, are not fully specified in the current reporting [5] [6].
7. How to interpret reports and misinformation risks
Because ivermectin has both approved human uses at narrow, weight‑based doses and widely available veterinary formulations, confusion and misinformation have driven harmful self‑administration, as documented by regulatory and academic reviews [3] [9]. Some advocacy groups promoted ivermectin for COVID‑19 despite randomized trials showing no clinical benefit; regulators and medical societies therefore emphasized risks from inappropriate dosing [3] [9]. Readers should treat anecdotal claims of safety at unapproved doses cautiously and consult medical professionals rather than social media or veterinary product labels [3] [2].
If you want, I can summarize specific symptom checklists for triage (what to watch for at home versus when to call emergency services) and pull exact wording from the CDC health advisory and FDA consumer page for patient handouts [1] [2].