What emergency treatments are recommended for ivermectin poisoning in 2025?
Executive summary
Emergency care for ivermectin poisoning in 2025 remains supportive: there is no specific antidote and management focuses on airway protection, hemodynamic support, seizure control and consultation with poison-control/toxicology services [1] [2]. Case reports since the COVID era describe gastrointestinal symptoms, neurologic depression, seizures, intracranial hypertension and, rarely, death—some managed with intubation, vasopressors, hemoperfusion or lipid-based therapies in animal reports, but human data are sparse and inconsistent [3] [4] [5].
1. What clinicians say: “Treat the patient, not the label”
Emergency and prehospital guidance emphasizes supportive care because no validated antidote exists for ivermectin toxicity [1] [2]. That means early airway management for depressed consciousness or coma, IV fluids and vasopressors for hypotension, and standard critical-care measures for respiratory failure and shock [1] [6]. Poison-control centers and toxicologists should be contacted early; the FDA and CDC have flagged increased clinical presentations and urged professional consultation [7] [6].
2. Neurologic risks drive much of the emergency response
Reports collected during and after the pandemic show that neurologic effects—drowsiness, confusion, hallucinations, seizures, coma—are common reasons for ED visits and hospitalization, and they determine urgency and level of care [6] [8]. Case reports document status epilepticus requiring continuous benzodiazepine infusions and intubation, with prolonged ICU stays [4]. Prehospital guidance specifically warns that benzodiazepines may increase GABA-mediated CNS depression when combined with ivermectin, so sedative choices should be considered carefully and toxicology input sought [1].
3. Supportive therapies used in severe or refractory cases
Beyond airway and hemodynamic support, clinicians have reported using continuous EEG for refractory seizures, intensive care-level respiratory support (including mechanical ventilation) and general measures for raised intracranial pressure in rare fatal cases [3] [4]. One 2025 case of transdermal overdose featured hemoperfusion and cardiorespiratory support but resulted in death—highlighting that invasive detoxification efforts have been attempted but are not proven lifesaving in humans [3].
4. Antidote status and adjunctive options: what’s promising, what’s experimental
Multiple sources state explicitly there is no specific antidote to ivermectin poisoning [2] [1]. Intravenous lipid emulsion (ILE) has been reported in veterinary cases and isolated animal/human case series as an adjunct for lipophilic drug toxicity; veterinary and small-animal reports describe ILE or single-pass lipid dialysis clearing ivermectin in dogs, but human evidence is minimal and experimental [5]. Available clinical literature does not establish ILE as standard of care for humans with ivermectin toxicity—use should follow toxicology advice and institutional protocols [5] [2].
5. Who is at higher risk — and why that shapes emergency choices
Poison-control surveillance shows many presentations involve veterinary formulations or huge overdoses taken intentionally for COVID-19 prevention, with older men over 60 making up a large fraction of cases; most of these patients required ED visit or hospitalization [8] [9]. Genetic or pharmacokinetic vulnerabilities (e.g., ABCB1/P-glycoprotein defects) can increase CNS penetration of the drug—these mechanisms explain why neurologic toxicity can be severe and unpredictable and why clinicians must manage airway and seizure risk aggressively [10].
6. Public-health context: why emergency services saw surges
During COVID-related interest in ivermectin, calls to poison centers and ED visits rose sharply and the FDA and CDC publicly warned against self-medication with veterinary products; that surge is the backdrop to contemporary clinical guidance emphasizing supportive emergency care and poison-center consultation [11] [7]. Media and policy debates amplified demand; clinicians were left to treat a spectrum from mild GI upset to life‑threatening neurologic collapse [12] [6].
7. Practical takeaway for clinicians and the public
If ivermectin ingestion or exposure is suspected, call poison control, assess and secure airway, monitor mental status and hemodynamics, treat seizures promptly with non‑benzodiazepine options when advised to avoid potentiation concerns, provide fluids/pressors for hypotension, and escalate to ICU care if respiratory failure, refractory seizures, or evidence of intracranial hypertension appear [1] [6] [3]. Remember: no antidote exists and some experimental interventions (hemoperfusion, lipid emulsion) have only limited or veterinary-level evidence—specialist toxicology consultation is essential before attempting these measures [3] [5] [2].
Limitations: available sources describe primary guidance as supportive care, case reports with variable interventions, and veterinary/animal data for techniques like lipid therapy; robust, controlled human trials of specific emergency treatments for ivermectin poisoning are not found in current reporting [2] [5].