What treatments and hospital interventions are used for ivermectin toxicity in humans?
Executive summary
Ivermectin overdose and misuse can produce gastrointestinal, dermatologic and—most concerning—neurologic toxicity that has required emergency department visits and hospitalization; there is no specific antidote and treatment is primarily supportive and symptomatic [1] [2] [3]. Reported hospital interventions range from observation and symptomatic medications (antihistamines, antipyretics, bronchodilators, corticosteroids) to more intensive care for encephalopathy and respiratory compromise, with many case series documenting admission for neurologic monitoring [4] [2] [5].
1. The clinical picture that drives care: why hospital care is often needed
Toxic presentations that prompt emergency or inpatient management typically include neurologic signs—confusion, ataxia, somnolence, tremor, myoclonus and, in severe instances, stupor or coma—as well as gastrointestinal upset, pruritus and dizziness; these manifestations have been described in clinical reviews and case series and explain why many patients are observed or admitted [1] [6] [2]. Large surveillance efforts and poison center reports documented that most clinically significant exposures in recent COVID-era series resulted in ED evaluation or hospital admission, highlighting that misuse (especially veterinary formulations or supratherapeutic dosing) is a common pathway to requiring inpatient care [2] [5].
2. Core principle of treatment: no antidote, supportive care only
Multiple contemporary reviews and experimental summaries emphasize there is currently no established standard antidote for ivermectin poisoning and no proven specific reversal agent for humans, so clinicians rely on supportive therapies and symptomatic management rather than a targeted antidote [3] [6]. Emergency and inpatient teams therefore prioritize airway, breathing and circulation, serial neurologic assessments, and management of complications as they arise, because definitive, evidence-based protocols for ivermectin overdose do not exist in the literature cited [3].
3. Common hospital interventions and symptomatic therapies reported
Published guidance and case reports indicate interventions used in practice include symptomatic medications such as acetaminophen for fever or discomfort, antihistamines for pruritus or rash, bronchodilators for bronchospasm, and systemic corticosteroids in select inflammatory presentations; these measures are described in poisoning-treatment overviews and emergency medicine reviews handling ivermectin adverse events [4] [1]. In the cohort series from poison-center data, older patients who had taken veterinary formulations or large doses often required observation or inpatient supportive care for neurologic depression, with at least one death reported in a small series [2].
4. Experimental or anecdotal therapies: animal data and limited human reports
Preclinical and small experimental studies have explored agents such as flumazenil and antioxidant therapy (vitamin C) in animal models to mitigate ivermectin-induced neurologic injury, but these remain experimental and have not established clinical efficacy or safety as human treatments [3]. Scholarly caution is repeated across reviews: suggested pharmacologic interventions in the laboratory setting do not translate into endorsed clinical antidotes, and more research is needed before any can be recommended for human poisoning [3] [6].
5. Risk factors, surveillance and the wider context that shapes treatment decisions
Risk factors that influence both disease severity and clinical approach include very high doses (often from veterinary products), chronic supratherapeutic use, advanced age in reported cohorts, and biological factors such as Loa loa co-infection or rare ABCB1 (P‑glycoprotein) variants that permit CNS penetration—each factor has been linked in the literature to more severe neurologic adverse events and therefore to heightened monitoring and intervention [2] [7] [8] [9]. Public-health and toxicology groups (ACMT/ToxIC) have catalogued unapproved use leading to severe cases, underscoring that many hospital-treated cases are rooted in self-medication driven by misinformation rather than standard therapeutic use [5] [10].
6. Limits of the evidence and practical takeaways for clinicians
The literature is explicit about its own limits: human data on specific, standardized treatment protocols are sparse and there are no randomized trials of interventions for ivermectin toxicity, so recommendations remain pragmatic and supportive and drawn from case series, poison-center surveillance and animal studies [3] [2]. Clinicians therefore manage patients with close monitoring, targeted symptomatic therapies already described in toxicology summaries, and escalation to intensive supportive measures as needed, while researchers and toxicology bodies call for better data to guide more specific interventions [4] [5].