Fact check: What are the most common off-label uses of ivermectin in human medicine?

1. Why COVID‑19 Became the Top Off‑Label Use — The Rise and Fall of a Hypothesis

The most visible off‑label use of ivermectin in the past five years was as a proposed COVID‑19 therapeutic, driven initially by in vitro antiviral signals and rapid dissemination of low‑quality clinical reports. Systematic reviews and meta‑analyses published in 2024 and 2025 consolidated higher‑quality randomized trial data and found no reduction in hospitalization or mortality for non‑hospitalized patients and mixed effects on symptom duration, weakening the claim that ivermectin is an effective COVID‑19 treatment ^{[1] [2]}. Concurrent bibliometric and pharmacologic analyses criticized the literature for methodological weaknesses and data gaps, noting that highly cited positive studies often displayed flaws that contributed to misinformation during the pandemic, which in turn propelled off‑label prescribing and public demand despite lack of robust clinical benefit ^{[5] [4]}. This sequence shows how urgent public health crises can catalyze off‑label adoption before confirmatory evidence emerges.

2. Off‑Label Interest Beyond COVID—Inflammation, Neurology, and Cancer Claims

Beyond infectious indications, recent reviews in 2025 and earlier surveys catalog proposed repurposing of ivermectin for non‑parasitic disorders including neurological, respiratory, inflammatory, dermal, cardiovascular, and neoplastic conditions, with mechanistic rationales such as modulation of host inflammatory pathways and ion channel effects ^[3]. These proposals are largely preclinical or observational, highlighting biologic plausibility without definitive clinical proof, and authors call for rigorous trials to define safety and efficacy. The existence of multiple review articles and repurposing studies indicates scientific curiosity and hypothesis generation, but the literature repeatedly emphasizes that translational gaps remain large and that potential benefits must be weighed against established safety profiles and environmental considerations raised when expanding mass use ^{[3] [6]}.

3. Dermatologic and Parasitic Uses: Off‑Label vs. Guideline‑Supported Practice

Ivermectin’s traditional approved uses for parasitic infections and ectoparasites underpin off‑label topical and systemic applications for skin conditions like scabies and head lice, where comparative effectiveness studies show variable results versus standard topical agents. Reviews conclude that oral ivermectin may be less effective than topical permethrin but sometimes superior to other scabicides, and topical ivermectin can be as effective as permethrin, supporting selective off‑label or guideline‑adjacent use for dermatologic infestations under clinician judgment ^[7]. Formulation research such as nanocrystals for topical delivery illustrates ongoing efforts to improve therapeutic index and target dermatologic indications more precisely, emphasizing that off‑label use in skin disease often aligns with evolving pharmacologic innovation rather than unsupported clinical claims ^{[8] [7]}.

4. Evidence Quality and Research Integrity — Why Opinions Diverge

Diverging conclusions across reviews and meta‑analyses stem from heterogeneity in trial quality, sample sizes, endpoints, and publication bias. The 2025 bibliometric analyses specifically flagged methodological weaknesses in influential ivermectin studies and stressed the need for quality control during crises to curb misinformation ^{[4] [5]}. Systematic reviews pooling randomized controlled trials in 2024–2025 that applied strict inclusion criteria reached more conservative conclusions about COVID‑19 outcomes, whereas broader meta‑analyses including observational and lower‑quality data sometimes reported modest benefits on non‑mortality endpoints, highlighting how analytic choices shape interpretations and inform off‑label adoption or guideline statements ^{[1] [2]}.

5. Practical Takeaway for Clinicians and Policymakers — Caution and Prioritization

Clinicians considering off‑label ivermectin should prioritize high‑quality evidence and guideline recommendations, recognizing that the strongest current randomized evidence does not support its routine use for COVID‑19 and that other proposed non‑parasitic indications remain investigational. Policymakers and public health authorities must balance scientific uncertainty, environmental impacts from expanded use, and the social dynamics that drove early off‑label uptake, while funding rigorously designed trials for the most promising repurposing hypotheses identified in 2024–2025 reviews ^{[1] [3] [6]}. Continued surveillance of trials, transparent reporting, and clear communication about evidence limitations are essential to prevent premature or widespread off‑label use that outpaces demonstrated benefit.