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Are there any reported cases of ivermectin topical to oral use conversions?
Executive summary
Available reporting shows no documented “conversion” practice or protocol where topical ivermectin products are intentionally converted into oral use for humans; topical formulations produce very low systemic levels compared with an oral 12 mg dose (mean Cmax topical 0.24 ng/mL vs oral 23.5–50 ng/mL) and manufacturers and monographs explicitly state topical products are for skin use only and “not for oral” administration [1] [2] [3]. Clinical literature describes using oral ivermectin as an alternative when topical therapies fail for lice or scabies, but that is a distinct, medically supervised oral prescription — not a conversion of a topical product into an oral dose [3] [4].
1. How pharmacology and PK separate topical and oral ivermectin
Clinical pharmacokinetic studies show topical ivermectin produces only trace systemic exposure and steady-state plasma AUC far lower than oral dosing; for example, repeated topical 1% cream under maximal use yielded mean Cmax ~1.74 ng/mL and AUC0–24h ≈ 35–36 ng·h/mL, whereas a single 12 mg oral dose produced Cmax values of 23.5–50 ng/mL — a difference of an order of magnitude or more, demonstrating limited transdermal absorption [1]. Reviews and pharmacology summaries echo “little transdermal absorption” after topical application and note oral dosing leads to sebum and sweat concentrations not seen with topical use [5].
2. Manufacturer and professional labeling: topical products are for skin only
Package inserts and professional monographs are explicit: ivermectin cream (1%) and ivermectin lotions are “for topical use only” and “not for oral, ophthalmic, or intravaginal use” [2]. Drugs.com’s topical monograph likewise warns patients that ivermectin topical lotion “should not be administered orally” and reports the very low mean peak plasma concentration after a single topical application (0.24 ng/mL in pediatric subjects) [3].
3. Clinical practice: oral ivermectin is used, but as a separate, approved systemic therapy
Medical literature and guidelines document use of oral ivermectin as a prescribed systemic treatment for certain parasitic infections and for difficult-to-treat lice or scabies when topicals fail; this is a clinician-directed oral drug regimen (typical dose ~200 μg/kg), not a repurposing of a topical formulation into an oral dose [6] [7] [8]. Reviews of topical ivermectin for head lice show high topical efficacy, reinforcing that topical use can replace oral therapy in many situations rather than be converted into it [4] [9].
4. Reports of misuse or accidental ingestion — what the sources say and don’t say
Drug safety resources and drugbank summaries document adverse events from accidental or intentional significant exposure to veterinary ivermectin formulations and warn about ingestion of non‑human products; they caution against ingestion but the provided sources do not describe systematic “conversion” of human topical products into oral dosing or documented case series of people dissolving topical creams to swallow as a deliberate practice [10]. If the user is asking about people ingesting veterinary formulations or misusing products, those risks are noted in safety literature, but specific documented case reports of converting human topical ivermectin to oral doses are not cited in the current results [10].
5. Ambiguities, competing perspectives, and gaps in reporting
Available sources consistently separate topical-authorized use (rosacea, head lice lotions) from oral-authorized use (systemic parasitic infections) and emphasize distinct pharmacokinetics [1] [2] [7]. What is not found in current reporting is peer‑reviewed documentation of a practice or medical protocol that converts a topical ivermectin product into an oral dose for humans; the materials neither assert nor document such a conversion procedure, so available sources do not mention an evidence base for that claim (not found in current reporting) [1] [2].
6. Practical takeaway and clinician guidance
Clinically, if topical therapy fails, the accepted pathway is prescribing an oral ivermectin formulation at established doses under medical supervision — not ingesting or repurposing topical creams or lotions. Monographs and labels instruct patients to use topical ivermectin only on skin and explicitly warn against oral administration of topical products [3] [2]. For individual medical advice or suspicion of ingestion/misuse, consult a clinician or poison-control; available sources do not provide case series documenting topical-to-oral conversion practices [10] [3].
If you want, I can search specifically for case reports of accidental ingestion or forensic toxicology reports that might document topical‑product ingestion, or look for media reports of misuse — say which angle you prefer and I’ll search those terms.