Ivermectin Dosing Guidelines

Standard Dosing Context

The standard therapeutic dose for ivermectin is 200 μg/kg (0.2 mg/kg) for most parasitic infections, as recommended by the CDC and the American Academy of Pediatrics 1, 2
For a 70 kg adult, the standard dose would be 14 mg (70 kg × 0.2 mg/kg), which is significantly lower than 70 mg 1
A patient would need to weigh approximately 350 kg (770 lbs) for 70 mg to be a standard 200 μg/kg dose, as calculated based on the standard dosing guidelines 2

Taking ivermectin with food increases bioavailability approximately 2.5-fold, which is clinically relevant for dosing, according to the CDC 1

The safety profile of ivermectin at doses that might achieve 70 mg in average-weight adults has not been established for routine clinical use, as stated by the CDC and the American Academy of Pediatrics 4
Hepatic impairment is a key safety consideration, as the safety of multiple or high doses in severe liver disease is not well established, according to the CDC and the American Academy of Pediatrics 1, 4
Neurotoxicity risk is a concern, as ivermectin can cross the blood-brain barrier and should not be used in children weighing <15 kg due to potential neural transmission blockade, as recommended by the American Academy of Pediatrics 2

The only guideline-supported scenario approaching higher cumulative dosing involves crusted scabies, where the CDC recommends oral ivermectin 200 μg/kg on days 1, 2, 8, 9, and 15 (five total doses) combined with daily topical permethrin, as recommended by the CDC 3