Ivermectin Tablet Dosing for Adults

Standard Dosing and Administration

The standard dose of ivermectin tablets for adults is 200 mcg/kg (0.2 mg/kg) as a single oral dose, taken on an empty stomach with water, as recommended by the Centers for Disease Control and Prevention (CDC) 1, 2, 3
Ivermectin must be taken on an empty stomach with water to optimize bioavailability, according to the CDC 2, 3

For strongyloidiasis, the standard regimen is 200 mcg/kg single dose, while immunocompromised patients require 200 mcg/kg on days 1, 2, 15, and 16, as recommended by the Infectious Diseases Society of America 1
For scabies, the standard regimen is 200 mcg/kg orally, repeated in 2 weeks, as recommended by the CDC 2, 3
For loiasis, alternative dosing is 150-200 mcg/kg, which may be given as single dose or repeated at monthly, quarterly, or biannual intervals depending on microfilarial load, according to the World Health Organization 4

No dose adjustments are required for renal impairment, but the safety of multiple doses in patients with severe liver disease is not established, as stated by the CDC 2, 3
Ivermectin is classified as "human data suggest low risk" in pregnancy and is probably compatible with breastfeeding, according to the CDC 2, 3
Children under 10 years of age should not receive ivermectin for scabies, and permethrin cream is the preferred treatment in this age group, as recommended by the American Academy of Pediatrics 2, 3

One study demonstrated increased mortality among elderly, debilitated persons who received ivermectin, though this has not been confirmed in subsequent reports, as noted by the CDC 2, 3
Always exclude co-existing onchocerciasis before treating loiasis, and exclude loiasis before treating lymphatic filariasis or onchocerciasis, as recommended by the World Health Organization 1, 4

The standard dose of ivermectin for strongyloidiasis and cutaneous larva migrans is 200 mcg/kg as a single oral dose, according to the Journal of Infection 5, 6
For onchocerciasis, the initial treatment is 200 mcg/kg monthly for 3 months starting on day one of doxycycline 200 mg daily for 6 weeks, as recommended by the Journal of Infection 5
The World Health Organization recommends combining ivermectin with doxycycline 200 mg daily for 6 weeks for optimal adult worm killing in lymphatic filariasis 5

The Centers for Disease Control and Prevention always exclude Loa loa infection before treating with ivermectin in anyone who has traveled to endemic regions, due to the risk of severe adverse events including encephalitis in hypermicrofilaremic patients (>8,000 mf/mL) with loiasis 5, 7

The American Society of Tropical Medicine and Hygiene considers empirical treatment with albendazole 400 mg plus ivermectin 200 mcg/kg as a single dose for travelers with eosinophilia and negative stool studies, to cover prepatent or undetected geohelminth infections 7

Patients who have traveled to Central or West African regions where Loa loa is endemic must be screened for Loa loa infection before receiving the ivermectin‑albendazole combination; omission of screening can result in fatal outcomes. 8
Individuals with high Loa loa microfilaremia (>8,000 microfilariae / mL) are at markedly increased risk of severe adverse events, including encephalitis and death, when treated with ivermectin. 8

Before administering the ivermectin‑albendazole fixed‑dose combination, onchocerciasis must be excluded because rapid microfilarial death can precipitate severe Mazzotti reactions (pruritus, erythema, hypotension, and possible blindness). 9
If skin‑snip microscopy is unavailable, a test dose of 50 mg diethylcarbamazine can be used to screen for onchocerciasis. 9