Ivermectin Side Effects and Management

Common Side Effects

The most common side effects of ivermectin include dizziness, nausea, fever, headache, muscle or joint pain, and skin reactions, with serious adverse effects being rare when used at approved doses for parasitic infections, according to the Journal of Infection guidelines 1
When used for onchocerciasis, patients may experience a Mazzotti reaction, characterized by tender lymphadenopathy, headache, bone/joint pain, fever, urticaria, and asthma due to microfilarial death, as reported in the Journal of Infection 1

Ivermectin's bioavailability is increased by 2.5 times when taken with high-fat food, and it is recommended to take it on an empty stomach with water, as stated in the Journal of Infection guidelines 1
Patients with severe liver disease may be at higher risk for toxicity, according to Praxis Medical Insights: Practical Summaries of Clinical Guidelines 2

Topical reactions to ivermectin can be relieved with topical corticosteroids and oral antihistamines, as recommended by Pediatrics guidelines 3

The Centers for Disease Control and Prevention notes that ivermectin can cause muscle pain as a side effect, particularly when used for parasitic infections like onchocerciasis and trichinellosis 4, 5
Musculoskeletal symptoms, including muscle pain, are prominent when ivermectin is used to treat certain parasitic infections like onchocerciasis 4, 5
Distinguishing between muscle pain caused by the underlying parasitic infection versus drug-induced myalgia can be challenging, particularly in trichinellosis 4, 6
In patients treated for scabies or other ectoparasitic infections, muscle pain is less common than when treating systemic parasitic infections 7, 8
Severe reactions, particularly in onchocerciasis, may require medical attention, including pretreatment with corticosteroids in high-risk patients 5