Ivermectin

Ivermectin is one of the most widely used medicines in the world and one of the few whose discovery earned a Nobel Prize. Hundreds of millions of doses have been given free of charge where river blindness and lymphatic filariasis are endemic. It is also an animal medicine, a cream for rosacea, a lotion for head lice and — from 2020 — the subject of one of the most studied and argued-over drug questions of the COVID-19 pandemic. This page reports what the research and the regulators found, each claim tied to a source listed at the bottom; decisions about any medicine belong with a clinician.

Table of Contents

  1. What Ivermectin Is
  2. Discovery: A Soil Microbe From Japan and a Nobel Prize
  3. How It Acts — and Why Mammals Are Protected
  4. Approved Uses and the Evidence Behind Them
  5. Mass Drug Administration and Malaria-Mosquito Research
  6. COVID-19: The Full Record
  7. Cancer Research (Laboratory and Animal Only)
  8. Safety Findings
  9. What Is Not Known
  10. Connections
  11. Key Research Papers
  12. Featured Videos

What Ivermectin Is

Ivermectin belongs to the avermectins, large ring-shaped molecules (macrocyclic lactones) made by the soil bacterium Streptomyces avermitilis. The 1983 paper introducing it described ivermectin as the 22,23-dihydro derivative of avermectin B1 — the natural compound with one double bond chemically reduced — active "at extremely low dosage against a wide variety of nematode and arthropod parasites" (Campbell and colleagues, 1983): roundworms, and mites, lice and insects. The avermectins have no meaningful antibacterial or antifungal activity (Burg and colleagues, 1979), so ivermectin is an antiparasitic, not an antibiotic.

The drug is semi-synthetic: the bacterium makes avermectin by fermentation and a chemical step converts it. The United States label for the oral tablets describes a mixture of at least 90% of one component (B1a) and under 10% of a close relative (B1b), insoluble in water, in 3 milligram tablets. After a single 12 milligram dose, average peak blood levels were 30.6 and 46.6 nanograms per millilitre in two studies, about four hours after dosing; the half-life is about 18 hours; the liver breaks it down mainly through the enzyme CYP3A4, and it leaves the body almost entirely in the faeces over about 12 days. A 30 milligram dose taken after a high-fat meal was absorbed about 2.5 times as well as on an empty stomach.

Human and veterinary products are different formulations

Ivermectin was a veterinary drug first, sold for cattle, horses and sheep before its value in people was known (Campbell and colleagues, 1983). The United States Food and Drug Administration's consumer update on ivermectin (archived copy under Other Sources) stated that animal formulations — pour-ons, injectables, pastes and "drenches" — "are often highly concentrated because they are used for large animals like horses and cows," whereas human tablets are approved "at very specific doses." The human forms sold in the United States are oral tablets, a 1% cream for the inflammatory lesions of rosacea, and a 0.5% lotion for head lice.

Discovery: A Soil Microbe From Japan and a Nobel Prize

In the 1970s the Japanese microbiologist Satoshi Ōmura at the Kitasato Institute in Tokyo cultured soil microbes and sent promising strains to a partner laboratory at an American drug company, where the parasitologist William Campbell and colleagues tested them against parasites in animals. Ivermectin originates "solely from a single microorganism isolated at the Kitasato Institute, Tokyo, Japan from Japanese soil" (Crump and Ōmura, 2011).

The 1979 paper naming the organism — Ōmura among its authors — reported a new species of actinomycete, Streptomyces avermitilis, whose avermectins were "fully active" against a gut roundworm in mice fed just 0.0002% of the diet for six days; fermentation work raised yields from 9 to 500 micrograms per millilitre (Burg and colleagues, 1979). Ivermectin, the modified derivative, followed in 1983 (Campbell and colleagues, 1983). Introduced for animals, it "was quickly discovered to be ideal in combating two of the world's most devastating and disfiguring diseases" — river blindness and lymphatic filariasis (Crump and Ōmura, 2011). According to the Mectizan Donation Program's history page, trials in West Africa were run with the World Health Organization in the 1980s, and in 1987 the manufacturer committed to donating the drug "as much as needed for as long as needed"; the programme reports partnering with 64 countries as of 2025.

On 5 October 2015 the Nobel Assembly at Karolinska Institutet awarded the Nobel Prize in Physiology or Medicine "with one half jointly to William C. Campbell and Satoshi Ōmura for their discoveries concerning a novel therapy against infections caused by roundworm parasites," the other half going to Tu Youyou for artemisinin. The press release stated that avermectin derivatives "have radically lowered the incidence of River Blindness and Lymphatic Filariasis." See the Nobel Prize in Medicine record and the page on the discovery.

How It Acts — and Why Mammals Are Protected

Nerve and muscle cells of roundworms and arthropods carry chloride channels that open when the messenger glutamate binds; chloride flowing in quiets the cell. In 1994 researchers cloned this glutamate-gated chloride channel from the roundworm Caenorhabditis elegans and showed it was "avermectin-sensitive" (Cully and colleagues, 1994). Reviews describe ivermectin binding ligand-gated ion channels for glutamate, gamma-aminobutyric acid and glycine, "resulting in parasitic paralysis and death" (Johnson-Arbor, 2022).

Those glutamate-gated channels are invertebrate channels. Avermectins also interact with vertebrate gamma-aminobutyric acid receptors (Cully and colleagues, 1994), which in mammals work in the brain and spinal cord — behind the blood-brain barrier. The barrier's cells carry a pump, P-glycoprotein, that pushes certain drugs, ivermectin among them, back into the blood. Mice bred without the main brain-barrier form of this pump became about 100 times more sensitive to ivermectin, with higher drug levels in the brain (Schinkel and colleagues, 1994). A toxicology review concludes that being a P-glycoprotein substrate "limits its neurological toxicity in humans," and that genetic variants in the pump, or drugs that block it, may increase neurotoxicity (Johnson-Arbor, 2022). Many parasites lack this protective P-glycoprotein (Kaur and colleagues, 2024).

Against the filarial worms, ivermectin kills the microfilariae — the microscopic larvae — not the adults. The label states it "has no activity against adult Onchocerca volvulus parasites," so the adults keep producing larvae and treatment is repeated (Van Laethem and Lopes, 1996). More detail is in the Ōmura wing's pharmacology and safety page.

Approved Uses and the Evidence Behind Them

The United States label approves the tablets for intestinal strongyloidiasis and onchocerciasis. The World Health Organization lists ivermectin among its essential medicines for several parasitic diseases (World Health Organization, 31 March 2021). Public-health programmes also use it for lymphatic filariasis and scabies; the topical forms are approved for rosacea and head lice.

Onchocerciasis (river blindness)

Onchocerciasis, caused by Onchocerca volvulus and spread by black flies, damages skin and eyes; a 1992 review estimated about 18 million people infected and wrote that in hyperendemic areas nearly half the population was likely to become blind before death (Malatt and Taylor, 1992). The earlier drug, diethylcarbamazine, "had very severe secondary effects" (Van Laethem and Lopes, 1996). The 1992 review reported that a single oral dose of 150 micrograms per kilogram "can control the manifestations of the disease and can be safely distributed on a mass scale" (Malatt and Taylor, 1992). The United States approval rests on randomized and comparative studies in 1,427 patients in West Africa. By 2010 the African Programme for Onchocerciasis Control, using annual community-directed treatment with donated ivermectin, covered 19 countries; Colombia became the first nation to interrupt transmission countrywide; and the review noted that "development of ivermectin resistance is a concern" (Murdoch, 2010). See the Ōmura wing's page on river blindness and the donation programme.

Lymphatic filariasis

Lymphatic filariasis, spread by mosquitoes, damages the lymphatic system and can lead to elephantiasis. Because ivermectin is provided free, blocks transmission of microfilariae and can be given once a year with "virtually no side-effects," the World Health Organization declared both onchocerciasis and lymphatic filariasis eradicable (Richard-Lenoble and colleagues, 2003).

Strongyloidiasis

Strongyloides stercoralis can reinfect its host for decades and, in people with suppressed immunity, multiply into a fatal hyperinfection. The label reports cure in 64% to 100% of patients after one dose of 200 micrograms per kilogram.

More: ivermectin treatment for Strongyloides.

Scabies

Scabies affects more than 200 million people at any time. For 30 years the main drugs have been topical permethrin and oral ivermectin; neither kills every stage of the mite, and at least two consecutive treatments are needed (Fernando and colleagues, 2024).

Rosacea and head lice (topical)

The 1% cream is approved "for the treatment of inflammatory lesions of rosacea"; in its trials 2,047 people used it daily and burning or irritation occurred in 1% or fewer. A 2019 systematic review (152 studies, 20,944 participants) found high-certainty evidence that topical ivermectin and azelaic acid reduce rosacea papules and pustules (van Zuuren and colleagues, 2019). A 2026 network meta-analysis of 32 trials (11,399 adults) found a greater lesion reduction with ivermectin than metronidazole (mean difference 4.17 lesions, 95% confidence interval 1.85 to 6.48) (Amstutz and colleagues, 2026). The 0.5% lotion is labelled to treat head lice; a BMJ Clinical Evidence review assessed ivermectin among the head-lice treatments it covered (Burgess, 2011).

A use outside the approved list is covered on ivermectin for Acanthamoeba.

Mass Drug Administration and Malaria-Mosquito Research

Ivermectin is an endectocide: it kills parasites inside the body and insects that feed on a treated person. It has been used in single-dose community campaigns against onchocerciasis and lymphatic filariasis for more than 30 years, and researchers are now designing regimens to reduce malaria transmission alongside bed nets and spraying (Chaccour and colleagues, 2017).

In a 2025 cluster-randomized trial in Kwale County, Kenya (84 clusters, 28,932 eligible participants, high bed-net use), mass administration of ivermectin 400 micrograms per kilogram monthly for three months was compared with albendazole. Among children aged 5 to 15, malaria infection incidence over six months was 2.20 versus 2.66 per child-year (adjusted incidence rate ratio 0.74, 95% confidence interval 0.58 to 0.95) — 26% lower; serious adverse events did not differ significantly (Chaccour and colleagues, 2025).

A study nested in a malaria mass-administration trial in The Gambia found scabies prevalence similar between arms after treatment and higher in the treated arm by 2021 (53.2% versus 38.8%); Strongyloides prevalence fell (9.1% versus 16.8%) but was similar again two years later (Kositz and colleagues, 2022).

COVID-19: The Full Record

The record below follows the evidence in the order it appeared. The Ōmura wing has a separate page on the history of the controversy.

2020: the cell-culture finding and the concentration problem

In April 2020 an Australian laboratory reported that ivermectin added to monkey kidney cells two hours after infection with the COVID-19 virus produced a roughly 5,000-fold reduction in viral genetic material at 48 hours, and that the drug "warrants further investigation for possible benefits in humans" (Caly and colleagues, 2020). The concentration used, per the full text, was 5 micromolar — about 4,400 nanograms per millilitre given ivermectin's molecular weight of about 875. The label's average peak after a standard 12 milligram dose is 30.6 to 46.6 nanograms per millilitre, roughly one-hundredth of that (a calculation from the two published figures). A toxicology review put it plainly: the antiviral effect appears "at very high concentrations," and the drug's pharmacokinetics "reduce the likelihood that high concentrations of the drug can be achieved in-vivo" (Johnson-Arbor, 2022).

The early, smaller trials

Retracted and unreliable studies

The large randomized trials

The meta-analyses — before and after removing unreliable trials

What the regulators stated

Cancer Research (Laboratory and Animal Only)

Everything in this section comes from cell-culture and animal studies. There are no large randomized trials of ivermectin for any cancer. Reviews report that in the laboratory ivermectin inhibits the growth of several tumour cell types, promotes programmed cell death and alters multiple signalling pathways (Tang and colleagues, 2021). A 2025 review for oncologists found that "evidence in humans is limited, with no large-scale randomized controlled trials," described self-medication driven by social media that led to toxicity in some cancer patients, and noted the risk that patients forgo proven therapies (Patel and colleagues, 2025). The fenbendazole page covers a related veterinary antiparasitic in the same position.

Safety Findings

Common side effects

In the label's strongyloidiasis studies (109 patients, 170 to 200 micrograms per kilogram), drug-related effects were few: dizziness and itching (2.8% each), diarrhoea and nausea (1.8%), and fatigue, abdominal pain, sleepiness, tremor and rash (0.9% each). A toxicology review lists swelling, rash, headache and eye complaints, "mild and short in duration" for the most part (Johnson-Arbor, 2022). In people with onchocerciasis, the death of many microfilariae can cause skin, whole-body and eye reactions — the Mazzotti reaction — which the label attributes to "allergic and inflammatory responses to the death of microfilariae."

Loa loa encephalopathy

The gravest known hazard arises in people heavily infected with Loa loa, the African eye worm of Central Africa's forests and savannahs (Boussinesq, 2006). When 17,877 people in Cameroon received 150 micrograms per kilogram, 20 had serious reactions with impairment lasting over a week and two fell into coma for two to three days, with Loa loa larvae in their cerebrospinal fluid. Risk rose with the larval load: significantly above 8,000 microfilariae per millilitre, and with an odds ratio above 1,000 for serious reactions above 50,000 (Gardon and colleagues, 1997). The label calls for pretreatment assessment for loiasis and careful follow-up in people with significant exposure to Loa loa-endemic areas of West or Central Africa.

Neurological reactions, overdose and veterinary products

The label records neurotoxicity — drowsiness, stupor, coma, confusion and death — "with recommended dosage and overdosage," generally resolving with supportive care; after exposure to veterinary products, rash, swelling, headache, dizziness, nausea, vomiting and diarrhoea were most often reported, with seizures and loss of coordination also described. The Food and Drug Administration's update noted that approved doses "can interact with other medications, like blood-thinners." Of 37 ivermectin poisonings seen through the Oregon Poison Center in 2021 to 2022, 21 were hospitalised and one died; 17 had taken veterinary products, 30 had neurological toxicity, and veterinary-product users took higher doses and more often had altered mental status (Hoang and colleagues, 2022).

The MDR1 gene in dogs — the mechanism lesson

A subpopulation of collies is extremely sensitive to ivermectin. The cause is a four-base-pair deletion in the MDR1 gene, which codes for P-glycoprotein; dogs with two copies of the deletion were sensitive, dogs with one or none were not (Mealey and colleagues, 2001). With the knockout mice (Schinkel and colleagues, 1994), this is the clearest demonstration that the brain's P-glycoprotein pump is what protects mammals from the drug.

Pregnancy, breastfeeding and young children

The label reports birth defects in mice, rats and rabbits at doses at or near those toxic to the mother, no adequate studies in pregnant women, and — because safety in pregnancy has not been established — excludes use during pregnancy; the drug passes into breast milk in low concentrations. A 2022 review states that oral ivermectin can be given during breastfeeding (Morgado-Carrasco and colleagues, 2022). The tablets are not licensed for children under 15 kilograms (Yang and colleagues, 2025).

What Is Not Known

Connections

Key Research Papers

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PubMed Topic Searches

  1. PubMed: ivermectin onchocerciasis
  2. PubMed: ivermectin scabies trials
  3. PubMed: ivermectin malaria endectocide
  4. PubMed: ivermectin COVID-19 trials

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