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Ivermectin has gained worldwide recognition as an antiparasitic medication used to treat conditions such as scabies, river blindness (onchocerciasis), intestinal strongyloidiasis, and other parasitic infections. More recently, it gained attention during the COVID-19 pandemic, though its use in that context remains controversial and unsupported by major health authorities.

Despite its wide application, ivermectin iverheal is not suitable for everyone. Like any medication, it comes with risks, interactions, and contraindications. Understanding who should not take ivermectin is crucial for avoiding potentially serious side effects or complications.

This blog explores which individuals should avoid ivermectin, who should use it with caution, and why medical supervision is always essential before taking this drug.

Ivermectin is not approved for use in infants and very young children, especially those weighing under 15 kilograms (33 pounds). Their bodies may not metabolize the drug effectively, increasing the risk of toxicity.

• Why it’s risky: In younger children, the blood-brain barrier is not fully developed. Ivermectin can cross this barrier and potentially cause neurotoxicity, leading to symptoms such as seizures, confusion, or coma.

• Guidelines: The World Health Organization (WHO) and U.S. FDA recommend avoiding ivermectin in this population unless the benefits clearly outweigh the risks, and only under medical supervision.

The safety of ivermectin in pregnant or breastfeeding women is not fully established.

• Pregnancy: Animal studies have shown birth defects when ivermectin is used at high doses. Although these results do not directly translate to humans, the drug is generally avoided during the first trimester, unless absolutely necessary.

• Breastfeeding: Ivermectin is excreted in small amounts in breast milk. While some sources say it's likely safe during breastfeeding, others recommend caution, especially when nursing preterm or very young infants.

• Best practice: Pregnant or nursing women should only take ivermectin under a doctor’s advice after evaluating risk vs. benefit.

Ivermectin is metabolized in the liver, so individuals with moderate to severe liver disease should avoid it or use it with caution.

• Why it’s risky: Impaired liver function can reduce the body’s ability to break down and eliminate the drug, increasing the risk of drug accumulation and toxicity.

• Signs of trouble: People with liver impairment may experience exaggerated side effects such as fatigue, dizziness, skin reactions, or neurologic symptoms.

• Monitoring: In some cases, ivermectin may still be used with liver function monitoring and dose adjustments.

Because ivermectin has the potential to affect the nervous system, individuals with active neurological diseases, such as meningitis, encephalitis, or epilepsy, should be especially cautious.

• Mechanism of risk: A weakened or compromised blood-brain barrier may allow ivermectin to enter the central nervous system, which could trigger or worsen seizures, confusion, or other neurotoxic effects.

• Alternatives: A doctor may choose alternative antiparasitic treatments or delay ivermectin use until the neurological issue has been resolved.

Ivermectin may interact with other drugs, leading to dangerous side effects or reduced effectiveness. Medications that inhibit the CYP3A4 enzyme (responsible for breaking down ivermectin in the liver) are especially concerning.

• Macrolide antibiotics (e.g., clarithromycin, erythromycin)

• Ketoconazole and other antifungals

• HIV protease inhibitors (e.g., ritonavir)

• Benzodiazepines, barbiturates, and valproic acid

• Warfarin (may increase bleeding risk)

These interactions can increase ivermectin levels in the body, raising the risk of toxicity. Always disclose all medications to your healthcare provider before taking ivermectin.

Though rare, allergic reactions to ivermectin can occur and range from mild skin rashes to anaphylaxis (a life-threatening reaction).

Symptoms of an allergic reaction may include:

• Hives

• Difficulty breathing

• Swelling of the face or throat

• Severe skin itching or rash

If you’ve ever experienced an allergic reaction to ivermectin, do not take it again without consulting an allergist or medical professional.

Ivermectin should be avoided in people with high levels of Loa loa microfilariae, a parasitic worm found in parts of Central and West Africa.

• Why it’s dangerous: Ivermectin can trigger a severe, sometimes fatal reaction in people heavily infected with Loa loa, including brain inflammation (encephalopathy), coma, or death.

• Precaution: People in or from Loa loa–endemic regions should be screened before receiving ivermectin.

Even if you're not in a high-risk group, you should take ivermectin only under a doctor’s supervision. It’s not a drug meant for casual or off-label use (such as unsanctioned COVID-19 treatment), and improper use can result in serious health issues, including:

• Headaches

• Dizziness

• Skin rash

• Nausea

• Visual disturbances

• Seizures (in rare cases)

Ivermectin is a powerful and effective drug when used correctly, but it’s not suitable for everyone. Children under 15 kg, pregnant women, people with liver disease or neurological conditions, and those on certain medications should avoid ivermectin or use it only with strict medical supervision.

Before taking ivermectin — for parasites or any other condition — always consult your healthcare provider. Never self-medicate, especially with versions meant for animals or sold from unverified sources. Your health and safety depend on it.

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