Treatment of Overdose

Currently, there is no specific antidote for people who have overdosed on ivermectin [1].

Once ivermectin enters the brain, it is very hard to get it out; this often means that ivermectin can be found in the brain during an autopsy of an overdose patient [2].
However, there are some things doctors can do to reduce the severity of the symptoms and encourage ivermectin to leave the body.

Treating ivermectin overdose

Because there is no cure for ivermectin overdose, treatment is mainly supportive [1, 3]. This means that patients will be monitored closely in the hopsital and anything doctors do is to alleviate the symptoms of overdose. Patients will be treated on a case-by-case basis and other medications / illnesses they have will be taken into account by the medical team. However, general treatments of ivermectin overdose are:

Stomach Pumping

Medically, this is called a gastric lavage [3].

A small tube is inserted into the stomach to remove toxic substances [4].

Ivermectin must be inside of the stomach for this to have an effect [4].

As such, it only works as an immediate treatment

Giving intravenous fluids

A small tube is inserted into a vein and provides important electrolytes and fluid to the body [3].

This reduces risks associated with low blood pressure, as well as reducing symptoms associated with low sodium and potassium [3, 5].

The type of fluid given will depend on the patient's medical needs and may be changed as the patients condition changes [5].

Anti-seizure medications

These might be given if the patient is experiencing seizures.

However, it is important to avoid benzodiazapines and barbiturates, as they can target the same receptors as ivermectin in the brain [2, 6].

This can increase, rather than alleviate, the symptoms of ivermectin overdose [2, 6].

Oxygen & Intubation

As ivermectin can result in coma, patients who have overdosed on ivermectin may require a tube to be inserted into their windpipe to allow air to get into their lungs whilst they are in a coma [3, 7]. In this case, a machine may breathe for them [3, 7].

If the patient who has overdosed also has COVID-19 infection, they may be given some extra oxygen through a mask or tube into their nose to help with the respiratory symptoms of the virus [8].

Treatments for animals who have overdosed

Intravenous Lipid Emulsion

This technique is currently only used in animals [9]. It involves inserting a small tube into the animal's vein and slowly pushing fat containing fluid into the blood stream [9]. Because ivermectin binds to lipids and fats easily, this treatment may reduce the amount of ivermectin getting into the brain and increase the amount of ivermectin leaving the body [9]. However, this is not yet approved for human use [9].

Lipid Pass Dialysis

When injecting lipids into the blood doesn't work, some vets use this process [10]. This involves taking the blood out of the animal's body, and running it through a machine that contains a fatty liquid [10]. The ivermectin leaves the blood and instead binds to the lipids in the machine, the blood then returns to the body [10]. This reduces the concentration of ivermectin in the blood stream [10]. However, lipid pass dialysis is not yet approved for human use [10].

Monitoring & management of ivermectin overdose

Patients who have overdosed on ivermectin require monitoring, often in the intensive care unit, to make sure they don't get worse. Ivermectin is usually excreted out by the body over time, but patients need to be managed and monitored closely until symptoms subside [11].

As such, monitoring of patients will involve:

Monitoring the heart

This is done with an electrocardiogram (or ECG) - where small pads are placed on the chest to determine how fast, strong, and at what rhythm the heart is beating [12].

As patients who have overdosed on ivermectin may develop a fast heart rate, electrocardiograms are needed to closely monitor their heart rate [6, 12, 13]. If their heart rate is too fast, they may suffer from cardiac arrest and death [6, 13].

Overdose can be associated with a loss of potassium [2]. Very low levels of potassium can lead to irregular heart beats [14]. By closely monitoring a patient's heart with an ECG, doctors can detect these irregular rhythms and treat them before they get worse.

Monitoring the blood pressure

This is done with a small cuff placed around the upper arm of a patient [15]. The cuff will then inflate and detect the pressure of the blood as the heart contracts and relaxes [15].

As ivermectin overdose can lead to low blood pressure, it is very important to keep a close eye on blood pressure [6, 13]. If blood pressure gets too low, the patient needs urgent care, or may need life-saving treatment [6, 13].

Monitoring the brain

This is done using the Glasgow Coma Scale

This scale assesses how conscious and alert a patient is [16]. Regularly assessing their level of consciousness can help monitor if patients are improving, or getting worse [16].

Monitoring the liver

This is done using liver function tests [17].

As ivermectin is metabolised by the liver, some patients who have taken too much ivermectin may lose some of their liver function [11]. This is because their liver is too busy metabolising ivermectin to function properly.

Regularly testing liver function can help doctors predict if liver faliure is going to occur, and potentially treat it before it arises [17].

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