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Ivermectin

Ivermectin

Ivermectin is an FDA-approved antiparasitic medication used to treat infections caused by worms, scabies, and lice. Available in oral tablets, oral solution, topical cream, and lotion, it disrupts parasites’ nerve and muscle functions, effectively eliminating them. Dosage varies based on the condition and patient weight, and it is typically taken on an empty stomach with water. Common side effects of Ivermectin may include headache, dizziness, and nausea. Severe side effects, though rare, include liver damage and neurological effects. Patients with liver issues or those taking anticoagulants should use caution. Store Ivermectin at room temperature, away from light, heat, and moisture. Always follow your healthcare provider’s instructions and consult them for any concerns.

Ivermectin Overview

Ivermectin is widely used to treat parasitic infections, including worm infections, scabies, and lice. It works by interfering with parasites’ nerve and muscle functions, effectively paralyzing and killing them. This mechanism targets the parasites’ nervous system, disrupting their ability to move and survive, which is crucial in eliminating infections like onchocerciasis and strongyloidiasis. Ivermectin is available in various forms: oral tablets (3 mg, 6 mg, 12 mg), oral solution (6 mg/ml), topical cream (1%), and topical lotion (0.5%). 

It is typically taken on an empty stomach with a full glass of water at least one hour before or two hours after eating food. The dosage of Ivermectin varies based on the condition being treated and the patient’s weight. Both adults and children can take it, but the dosage must be adjusted accordingly. It is important to follow your healthcare provider’s directions closely. Common side effects of Ivermectin include dizziness, headache, muscle pain, nausea, and mild skin rash. Severe side effects, though rare, may include severe allergic reactions, liver damage, and neurological effects like seizures. 

Patients with liver problems or conditions affecting the blood-brain barrier should use Ivermectin with caution. If a dose is missed, take it as soon as possible unless it’s almost time for the next dose; do not double up. In case of an overdose, seek medical attention promptly. Store Ivermectin in a tightly closed container at a controlled room temperature, away from moisture, direct sunlight, and heat. Keep it out of reach of children and pets. For proper disposal of unused medication, consult your pharmacist or local waste management company. Always consult your physician, pharmacist, or healthcare provider for any questions or concerns regarding using Ivermectin.

Uses of Ivermectin

It is used to treat:

  • Worm infections
  • Scabies
  • Lice 
  • Parasitic infections

Ivermectin Dosage

Form: Oral Tablets

Strength: 3 mg, 6 mg, 12 mg

Form: Oral Solution

Strength: 6 mg/ml

Form: Topical Cream

Strength: 1% (10 mg/g)

Form: Topical Lotion

Strength: 0.5% (5 mg/g)

Recommended Dosage for Different Patients/Ivermectin

For Strongyloidiasis

  • Adults: The recommended dosage is 0.2 mg/kg taken orally by mouth every day on an empty stomach. 
  • Children: 
    • Children: 
    • Weighing 15-24 kg: 3 mg should be taken orally by mouth on an empty stomach daily. 
    • Weighing 25-35 kg: 6 mg should be taken orally by mouth on an empty stomach daily. 
    • Weighing 36-50 kg: 9 mg should be taken orally by mouth on an empty stomach daily. 
    • Weighing 51-65 kg: 12 mg should be taken orally by mouth on an empty stomach daily. 
    • Weighing 66-79 kg: 15 mg should be taken orally by mouth on an empty stomach daily. 
    • Children weighing >80 kg should take 0.2 mg/kg/dose orally by mouth on an empty stomach daily. 

For Onchocerciasis 

  • Adults: The recommended dosage is 0.15 mg/kg/dose taken orally by mouth on an empty stomach daily. The dosage may be repeated in three to twelve months. 
  • Children (daily dose): 
    • Weighing 15-25 kg: 3 mg should be taken orally by mouth on an empty stomach. 
    • Weighing 26-44 kg: 6 mg should be taken orally by mouth on an empty stomach. 
    • Weighing 45-64 kg: 9 mg should be taken orally by mouth on an empty stomach. 
    • Weighing 65-84 kg: 12 mg should be taken orally by mouth on an empty stomach. 
    • Weighing >85 kg: 0.15 mg/kg/dose should be taken orally by mouth on an empty stomach daily. The dosage may be repeated in three to twelve months. 

For Non-crusted scabies 

  • Adults should take 0.15 mg/kg/dose orally by mouth with food once every two weeks. A first-line agent provides the medication. 
  • Children weighing >15 kg should take 0.15 mg/kg/dose orally by mouth with food for two weeks. A first-line agent provides the medication. 

For Crusted scabies 

  • Adults should take 0.2 mg/kg/dose taken orally by mouth with food once daily on the 1st, 2nd, 8th, 9th, and 15th day. For severe cases, 5% permethrin topical cream may be given on the 22nd and 29th day. 

For Head lice infestation (pediculosis capitis)

  • Adults:  The recommended dosage is 0.2 mg/kg/dose taken orally by mouth with food once every ten days. 

For Head lice infestation (pediculosis corporis)

  • Adults:  The recommended dosage is 12 mg taken orally by mouth with food once thrice weekly. 

For Head lice infestation (pediculosis pubis) 

  • Adults:  The recommended dosage is 0.25 mg/kg/dose taken orally by mouth with food twice for 1-2 weeks. 
  • In adolescents: The recommended dosage is 0.25 mg/kg/dose taken orally by mouth with food twice for 1-2 weeks. 

[Note: Remember, these recommendations may vary from person to person. Discuss it with your doctor, and they’ll customize your dosage accordingly.]

How to Take Ivermectin?

  • Before taking Ivermectin, you should carefully read and follow the instructions on the prescription label provided by your pharmacist or healthcare provider. 
  • Ask your physician, pharmacist, or healthcare provider for any questions or concerns regarding the medication use. 
  • Do not take Ivermectin more or less than prescribed, more frequently, or for a longer duration than recommended by your healthcare provider. 
  • You should use Ivermectin exactly as your doctor directed. 
  • This medication may be taken at least one hour before or two hours after eating, on an empty stomach.
  • Your doctor may recommend a single dose of Ivermectin, to be taken orally by mouth with a full glass of water. 
  • In some cases, the doctor may recommend multiple doses of Ivermectin taken several months to a year after the first dose to effectively treat the infection, especially if the patient’s immune system is weak. 
  • Frequent stool samples may be required to assess the efficiency and performance of Ivermectin. 
  • Store Ivermectin at room temperature, away from direct light, moisture, and heat. 
  • In case of an overdose or missed dose, consult your physician or healthcare provider. 

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Ivermectin Work?

Ivermectin is an anti-parasite medication used to treat various parasitic diseases. It interferes with worms’ nerve and muscle functions, paralyzing and killing them. Specifically, it targets parasites’ nervous systems, disrupting their ability to move and survive. River blindness (onchocerciasis): Ivermectin kills the developing worms responsible for this disease. Ivermectin is effective against parasitic worms, hookworms, and whipworms.

Important Safety Information

Ivermectin Side Effects

Common side effects of Ivermectin may include:

  • Headache
  • Dizziness
  • Muscle pain
  • Nausea
  • Diarrhea
  • Mild skin rash
  • Itching

Mild side effects of Ivermectin may include:

  • Stomach pain
  • Constipation
  • Weakness
  • Drowsiness
  • Tremor
  • Vertigo
  • Temporary changes in heart rate

Serious side effects of Ivermectin may include:

  • Severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis)
  • Neurological effects (seizures, confusion, coma)
  • Liver damage
  • Severe allergic reactions (anaphylaxis)
  • Blood disorders (low white blood cell count, anemia)
  • Eye problems (eye pain, swelling, redness)
  • Neck or back pain with fever
  • Shortness of breath
  • Inability to control urination
  • Severe dizziness or fainting

[Note: This list may not cover all possible side effects. Always consult with your healthcare giver for medical advice about side effects.]

Ivermectin Warnings

  • After taking Ivermectin, you should have a stool examination to ensure the infection is gone. Some patients may need to take another dose of the medication to treat the infection properly.
  • This medication may make you dizzy. To reduce your chance of dizziness or passing out, you should rise slowly if you have been sitting or lying down. Be careful while going up and down the stairs. 
  • Individuals with severe liver disease may be more vulnerable to toxicity because their livers are not able to process drugs as well.
  • Patients with conditions that affect the blood-brain barrier (such as meningitis or other CNS infections) may be at higher risk of neurotoxicity by using this medication. 
  • Ivermectin can cause severe adverse reactions in patients with high microfilarial loads of Loa loa (a type of parasitic worm).

Ivermectin Precautions

  • Before taking Ivermectin, let your doctor or pharmacist know if you have an allergy to this medication, any of its inactive ingredients, or any other allergies. Ask your pharmacist for the complete list of its ingredients. 
  • Before using this medication, share your complete medical history with your doctor, especially if you have liver problems. 
  • It’s possible that you have parasite infections, such as African trypanosomiasis and Loa Loa, if you’ve been to or lived in West or Central Africa. These infections could interfere with the way this medication is treated. Seldom could these effects-like encephalopathy have a significant negative effect on the brain. For further information, speak with your physician. 
  • This medication may make you feel dizzy, but alcohol or cannabis can make you feel more dizzy. You should not drive, operate heavy machinery, or engage in any activity requiring alertness until you determine how this medication may affect you. 
  • You should try to limit your use of alcohol. You should avoid beverages and medications that may contain alcohol. Talk to your doctor about using marijuana. 
  • If you are having surgery, including a dental procedure, tell your doctor, dentist, or surgeon that you are taking Ivermectin. Also, tell them about all the prescription medications, non-prescription medications, over-the-counter drugs, and herbal supplements you may be taking. 
  • If you have HIV infection and your immune system is compromised, you may need repeated treatments with this medication. For more details, talk to your doctor. 
  • This medication should only be used when it is clearly needed. Discuss the potential risks and benefits with your doctor, and take the medication only when the benefits outweigh the risks. 
  • This medication passes into the breast milk. You should consult your doctor, healthcare provider, or pharmacist before breastfeeding a baby while you are taking this medication.

Ivermectin Contraindications

Ivermectin is contraindicated for use in patients who have:

  • Hypersensitivity to Ivermectin or any of its ingredients
  • Pregnancy
  • Breastfeeding a baby
  • Children weighing less than 15 kg or under five years of age
  • Liver disease
  • Blood-brain barrier disorders
  • Loiasis
  • Ocular disease
  • S. stercoralis hyperinfection

Ivermectin Missed Dose

  • It’s crucial to complete the entire course as prescribed for parasitic infections.
  • If you miss a dose of Ivermectin, you should take it as soon as you remember.
  • You may omit the missed dose if it’s almost time for your next scheduled dose.
  • You should not double up or take extra doses to compensate for a missed dose.

[Note: If you have missed a medication dose and are unsure when to take the next one, immediately consult your doctor or pharmacist.]

Ivermectin Overdose

You should not take Ivermectin more than prescribed. Symptoms of Ivermectin overdose may include nausea, vomiting, diarrhea, dizziness, balance problems, visual disturbances, confusion, severe skin rash, and drowsiness. If someone has taken an overdose of the medication and is having severe symptoms such as difficulty breathing, loss of consciousness, and seizures, immediately seek medical assistance. You can call 911 or the poison control center. 

[Note: If you consumed more than the recommended dose, get medical help immediately or call the Poison Help line at 1-800-222-1222.]

Ivermectin Storage

  • Keep Ivermectin in a tightly closed container at a controlled room temperature between 68°F-77°F or 20°C-25°C, away from direct sunlight, moisture, and excess heat. 
  • Keep all medications, including Ivermectin, in a safe place, away from the sight and reach of children and pets. 
  • Do not allow Ivermectin to freeze. 
  • Do not use this medication if its expiration date has passed. 
  • Do not keep medications that are outdated or no longer needed. Discard them safely. 
  • Do not throw it in the household garbage bin or wastewater, pour it down the drain, or flush it down the toilet.  
  • The best way to eliminate unwanted medications is to give them in the medicine take-back program. 
  • For more information on how to properly dispose of unwanted medications, consult your healthcare provider, pharmacist, or local waste management company. 

[Note: Discuss with your healthcare professional the proper disposal of unused medicine and any questions you may have regarding its storage.]

Ivermectin Interactions

  • Warfarin
  • P-glycoprotein substrates (e.g., digoxin, cyclosporine):
  • CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, erythromycin):
  • CYP3A4 inducers (e.g., rifampin, carbamazepine, phenytoin):
  • Barbiturates
  • Benzodiazepines
  • GABA-ergic drugs
  • Alcohol
  • Other antiparasitic drugs (e.g., albendazole)
  • Statins
  • Vincristine
  • Antiretroviral drugs
  • Tacrolimus
  • Valproic acid
  • Levamisole
  • Diethylcarbamazine

[Note: This isn’t a complete list, and there could be other drugs that interact with Ivermectin. Tell your doctor any prescription, over-the-counter medicines, and herbal products you’re taking.]

Ivermectin Alternatives

  • Albendazole (albendazole)
  • Mebendazole (mebendazole)
  • Praziquantel (praziquantel)
  • Diethylcarbamazine (diethylcarbamazine citrate)
  • Pyrantel pamoate (pyrantel)
  • Niclosamide (niclosamide)
  • Thiabendazole (thiabendazole)
  • Levamisole (levamisole hydrochloride)
  • Nitazoxanide (nitazoxanide)
  • Oxamniquine (oxamniquine)
  • Bithionol (bithionol)
  • Suramin (suramin sodium)
  • Metrifonate (metrifonate)
  • Oxantel pamoate (oxantel)
  • Tribendimidine (tribendimidine)

[Note: Your doctor will choose what’s best for you. Only use these alternative medications after consulting your healthcare provider. Taking them by yourself may cause serious side effects.] 

Frequently Asked Questions

How does Ivermectin impact the treatment of COVID-19, and what are the current recommendations?

Ivermectin has been investigated for its potential use in treating COVID-19. However, current evidence from clinical trials does not support its use for COVID-19 treatment outside of clinical studies. Leading health organizations such as the WHO and FDA recommend against using Ivermectin for COVID-19 treatment unless part of a supervised clinical trial. Always consult your doctor, pharmacist, or healthcare provider for personalized guidance and advice on COVID-19 treatments.

Can Ivermectin be used as a preventative measure for parasitic infections in endemic areas?

Ivermectin has been administered to large populations of people to prevent parasitic infections like onchocerciasis and lymphatic filariasis in endemic areas. Public health organizations typically coordinate these programs and involve the periodic administration of Ivermectin to at-risk populations. Consult with public health officials or your healthcare provider for more information on preventative measures in specific regions.

What are the risks of using Ivermectin in patients with compromised liver function?

Due to impaired metabolism, patients with compromised liver function may be at a higher risk of toxicity when using Ivermectin. It is important to inform your physician or healthcare provider if you have liver problems before starting Ivermectin. Your provider may need to adjust the dosage or monitor your liver function closely during treatment to mitigate potential risks.

How does Ivermectin interact with anticoagulants like warfarin, and what precautions should be taken?

Ivermectin can interact with anticoagulants such as warfarin, potentially altering their effects and increasing the risk of bleeding. If you are taking warfarin or any other anticoagulant, it is important to inform your healthcare provider before starting Ivermectin. Your provider may need to monitor your blood clotting parameters more closely and adjust the dosage of either medication as necessary to ensure safe and effective treatment.

Can Ivermectin cause neurological side effects, and how can they be managed?

Ivermectin can cause neurological side effects, particularly in patients with conditions affecting the blood-brain barrier, such as meningitis. Symptoms may include dizziness, confusion, seizures, and encephalopathy. If you experience neurological symptoms while taking Ivermectin, seek medical attention immediately. Inform your healthcare provider of any pre-existing neurological conditions before starting the medication. Management typically involves discontinuing Ivermectin and providing supportive care for any adverse effects. Regular monitoring by your healthcare provider can help prevent and manage potential neurological side effects.

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