BONUS: Mailbag - Can Ivermectin be used in all kids?

This one is about ivermectin that came in through our Send Us Fan Mail link in the podcast show notes.

And they asked, I saw the kids list was updated.

So can ivermectin be used in all kids? The

kids list.

So for those who are unfamiliar, that's the list of key potentially inappropriate drugs in pediatrics.

Think of it similar to the beers criteria list we use for geriatric patients, right? The original kids list was published in 2020, and the first update was released recently in 2025.

Well,

Steve, you are the pediatric specialist here, so let's not kid around.

What's the deal here with ivermectin?

Well, the listener does bring up a good point.

I have seen oral ivermectin used in rare cases for things like scabies or lice in kids.

And the original list did recommend avoiding oral ivermectin in kids less than one year old.

And that was due to the risk of encephalopathy, which involves the brain.

Uh, symptoms can include things like altered mental status, confusion, and in rare cases, potentially even coma.

But keep in mind the kids list authors at the time noted this was a weak recommendation based on the evidence they had.

All right.

So then what

is

new? Well, oral ivermectin was indeed removed in the 2025 list due to newer evidence that came out afterwards, mostly case reports or case series and an observational study or two that suggested ivermectin was safe in kids under 15 kilograms, with side effect rates being low, around 1% in some studies.

But keep in mind that these studies looked at scabies and other parasitic diseases and used doses typically ranging from 200 to 300 micrograms per kilo per dose.

So I wouldn't say, based on this listener's question, that this means ivermectin is safe for all situations in kids.

We know safety always depends on things like indication and dose, right? Yeah, good

points.

And that evidence is also different from other higher doses and other off-label claims we've talked about in our recent iRomackin episode, conditions like COVID-19 and cancer.

For our listeners, if you haven't already, check out that episode for a deeper dive into the evidence behind those claims.