Few medications have become as misunderstood—or as emotionally charged—as Ivermectin. Depending on who you ask, it is either a miracle cure, a dangerous fringe drug, or something best avoided altogether to keep the peace with doctors, friends, or family members.

The reality is far less dramatic. And far more useful.

Long before COVID, ivermectin was a quiet workhorse in medicine. It has been used safely for decades to treat parasitic infections such as onchocerciasis, strongyloidiasis, and scabies. Its impact on global health was so significant that it earned a Nobel Prize. In everyday clinical practice, it developed a reputation for being reliable, well tolerated, and relatively gentle when used at appropriate doses.

I used ivermectin regularly before the pandemic, particularly in cases where parasitic or protozoal infections were suspected. It was easy to prescribe, generally covered by insurance, and inexpensive when it wasn’t. Most importantly, it worked when it needed to, and I did not encounter meaningful safety concerns in the way it was being used.

That changed during COVID.

When ivermectin became part of the conversation around viral treatment, it quickly moved out of the realm of routine medicine and into something far more polarizing. Strong opinions formed on both sides. Some began promoting it as a cure-all, while others dismissed it entirely. In the middle of that, patients were left trying to make sense of conflicting information—and in some cases, turning to veterinary formulations when prescriptions were difficult to obtain.

It is worth stating clearly: using animal formulations is not something I recommend. If ivermectin is used, it should be prescribed and dosed appropriately for humans. At the same time, the controversy surrounding its use in COVID does not erase its long-standing role as an antiparasitic medication, nor does it invalidate emerging areas where it may be helpful.

One of those areas is Babesia.

Babesia infections can be surprisingly difficult to treat, particularly when dealing with species beyond Babesia microti. While microti often responds to more conventional combinations such as macrolides and atovaquone, other species—like duncani, divergens, or odocoilei—can be far more resistant. This is where clinicians often find themselves needing additional tools.

A 2019 study (PMCID: PMC6625054) examined ivermectin’s effects on multiple Babesia species and related parasites. The findings were notable. Ivermectin demonstrated inhibitory activity against several Babesia strains in vitro, and in a mouse model of Babesia microti infection, it reduced parasite growth by approximately 63 percent. Even more compelling, when used in combination with other therapies such as atovaquone or diminazene, parasite levels dropped significantly further, and in some cases became undetectable over time.

The authors concluded that ivermectin shows potential as an alternative or adjunctive therapy for piroplasmosis. That aligns with what many clinicians have observed in practice: it is not a standalone cure, but it can be a meaningful piece of a broader treatment strategy.

In my experience, ivermectin tends to be easy to work with. At lower doses, it is generally well tolerated and can be layered into a treatment plan without creating significant additional burden. I typically start conservatively, using a lower dose every other day and gradually increasing as tolerated, with a general upper range around 0.15 mg/kg per day. This slower approach helps minimize side effects and allows the body to adapt.

There are, of course, other options. Tafenoquine is sometimes considered for Babesia, but it comes with a more complex safety profile, requires specific screening, and is often cost-prohibitive. For many patients, ivermectin remains a more practical and accessible option—at least in principle.

Unfortunately, access is no longer what it used to be. Since the pandemic, ivermectin has become harder to obtain, more expensive, and frequently not covered by insurance. Compounding is often required, adding another layer of complexity. Beyond that, there is a social dimension that did not previously exist. Simply bringing up the medication can provoke strong reactions, even when the context has nothing to do with COVID.

That is perhaps the most frustrating part. A medication with a long history of safe and appropriate use has become entangled in a narrative that obscures its actual value. It is neither a miracle cure nor something to categorically avoid. It is a tool—one that, when used thoughtfully and in the right context, can help move patients forward when other approaches have stalled.

The goal, as always, is not to win an argument. It is to help people get better.

Bibliography

Batiha, G. E.-S., Beshbishy, A. M., Tayebwa, D. S., Adeyemi, O. S., Yokoyama, N., & Igarashi, I. (2019).
Evaluation of the inhibitory effect of ivermectin on the growth of Babesia and Theileria parasites in vitro and in vivo. Parasites & Vectors, 12(1), 297.
https://doi.org/10.1186/s13071-019-3559-8
(PMCID: PMC6625054 | PMID: 31337949)

Crump, A., & Ōmura, S. (2011).
Ivermectin, ‘wonder drug’ from Japan: The human use perspective. Proceedings of the Japan Academy, Series B, 87(2), 13–28.
https://doi.org/10.2183/pjab.87.13

Vannier, E., Gewurz, B. E., & Krause, P. J. (2008).
Human babesiosis. Infectious Disease Clinics of North America, 22(3), 469–488.
https://doi.org/10.1016/j.idc.2008.03.010

Krause, P. J. (2019).
Babesiosis diagnosis and treatment. Vector-Borne and Zoonotic Diseases, 19(6), 379–381.
https://doi.org/10.1089/vbz.2019.2465

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