Mary Talley Bowden on ivermectin: what the evidence says · JRE #2335

What the evidence says 01 / RECORD

The pharmacology of ivermectin supports the metabolism point. The FDA-approved STROMECTOL (ivermectin) label states the drug is metabolized in the liver and that ivermectin and its metabolites are excreted almost exclusively in the feces over about 12 days, with less than 1 percent of the dose appearing in the urine. A study of human liver microsomes concluded that cytochrome P4503A4 (CYP3A4), a hepatic enzyme, is the predominant isoform responsible for ivermectin metabolism. So the core statement that ivermectin is cleared by the liver rather than the kidney is correct, which is why renal impairment or a kidney transplant does not by itself change ivermectin's elimination. The broader clinical inference of no harm is more than the metabolism data alone establish, since transplant patients take CYP3A4-affecting immunosuppressants and drug interactions still warrant caution, but the specific pharmacological claim stated on air is largely accurate.