150 mcg/kg is an onchocerciasis count
The number headlines borrowed from the oncho table
Open the STROMECTOL table for river blindness. The target is about 150 mcg of ivermectin per kg, given once, on an empty stomach with water. At 45 to 64 kg that is three 3 mg tablets. At 65 to 84 kg it is four.
The same file uses a different count, about 200 mcg/kg, when the infection is intestinal Strongyloides. Mixing 150 into a Strongyloides order under-doses the worm the label actually wants cleared.
Onchocerciasis studies showed what 150 mcg/kg does to skin microfilariae. The geometric-mean count fell 83.2% by day 3 and 99.5% by month 3. More than 90% of that drop was still there at 12 months. That is a parasite endpoint. It is not an oxygen-saturation endpoint.
Adult Onchocerca worms survive the swallow. Programmes repeat the count. CDC often writes every 6 months for an individual. Mass rounds often sit at 12 months. None of those calendars was written for SARS-CoV-2.
When a post says 'the ivermectin dose' and pastes 150 mcg/kg next to a respiratory virus, it has lifted river-blindness arithmetic into a disease the tablet file never named.
TOGETHER did not cut hospital admission
TOGETHER was a double-blind, randomized, placebo-controlled adaptive platform trial in Minas Gerais, Brazil. Adults with COVID-19 symptoms for up to 7 days and at least one risk factor for progression entered the ivermectin question.
The ivermectin arm was 400 mcg per kg once daily for 3 days, on an empty stomach. That is more than double the 150 mcg/kg oncho count, repeated for 3 days. It is not a hidden 'label dose' that regulators forgot to try.
1358 people were randomized to ivermectin or matching placebo, 679 in each group. Other platform arms enrolled separately. ClinicalTrials.gov number NCT04727424. The report sits in the New England Journal of Medicine.
The primary composite was hospital admission for COVID-19 within 28 days, or an emergency stay longer than 6 hours for clinical worsening. Limited ward space made the emergency-observation piece a planned proxy for admission.
100 of 679 ivermectin patients (14.7%) met that composite. 111 of 679 placebo patients (16.3%) did. Relative risk 0.90. The 95% Bayesian credible interval ran from 0.70 to 1.16. The interval included 1. The trial's superiority threshold was not crossed.
171 of 211 primary events were hospital admissions. Modified intention-to-treat and per-protocol looks were similar (relative risks 0.89 and 0.94, intervals still crossing 1). Viral clearance at day 7 did not move (relative risk 1.00). Secondary clinical outcomes stayed null.
A laboratory dish is not a recovery clock
Early interest started from cell-culture reports that ivermectin could interfere with SARS-CoV-2 in a dish. A dish concentration is not a plasma level after a 3 mg human count. It is not a 150 mcg/kg oncho swallow.
TOGETHER measured hospital-level worsening. ACTIV-6 measured days until three clear days in a row. Those are the endpoints people actually wanted. Both stayed with placebo.
Pushing to 400 mcg/kg for 3 days, then 600 mcg/kg for 6 days, was the honest test of the 'you just needed more' claim. More did not shorten recovery. More did not clear the composite.
Withdrawn or tiny trials cannot outvote that pair. A mechanism slide cannot outvote it. A 2015 prize cannot outvote it.
If a reader still wants a number from the oncho table, keep it attached to Onchocerca. Three 3 mg tablets at 45 to 64 kg is river-blindness math. It is not a three-day COVID course. It is not a paste teaspoon.
People who need the licensed worm uses should leave this claim audit and read the 3 mg uses cut. That page grades Strongyloides stools and skin microfilariae. It does not reopen TOGETHER.
The FDA file never added COVID
FDA consumer updates state the agency has not authorized or approved ivermectin to prevent or treat COVID-19 in people or in animals. Human tablets remain approved for certain parasitic worms. Separate topicals cover head lice and rosacea.
A later FDA wording is blunt: currently available clinical trial data do not demonstrate that ivermectin is effective against COVID-19. That sentence survived the period when a social-media post claimed the agency had 'reversed.' It had not reversed the indication.
Even labeled human doses can interact with medicines such as some anticoagulants. Overdose is not theoretical. FDA lists nausea, vomiting, diarrhea, low blood pressure, hives, dizziness, ataxia, seizures, coma, and death among overdose harms.
Small early trials and withdrawn papers left a noisy evidence pile. TOGETHER itself noted that more than 60 COVID ivermectin trials had been registered and that results were discordant, with some papers later withdrawn. That noise is why a platform trial with a hospital-level composite mattered more than another small preprint.
TOGETHER and ACTIV-6 were built to settle the outpatient question at doses no one can call timid. They did not give the tablet a viral indication. A 150 mcg/kg oncho count was never the missing ingredient. Those arms already sat at 400 and 600 mcg/kg.
ACTIV-6 left recovery time where placebo left it
| Trial | Dose vs 150 mcg/kg oncho | N (drug / placebo) | What did not move |
|---|---|---|---|
| TOGETHER, Brazil | 400 mcg/kg x 3 days | 679 / 679 | Hospital or >6 h ED; RR 0.90 (0.70-1.16) |
| ACTIV-6, US | 400 mcg/kg x 3 days | 817 / 774 | Recovery time; HR 1.07 (0.96-1.17) |
| ACTIV-6, US | 600 mcg/kg x 6 days | 602 / 604 | Recovery 11 vs 11 days; HR 1.02 |
ACTIV-6 is a US decentralized, double-blind, placebo-controlled platform for outpatients with mild to moderate COVID-19. Two ivermectin arms were published. Both used doses above the 150 mcg/kg oncho line.
The first published arm used 400 mcg/kg daily for 3 days. 817 people received ivermectin and 774 received placebo after eligibility checks. Participants were 30 or older, with confirmed infection and at least two symptoms for 7 days or less.
The primary outcome was time to sustained recovery, meaning at least 3 days in a row without symptoms. The hazard ratio for faster recovery was 1.07 (95% credible interval 0.96 to 1.17). Median recovery was 12 days on ivermectin and 13 days on placebo.
Hospitalization or death by day 28 was uncommon: 10 events on ivermectin, 9 on placebo. The authors wrote that the findings do not support ivermectin for mild to moderate outpatient COVID-19.
A later arm pushed the dose again: a maximum targeted 600 mcg/kg daily for 6 days versus placebo. 602 received ivermectin, 604 placebo. Median recovery was 11 days in both groups. Hazard ratio 1.02 (0.92 to 1.13).
A composite of hospitalization, death, or urgent care by day 28 was 34 of 602 (5.7%) versus 36 of 604 (6.0%). Raising the count from 400 to 600 mcg/kg and stretching the course to 6 days did not rescue the claim.
Veterinary paste is a different product
Four products, one molecule, not one use
- Human tablet: 3 mg, counted to 150 or 200 mcg/kg for labeled worms.
- Human topicals: 1% rosacea cream, 0.5% lice lotion.
- Animal products: paste, pour-on, injectable, drench - not interchangeable.
- COVID: no FDA authorization; TOGETHER and ACTIV-6 negative.
Horse and cattle ivermectin comes as paste, pour-on, injectable, chewable, or drench. Those products are concentrated for large animals. They are not scored 3 mg human tablets. Inactive ingredients were not cleared for people.
FDA's Center for Veterinary Medicine and CDC warned that poison-control centers saw a rise in human exposures when people swallowed animal formulations during COVID waves. Some vendors started asking for a photo with the horse. That was not a joke about science. It was a stock-control reaction to misuse.
Paste is hard to portion into a 150 or 200 mcg/kg human count. A tube meant for a horse or a steer is not a kitchen measuring problem you should try to solve. Topical farm solutions are not drinks.
If someone has already swallowed a veterinary product, the move is poison control (1-800-222-1222 in the US) or emergency care, not a second internet dose. Do not induce vomiting unless a specialist says to.
Human 3 mg tablets taken for a labeled worm, at a labeled count, are not the same event as a paste binge. Conflating them is how a safe oncho programme drug gets described as 'the dangerous one' and how a dangerous misuse gets described as 'just ivermectin.'
The claim that still fails the protocol
150 mcg/kg remains a river-blindness count on a human label. 200 mcg/kg remains a Strongyloides count. Neither is a COVID regimen that beat placebo in TOGETHER or ACTIV-6.
Paste remains a veterinary product. FDA still has no COVID authorization. For the infections the tablet does treat, use the uses page. For gut worms that want a chewable instead, use mebendazole 100 mg or the which-tablet comparison.
The file did not move. The headlines did. Keep the count attached to the parasite that earned it.
A last arithmetic check: 150 mcg/kg on a 60 kg adult is about three 3 mg tablets. TOGETHER's 400 mcg/kg on that same adult is a much larger daily pile, given for 3 days. The larger pile still missed hospital admission. Borrowing the smaller oncho count for a virus still names the wrong infection.