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

Ivermectin continues to come up in patient conversations—and not just for adults.

Can ivermectin now be used safely in all kids after the recent KIDs List update?

In this BONUS mailbag episode of Rumor vs Truth, we answer a listener question about ivermectin use in kids. Hosts Don Weinberger, PharmD and Steve Small, PharmD break down what actually changed with ivermectin in the 2025 update to the KIDs List—and what it does (and doesn’t) mean for clinical practice. This “kid-sized” question packs a bigger clinical punch than you might expect.

Together, they discuss:

• What actually drove the KIDs List change
• Where the supporting evidence is strong—and where it’s limited
• Why “removed from the list” ≠ “safe for all kids”
• How to apply this update in real-world pediatric decisions

No CE credit is available for this bonus episode.
Want the full breakdown? CE credit is available for our full episode on ivermectin.

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🎧 Related Episode (CE Available)

• Rumor vs Truth: Ivermectin
  (Over the Counter or Out of Control?)
  🎧Listen: https://rumorvstruth.buzzsprout.com/episodes/19333230
  ▶️ Watch: https://youtu.be/-ehs0ucbaTQ 

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TRC Healthcare Editor Hosts

• Steve Small, PharmD, BCPS, BCPPS, BCCCP, CNSC
• Don Weinberger, PharmD, PMSP

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Clinical Resource: 

• Chart: Potentially Harmful Drugs in Children

🏷️ Our listeners can get 10% off a new or upgraded subscription with code rvt1026 at checkout. 

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Email us: rumorvstruth@trchealthcare.com

The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

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Transcript

This transcript is automatically generated. 

00:00:12 Don Weinberger

Welcome to Rumor vs Truth.

00:00:14 Don Weinberger

This is a bonus mailbag episode where we answer one listener question outside of our regular full episodes.

00:00:20 Steve Small

And we're dropping this as a separate bonus or main episodes, stay focused and clean.

00:00:25 Steve Small

So there is no CE available for this episode.

00:00:29 Don Weinberger

This one is about ivermectin that came in through our send us fan mail link in the podcast show notes.

00:00:35 Don Weinberger

And they asked…

00:00:36 Don Weinberger

I saw the kids list was updated.

00:00:39 Don Weinberger

So can ivermectin be used in all kids?

00:00:42 Steve Small

The kids list.

00:00:43 Steve Small

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

00:00:50 Steve Small

Think of it similar to the Beers criteria list we use for geriatric patients, right?

00:00:55 Steve Small

The original kids list was published in 2020 and the first update was released recently in 2025.

00:01:02 Don Weinberger

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

00:01:07 Don Weinberger

What's the deal here with ivermectin?

00:01:09 Steve Small

Well, the listener does bring up a good point.

00:01:12 Steve Small

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

00:01:18 Steve Small

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

00:01:23 Steve Small

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

00:01:28 Steve Small

Symptoms could include things like altered mental status, confusion, and in rare cases, potentially even coma.

00:01:34 Steve Small

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

00:01:40 Don Weinberger

All right, so then what is new?

00:01:42 Steve Small

Well, oral ivermectin was indeed removed in the 2025 list.

00:01:46 Steve Small

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.

00:02:02 Steve Small

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

00:02:13 Steve Small

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

00:02:20 Steve Small

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

00:02:24 Don Weinberger

Good points.

00:02:25 Don Weinberger

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

00:02:37 Don Weinberger

For our listeners, if you haven't already, check out that episode for a deeper dive.

00:02:40 Don Weinberger

We know the evidence behind those claims.

00:02:42 Steve Small

Yeah, it's a great episode.

00:02:43 Steve Small

Plus, we have our own handy potentially harmful drugs and children chart that lists meds to typically avoiding kids, along with why.

00:02:51 Steve Small

And also, we offer alternatives and other considerations to think about, so check it out.

00:02:57 Don Weinberger

That wraps up our kid-sized question today.

00:03:00 Don Weinberger

Thanks for listening to this bonus mailbag.

00:03:02 Don Weinberger

Keep sending questions to the link in the show notes or e-mail.

00:03:06 Steve Small

And be a regular listener in more ways than one by tuning into our next full episode on the laxatives, coming soon on July 21st.

00:03:15 Don Weinberger

We promise a smooth delivery.

00:03:17 Don Weinberger

See you then.