Is ivermectin safe for immunosuppressed and organ transplant patients?

Immunosuppressed or organ transplant patients who are on calcineurin inhibitors such as tacrolimus or cyclosporine or the immunosuppressant sirolimus should have close monitoring of drug levels when on ivermectin given that interactions exist which can affect these levels. A longer list of drug interactions can be found on the database of with nearly all interactions leading to a possibility of either increased or decreased blood levels of ivermectin. Given studies showing tolerance and lack of adverse effects in human subjects given even escalating, high doses of ivermectin, toxicity is unlikely, although a reduced efficacy due to decreased levels may be a concern.