Hi, im not sure iveormectin alone will do much. If your parasites are real bad u need albenza or prazi and several rounds. Many of us have done mny many tubes of horse paste. Combined with other meds and still suffering. Its best u look up ICU's protocol. U dont have to refridgerate the ivermectin. As far as taking it on an empty stomach at night might be agood idea but many of the meds require a high fat diet. Its not reccomended to take herbs and meds at same time, but to rotate them. I had zero luck with ivermec inject. And it stings bad. If u can acess prazi or albenza inject please pm me. It is ok to do enemas while on the meds.