Ivermectin (IVM), a broad-spectrum antiparasitic agent that has been extensively used in both human and veterinary medicine for decades. Conventional formulations of IVM are challenged by poor aqueous solubility, low bioavailability, and limited tissue targeting, which can limit its therapeutic potential, despite its clinical success. The investigation of novel dosage forms and drug delivery technologies has been facilitated by recent advancements in pharmaceutical sciences, with the objective of improving the pharmacokinetic and pharmacodynamic profiles of IVM. Innovative systems, including lipid-based drug delivery systems, nanoparticles, polymeric carriers, solid lipid nanoparticles, and nanostructured lipid carriers, have demonstrated significant potential in terms of their ability to enhance solubility, facilitate controlled and targeted drug release, and reduce systemic toxicity. Additionally, these advanced systems open new possibilities for repurposing IVM in therapeutic areas beyond parasitic infections, including antiviral and anticancer applications. This review highlights the current progress and future prospects of modern dosage forms designed to optimize IVM delivery and broaden its clinical utility. Thereby providing an in-depth and critical evaluation of advanced IVM dosage forms, with a particular emphasis on their design rationale, pharmacokinetic enhancements, and capacity to address the limitations associated with conventional formulations.