Gurpreet Singh Guliani, M.D., Steven Lippmann, M.D.

We have been hearing a lot about ivermectin these days. You too? Well, ivermectin has long been established as a veterinary medication to treat animals with many different types of parasitic infections; useful there, it has been around for a while without fanfare. Ivermectin is also approved for prescribing to people; it comes in topical and oral formats for a variety of indications.

Lately, the news is buzzing with use of this pharmaceutical at prophylaxis and/or treating COVID-19 illness; supposedly, supplies are dwindling due to high-volume purchases. Unfortunately, so are many reports of ivermectin toxicities, even deaths. Much of the danger comes from self-administration of veterinary preparations that are more concentrated than those recommended for humans, and they also contain substances there not accepted for our consumption. Ivermectin is not approved for treating people with coronavirus infection exposure and/or illness.

What about ivermectin? It is a pharmaceutical of good bioavailability, handled by the liver before excretion, and with a relatively short half-life. It prevents glutamate chloride channel closures, cytotoxic to parasites, and at high dosages also influence gamma-aminobutyric acid channels. Penetration into the brain is usually not prominent, but over-dosing, pharmaceutical interactions, and hereditary factors can allow dangerous blood-brain barrier transfer. Adverse psychiatric problems can follow, with sedation, confusion, coma and/or seizures. Other side effects include gastrointestinal track upset and low blood pressure. Overdose deaths are increasingly reported to poison control centers.

Otherwise, there is “in-vivo” research evidencing ivermectin acting against SARS-CoV-2 viruses in laboratory cell studies. There are a wide range of anecdotal accounts and investigative reports indicating that ivermectin has efficacy in treating individuals affected by this virus; however, much of this is less well controlled and in small volume. More study is indicated.

There are a variety of clinics and physicians prescribing ivermectin to their patients. Many report success with its use under medical supervision. Perhaps this medicine is doing precisely what they say. Nevertheless, it has not been approved for this indication; this use is in off-label prescribing (of course, doctors do lots of off-label distribution). Animal preparations are not for people, thus not well researched.

Despite concerns about ivermectin, if utilized in human patients, it is best only be prescribed by physicians familiar with this medication. Administration would be done under observation in a clinical setting. Future research and clinical use will tell us the true utility and risks involved. In the meantime, coronavirus delta is raging! Hoping for a good outcome.