An interesting letter published in the New England Journal of Medicine by Courtney Temple and others October 20th 2021 highlights this issue.
Ivermectin is approved by the FDA as an oral treatment for intestinal strongyloidiasis and onchocerciasis and is a topical treatment for pediculosis and rosacea. It is also used as a treatment for parasites in pets and livestock.
Ivermectin may decrease severe SARS-CoV-2 replication in vitro, but randomised, controlled trials have shown no clinical benefit in the prevention or treatment of COVID-19.
Veterinary use of Ivermectin has increased, and the number of prescriptions for use by humans in the United States has been 24 times as high as the number before the pandemic. Moreover, the number of such prescriptions in August 2021 was four times as high as the number in July 2021.
The Oregon Poison Centre is a telephone consultative centre staffed by specialty-trained nurses, pharmacists, and physicians who provide treatment advice for the public and comprehensive treatment consultation for healthcare workers caring for patients in Oregon, Alaska and Guam.
The Centre has recently received an increasing number of calls regarding Ivermectin exposure related to Covid-19. The rate of calls regarding Ivermectin had been 0.25 calls per month in 2020 and had increased to 0.86 calls per month from January through July 2021.
In August 2021, the centre received 21 calls. Monthly total call volumes for all poison exposures were stable throughout 2020 and 2021. Of the 21 patients who called in August 11 were men and most were older than 60 years of age.
Approximately half, 11 persons, were reported to have used Ivermectin to prevent COVID-19 and the remaining persons had been using the drug to treat COVID-19 symptoms.
Three patients had received prescriptions from physicians or veterinarians and 17 had purchased veterinary formulations; the source of Ivermectin for the remaining persons was not confirmed.
Symptoms had developed in most persons within two hours after a large, single, first-time dose.
In six persons symptoms had developed gradually over several days to weeks of repeated doses taken every other day or twice weekly. One person had also been taking vitamin D to treat or prevent COVID-19. Reported doses ingested by the persons who had been using veterinary products ranged from 6.8 mg to 125 mg of 1.87% paste and 20-50 mg of the 1% solution. The dose of the human-use tablets was 21 mg per dose twice weekly prevention.
Six of the 21 persons were hospitalised for toxic effects from Ivermectin use. All six reported preventive use, including the three who had obtained the drug by prescription. Four received care in an intensive care unit and none died.
Symptoms were gastrointestinal disease in four persons, confusion in three, ataxia and weakness in two, hypotension in two and seizures in one. Of the persons who were not admitted to a hospital most had:
- Gastrointestinal distress
- Vision symptoms
These cases illustrate the potential toxic effects of Ivermectin, including severe episodes of confusion, ataxia, seizures and hypotension and the increasing frequency of inappropriate use.
There is insufficient evidence to support the use of Ivermectin to treat or prevent COVID-19 and improper use, as well as the possible occurrence of medication interactions, may result in serious side effects requiring hospitalisation.
The London General Practice, the leading London doctors’ clinic in Harley Street provides a full COVID service from testing to referral for long COVID. It encourages the use of all proven medications and discourages all alternative therapies.
If you have any medical issue relating to COVID, please do not hesitate to make an appointment. We are, however, unable to provide vaccines or actual acute treatment apart from our leading COVID safety net service, which provides a daily phone call to ensure that there is no deterioration of symptoms.
Dr Paul Ettlinger
BM, DRCOG, FRCGP, FRIPH, DOccMed