Correspondence in the New England Journal of Medicine (NEJM) chronicles increased use of veterinary-use Ivermectin and increased COVID-19-related calls at the Oregon Poison Centre.
The writers express concern about the escalation in the use of Ivermectin. They emphasise that controlled trials have shown absolutely no benefit from Ivermectin in the prevention of COVID-19, and yet coincidentally, veterinary use of the medication (for which it was originally designed) as well as prescriptions for human use in the US, has increased dramatically.
Dr Courtney Temple, Dr Ruby Hoang, Dr Robert Hendrickson, from Oregon Health and Science University, Portland, Oregon, write that Ivermectin is approved by the US Food and Drug Administration as an oral treatment for intestinal strongyloidiasis and onchocerciasis, and as a topical treatment for pediculosis and rosacea.
It is also used as a treatment for parasites in pets and livestock. Ivermectin may decrease severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication in-vitro, the doctors wrote, but randomised, controlled trials have shown no clinical benefit in the prevention or treatment of coronavirus disease 2019 (COVID-19).
Yet veterinary use of Ivermectin has increased, and the number of prescriptions for use by humans in the United States is 24 times higher than the number before the pandemic. Moreover, the doctors wrote, 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 facility staffed by specialty-trained nurses, pharmacists, and physicians who provide treatment advice for the public and comprehensive treatment consultation for health care 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 to 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 people who called in August, 11 were men, and most were older than 60 years of age (median age, 64; range, 20 to 81). Approximately half (11) were reported to have used Ivermectin to prevent COVID-9, and the remaining callers had been using the drug to treat COVID-19 symptoms.
Three of them had received prescriptions from physicians or veterinarians, and 17 had purchased veterinary formulations; the source of Ivermectin for the remaining person was not confirmed. Symptoms had developed in most of them within two hours after a large, single, first-time dose. In six persons, symptoms had developed gradually after 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 people who had been using veterinary products ranged from 6.8mg to 125mg of 1.87% paste and 20mg to 50mg of the 1% solution. The dose of the human-use tablets was 21mg per dose twice weekly for prevention.
Six of the 21 people 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 distress in four persons, confusion in three, ataxia and weakness in two, hypotension in two, and seizures in one. Of those who were not admitted to a hospital, most had gastrointestinal distress, dizziness, confusion, vision symptoms, or rash.
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.
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