ivermectin (Stromectol, Sklice)

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Introduction

Tradename: Stromectol.

Indications

* in vitro activity against COVID-19[5]

* NIH no longer recommends against or for use of ivermectin for treatment of COVID-19[7]

* WHO & FDA recommend against use of ivermectin for treatment of COVID-19[8]

* 5-day course of ivermectin does not reduce time to resolution of symptoms[9]

* ivermectin does not prevent progression to severe disease[17]

* ivermectin does not reduce all-cause mortality, length of stay or viral clearance in randomized controlled trials in Covid-19 patients[10]

* ivermectin 400 ug/kg/day for 3 days of no benefits for mild-moderate Covid-19[20]

* ivermectin 600 ug/kg/day for 6 days of no benefits for mild-moderate Covid-19[20]

* meta-analysis of 15 trials found ivermectin reduced risk of death (RR=0.38)[11]

* meta-analysis of 11 trials found ivermectin reduced risk of death (RR=0.44)[12]

* Cochrane review concludes reliable evidence available does not support use of ivermectin for prevention or treatment of COVID-19 outside of clinical trials[15]

* no evidence suggests ivermectin prevents mortality from COVID-19 in regions where strongyloidiasis is not endemic[18]

* treatment of early Covid-19 does not lower risk for hospitalization or reduce length of time spent in the emergency department[19]

Dosage

Tabs: 6 mg.

Lotion: 0.5% (now OTC)

Adverse effects

Notes

More general terms

Additional terms

Component of

References

  1. ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1214.
  3. ↑ Foucault C et al, Oral ivermectin in the treatment of body lice J Infect Dis 2006, 193:474 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16388498
  4. ↑ Pariser DM et al Topical 0.5% Ivermectin Lotion for Treatment of Head Lice N Engl J Med 2012; 367:1687-1693 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23113480 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1200107
    Chosidow O and Giraudeau B Topical Ivermectin - A Step toward Making Head Lice Dead Lice? N Engl J Med 2012; 367:1750-1752 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23113487
  5. ↑ 5.0 5.1 Caly L, Druce JD, Catton MG et al The FDA-approved Drug Ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Research. Published online April 3, 2020 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32251768 Free PMC Article https://www.sciencedirect.com/science/article/pii/S0166354220302011
    FDA Safety information. April 10, 2020 Ivermectin Intended for Animals: Letter to Stakeholders - Do Not Use in Humans as a Treatment for COVID-19. https://www.fda.gov/safety/medical-product-safety-information/ivermectin-intended-animals-letter-stakeholders-do-not-use-humans-treatment-covid-19
  6. ↑ 6.0 6.1 6.2 FDA News Release. Oct 27, 2020 FDA Approves Lotion for Nonprescription Use to Treat Head Lice https://www.fda.gov/news-events/press-announcements/fda-approves-lotion-nonprescription-use-treat-head-lice
  7. ↑ 7.0 7.1 7.2 Frontline COVID-19 Critical Care Alliance (FLCCC) Prophylaxis & Treatment Protocols for COVID-19 https://covid19criticalcare.com/
    Kory P et al Clinical and Scientific Rationale for the "MATH+" Hospital Treatment Protocol for COVID-19 Journal of Intensive Care. Dec 2020 https://covid19criticalcare.com/wp-content/uploads/2020/12/MATH-plus-Rationale-Journal-of-Intensive-Care-Medicine-Dec2020.pdf
    Sax PE Ivermectin for COVID-19 - Breakthrough Treatment or Hydroxychloroquine Redux? N Eng J Med Journal Watch HIV and ID Observations. Jan 4, 2021 https://blogs.jwatch.org/hiv-id-observations/index.php/ivermectin-for-covid-19-breakthrough-treatment-or-hydroxychloroquine-redux/2021/01/04/
    Frellick M Controversy Flares Over Ivermectin for COVID-19. Medscape. Jan 20, 2021 https://www.medscape.com/viewarticle/944440
    COVID-19 Treatment Guidelines Panel. The COVID-19 Treatment Guidelines Panel's statement on the use of ivermectin for the treatment of COVID-19. 2021 Jan 14 https://www.covid19treatmentguidelines.nih.gov/statement-on-ivermectin
  8. ↑ 8.0 8.1 8.2 Reuters Staff WHO Joins Europe, Merck in Recommending Against Ivermectin for COVID-19. Medscape - Mar 31, 2021 https://www.medscape.com/viewarticle/948471
  9. ↑ 9.0 9.1 Lopez-Medina E, Lopez P, Hurtado IC et al Effect of Ivermectin on Time to Resolution of Symptoms Among Adults With Mild COVID-19. A Randomized Clinical Trial, JAMA. Published online March 4, 2021 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33662102 https://jamanetwork.com/journals/jama/fullarticle/2777389
  10. ↑ 10.0 10.1 Roman YM, Burela PA, Pasupuleti V et al Ivermectin for the treatment of COVID-19: A systematic review and meta-analysis of randomized controlled trials. medRxiv 2021. May 25 Not indexed in PubMed https://www.medrxiv.org/content/10.1101/2021.05.21.21257595v1
  11. ↑ 11.0 11.1 Bryant A, Lawrie TA, Dowswell T et al Ivermectin for Prevention and Treatment of COVID-19 Infection. A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines. Am J Ther. 2021 Jun 17. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34145166 https://journals.lww.com/americantherapeutics/Abstract/9000/Ivermectin_for_Prevention_and_Treatment_of.98040.aspx
  12. ↑ 12.0 12.1 12.2 Hill A, Garratt A, Levi J et al Meta-analysis of randomized trials of ivermectin to treat SARS-CoV-2 infection. Open Forum Infectious Diseases. 2021. July 6 https://academic.oup.com/ofid/advance-article/doi/10.1093/ofid/ofab358/6316214
  13. ↑ Wilson FP Ivermectin for COVID: How Do We Know What to Believe? Medscape - Jul 14, 2021 https://www.medscape.com/viewarticle/954681
  14. ↑ Fiore K Large Ivermectin Study Retracted. Preprint publisher finds evidence of plagiarism, problems with raw data. MedPage Today July 20, 2021 https://www.medpagetoday.com/special-reports/exclusives/93658
  15. ↑ 15.0 15.1 Popp M, Stegemann M, Metzendorf MI et al Ivermectin for preventing and treating COVID-19. Cochrane Database of Systematic Reviews. 2021. July 28 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015017.pub2/full
  16. ↑ 16.0 16.1 Temple C, Hoang R, Hendrickson RG. Toxic Effects from Ivermectin Use Associated with Prevention and Treatment of Covid-19. N Engl J Med. October 20, 2021. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34670041 https://www.nejm.org/doi/full/10.1056/NEJMc2114907
  17. ↑ 17.0 17.1 Lim SCL, Hor CP, Tay KH et al Efficacy of Ivermectin Treatment on Disease Progression Among Adults With Mild to Moderate COVID-19 and Comorbidities. The I-TECH Randomized Clinical Trial. JAMA Intern Med. Published online February 18, 2022. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35179551 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2789362
  18. ↑ 18.0 18.1 Bitterman A, Martins CP, Cices A et al Comparison of Trials Using Ivermectin for COVID-19 Between Regions With High and Low Prevalence of StrongyloidiasisA Meta-analysis. JAMA Netw Open. 2022;5(3):e223079 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35311963 Free article https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790173
  19. ↑ 19.0 19.1 Reis G, Siva EASM, Silva DCM et al Effect of Early Treatment with Ivermectin among Patients with Covid-19. N Engl J Med 2022. March 30 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35353979 https://www.nejm.org/doi/full/10.1056/NEJMoa2115869
  20. ↑ 20.0 20.1 20.2 Naggie S, Boulware DR, Lindsell CJ et al Effect of Ivermectin vs Placebo on Time to Sustained Recovery in Outpatients With Mild to Moderate COVID-19. A Randomized Clinical Trial. JAMA. Published online October 21, 2022 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36269852 https://jamanetwork.com/journals/jama/fullarticle/2797483
    Naggie S, Boulware DR, Lindsell CJ et al Effect of Ivermectin vs Placebo on Time to Sustained Recovery in Outpatients With Mild to Moderate COVID-19: A Randomized Clinical Trial. medRxiv. Dec 15, 2022 https://www.medrxiv.org/content/10.1101/2022.12.15.22283488v1
    Naggie S, Boulware DR, Lindsell CJ et al Effect of Higher-Dose Ivermectin for 6 Days vs Placebo on Time to Sustained Recovery in Outpatients With COVID-19. A Randomized Clinical Trial. JAMA. Published online February 20, 2023 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36807465 PMCID: PMC9941969 (available on 2023-08-20) https://jamanetwork.com/journals/jama/fullarticle/2801827

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