FACT VS. FICTION: IVERMECTIN’S ROLE IN MEDICINE, COVID-19, AND CANCER
Ivermectin was discovered in the 1970s and initially used as an antiparasitic drug for livestock and, later, for humans. Notably, in 2015, the drug earned its developers the Nobel Prize in Physiology or Medicine for its transformative role in reducing the global burden of parasitic diseases such as lymphatic filariasis and river blindness. Besides its medical applications, ivermectin has been added to the World Health Organization’s List of Essential Medicines, highlighting its significance in public health.
In this article, we discuss the clinically approved uses of ivermectin and some of the confusion and misinformation surrounding this medication.
What is Ivermectin?
Ivermectin is an antiparasitic drug (anthelmintic). It treats many worm infections, such as onchocerciasis (river blindness), ascariasis, and strongyloidiasis. These are all conditions caused by nematode worms, which are internal parasites residing mostly in the intestines of animals. It is also used against ectoparasites (external parasites) like lice, mites, and ticks.
In humans, the FDA has approved the drug for treating onchocerciasis and intestinal strongyloidiasis. Topical ivermectin is approved for use against head lice and to treat rosacea.
How Ivermectin Works
Ivermectin is a potent anthelmintic (against worms) that acts on the nerves of parasitic worms.
Ivermectin’s mechanism of action involves ligand-gated ion channel receptors on cells. These receptors are proteins to which molecules have to bind for an action to occur in the cell. Ivermectin interferes with how these receptors work, disrupting the balance of ions inside the nerve cell by affecting which ions can enter.
Nerve cells work because a certain number and type of charged particles (ions) enter the cell. Disruption of this process affects how the cells function and, in the case of ivermectin, eventually causes the cell to stop functioning, leading to paralysis and the death of the parasite.
Ivermectin Dosage for Humans
The dose of ivermectin depends on the condition and the individual being treated. Dosage will be influenced by body weight. With tablets, the dose to treat strongyloidiasis is 200 mcg per kg, while the dose for treating onchocerciasis is 150 mcg per kg. Tablets come in 3 mg doses. The number of tablets to take will vary by weight and the infection being treated. Your doctor will prescribe the dose appropriate for your condition and weight.
How Long Does It Take for Ivermectin to Kill Parasites?
Depending on the dosage, ivermectin reduces skin microfilaria by 80% within the first 48 hours of treatment. Onchocerciasis in children may require repeated treatment every six months for up to 15 years to effectively control the infection. With strongyloidiasis, ivermectin eliminates 96% of worms after 14 days of treatment with the first dose and then 98% after the second dose. These studies prove that ivermectin is highly effective as an anthelmintic.
- What to do in case of a missed dose
If you miss a dose of ivermectin, take it as soon as you remember - unless it is almost time for your next dose, in which case just skip the missed dose and take the next one as scheduled. The medication is typically recommended to be taken on an empty stomach.
Indications of Ivermectin
Ivermectin is used to treat a number of parasitic infections, including:
- Strongyloidiasis
- Onchocerciasis
- Ascariasis
- Cutaneous larva migrans
- Trichuriasis
- Pediculosis (lice infestation)
- Scabies (mite infestation)
Ivermectin topical use for skin conditions like rosacea:
A 1% ivermectin topical cream can be used for treating the lesions of rosacea. It is thought that the reason ivermectin works with rosacea is that it kills the Demodex mites that are found on the skin. Ivermectin also has an anti-inflammatory effect.
How long should ivermectin be used for rosacea?
The topical cream should be used on rosacea papules daily for 4 months.
Clarifying Usage in Cases of Pediculosis and Scabies:
Ivermectin can be used for head lice infestation and scabies mites. Studies have shown the medication to be effective against both these ectoparasites. It is important to note that oral ivermectin is not FDA-approved for treating scabies but might be prescribed off-label for cases that do not respond to topical therapies. However, topical ivermectin is FDA-approved for treating head lice.
Does ivermectin kill ringworm?
Despite the name, ringworm (tinea) is caused by a fungus, not a worm, and is not treated using ivermectin. Rather, there are various FDA-approved fungal creams to treat ringworm.
Ivermectin Side Effects
Side effects can vary depending on the route of administration, i.e., oral or topical. It is advisable to promptly consult a doctor in case of severe or persistent adverse reactions. Potential side effects of oral ivermectin include:
- Redness
- Pain
- Eye or eyelid irritation
- Dizziness and shakiness
- Fainting
- Rapid or irregular heartbeat
- Muscle or joint pain
- Skin rash
- Fever and chills
- Chest pain
- Tarry stools
- Edema
- Swollen glands
- Sore throat and mouth ulcers
- Tiredness
Side effects of topical ivermectin may include:
- Itching
- Burning
- Redness of the skin
- Dry skin
- Dandruff
- Eye and eyelid swelling
Side effects can sometimes be avoided when topical ivermectin is used correctly to treat Demodex mites if applied in an office setting. Side effects may lessen with time as the body adjusts to the medication. While rare, there can be long-term side effects such as:
- Liver damage
- Tachycardia
- Vision loss and other eye issues
- Allergic reaction
- Problems with the nerves and brain
- Sleepiness
- Confusion
When to See a Doctor
You should seek emergency care if any of the following signs present after taking oral ivermectin, as these may occur due to an overdose:
- Confusion
- Unusual and severe drowsiness
- Reduced responsiveness
Urgent attention is also essential if you experience the following issues after using topical ivermectin:
- Trouble with breathing
- Skin rash
Ivermectin and COVID-19
Several podcasts and claims on social media have referenced ivermectin as a viable COVID-19 treatment.
- Early Interest:
- Studies investigated whether ivermectin has antiviral properties. At least one study tested ivermectin in monkey kidney cells and reported decreased replication of the COVID-19 virus. However, it is worth noting that these studies neither involved human subjects nor pulmonary cells, which is what the virus typically infects in humans.
- Public and media attention led to an increased demand for ivermectin between January 2020 and June 2023.
- Scientific Evaluation:
- Recent research indicates no benefit to using ivermectin for treating COVID-19. Ivermectin also does not decrease the risk of hospitalization from COVID-19.
- The FDA has not approved ivermectin for treating COVID-19. The WHO recommends only using ivermectin in clinical trials.
- Controversies and Misuse:
- Several people have tried medicating with the veterinary formulation of ivermectin. This led to health problems, including rapid heart rate. There is concern that using ivermectin meant for livestock is dangerous and can lead to neurotoxicity, overdose, and even death. People who have self-medicated with veterinary ivermectin have often ended up in the emergency room with serious symptoms. Veterinary ivermectin contains ingredients that have not been tested on humans, and the product is more concentrated since it is designed for use on livestock and not humans.
- People have continued to tout the benefits of ivermectin against COVID-19 despite the findings that many of the studies claiming benefits were suspect. Reports state that some studies may have faked data.
The Ivermectin Controversy: Cancer
Recent social media trends have been promoting ivermectin for cancer treatment.
There is some data to suggest ivermectin has an adverse impact on tumors, but its precise target within cancer cells remains unknown. Research is still in the early stages, and more data and clinical studies are needed to verify if ivermectin has a noticeable effect on cancerous tumors.
It is important to follow proven cancer treatment plans that have been verified to have a positive effect. Your oncologist will be able to suggest optimal treatment options depending on your specific type and stage of cancer.
Studies into ivermectin for cancer treatment need to be done systematically, along with clinical trials. At present, the medicine is not thoroughly tested or FDA-approved for use in cancer treatment. Yet, there are cancer patients who are self-medicating with veterinary ivermectin instead of using conventional treatment methods, which is not recommended.
Latest Research on Ivermectin
Recent research has shown that ivermectin also helps with seizures caused by parasitic worms like Onchocerca. Trials have also been conducted using ivermectin against Trichuris trichiura and hookworm. These trials showed that using ivermectin along with albendazole is an effective way to rid the body of Trichuris and hookworm.
There has been ongoing research on ivermectin and COVID-19. In fact, a recent meta-analysis was completed, but the findings showed that ivermectin did not affect COVID-19 outcomes. Ivermectin is also being tested for use against parasites transmitted by mosquitoes. There is some evidence that modified ivermectin affects the development of Plasmodium falciparum malaria in the blood.
Conclusion
Ivermectin is a medication used to treat internal and external parasitic infections. The medicine is taken as tablets or as a topical cream, depending on the infection being treated. It does have side effects, which may lessen with time.
More recently, there have been claims that ivermectin helps treat COVID-19 and cancer. There is little research to support these ideas, and the medicine is not FDA-approved to treat cancer or coronavirus. Clinical trials have not yet been completed; however, there is research indicating that ivermectin is not effective against tumors or COVID-19.
Social media has contributed to misinformation, promoting unproven claims that ivermectin treats cancer and COVID-19. As often cautioned, it is not advisable to rely on social media for medical advice since the statements may not be based on actual, rigorous scientific research. Medications have to go through thorough testing and well-designed clinical trials to demonstrate safety and efficacy before they receive governmental approval.
FAQ
What are the contraindications for ivermectin?
The current recommendation is that Ivermectin should not be given to children under 5 years of age or who weigh less than 15 kg. However, some research indicates that Ivermectin is safe when given to children weighing less than 15 kg. Ivermectin is contraindicated in pregnancy. Limited research is available on the effect of ivermectin on breastfed infants, so it is important to consult your doctor for advice. Ivermectin should be used with caution when treating patients with CNS disorders, such as trypanosomiasis, epilepsy, or meningitis. You should consult your doctor before using it if you are on warfarin, with which ivermectin interacts.
How long does ivermectin stay in your system?
The half-life of the drug varies from 12 to 36 hours, but ivermectin can stay in your body for up to 12 days.
Is ivermectin safe for asthma patients?
There is debate on whether ivermectin is safe for people with asthma. Some studies suggest that it attenuates lung injury and has an anti-inflammatory effect that helps with asthma. However, these studies were done on mice. Others suggest caution, as some people may have an allergic response to the medication, which may worsen bronchial asthma.
Is ivermectin effective against malaria?
Ivermectin has generally been considered safe when used in studies testing its effect against malaria. However, the medication did not have a significant effect in reducing malaria. Currently, ivermectin is not FDA-approved to treat malaria, and more trials are needed to test if the medicine can benefit malaria patients.
Does ivermectin kill bacteria?
Some research indicates that ivermectin kills Mycobacterium tuberculosis. However, more research is needed to assess the effect of ivermectin on Mycobacterium and other bacteria.
Can you take ivermectin with antibiotics?
In some cases, you can take ivermectin with an antibiotic. For instance, ivermectin and doxycycline, when taken together, work well to treat river blindness. There are known interactions with other antibiotics, such as clarithromycin and amoxicillin. In such cases, the ivermectin dose would need to be adjusted.
Is ivermectin classified as an antiviral, antifungal, antibiotic, or a steroid?
Ivermectin is not a steroid or antifungal. Although some research indicates an antibiotic and antiviral effect, ivermectin is still classified as an antiparasitic drug. More studies are needed to test and confirm the effects of ivermectin on bacteria, fungi, and viruses.
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