Why You Should Not Use Ivermectin to Treat or Prevent Covid-19 | Hacker News Reader

Why You Should Not Use Ivermectin to Treat or Prevent Covid-19

fda.gov

37 points_Microft56 comments

> Ivermectin tablets are approved by the FDA to treat people with intestinal strongyloidiasis and onchocerciasis, two conditions caused by parasitic worms. In addition, some topical forms of ivermectin are approved to treat external parasites like head lice and for skin conditions such as rosacea.

I wish people would stop making the claim that it's "just a horse dewormer" when even the FDA says it has some uses in humans. Whether or not it is effective against COVID19 is a valid issue, but trying to portray the whole drug as something else just makes your opponents jump to conclusions when they find it does actually work in certain situations/diseases.

The big problem is that the pills people are obtaining are "just a horse dewormer". The specification is different, the dosages are different, and the active ingredients differ (drug delivery is frighteningly complex area).

Meanwhile people made enough run on ivermectin-based horse dewormer that people had trouble getting it for livestock.

> the dosages are different, and the active ingredients differ

Neither the dosages nor the active ingredients are different. Both for humans and for animals, the recommended dose of Ivermectin to treat parasites is 200 micrograms per kilogram of body weight. The "active ingredients" are Ivermectin, period.

I have a bottle of injectable Ivermectin intended for cattle here, and it says it's pure Ivermectin in propylene glycol (typical carrier for injectables even for humans). I got it to treat Histomoniasis in our turkeys, which is btw an off-label use, because officially Ivermectin is not supposed to be effective against protozoa, but Histomoniasis is almost 100% fatal in turkeys and I haven't lost one since starting to give them Ivermectin as soon as I notice they have it. I've found that if I give them 600 micrograms/kg body weight every other day 3 times, they recover fully. What does this have to do with Covid? Only that a) Ivermectin works for some things other than those for which it's officially "blessed", b) at least in turkeys a much larger than normal dose doesn't seem to have any ill effects. As for the dose, I decided that it was probably safe for our turkeys because I read a paper where they gave that dosage to humans to combat malaria by making those humans lethally toxic to the mosquitos. The paper said the dose was "well tolerated". If they can do that to their human patients I can do it with my turkeys.

I'm not planning to inject myself with my veterinary Ivermectin even if I did come down with Covid... because I agree that so far the evidence that it's helpful isn't very strong. But I also think that this article is quite laughable... basically it says "Why You shouldn't use Ivermectin to treat or prevent Covid: because, uh... because we haven't said it's OK to do so." Sorry CDC, but your credibility just isn't /that/ high. And going to a hospital for /anything/ is also really dangerous... almost certainly more so than a couple of doses of Ivermectin.

They give two reasons that I think are much more than uh, we haven't said it's ok. One is people are getting sick and hospitalised for taking this stuff. The second is, it can have interactions with other medications people might be taking or conditions they might have. Also the stuff you have might be free of non-active ingredients with adverse risks for humans, but other formulations might well contain such ingredients.

Note that the FDA does not say don't take it if your doctor prescribes it, they just say in that case you should follow the directions precisely. The problem is the majority of people taking this stuff don't seem to be doing so under medical guidance. That's a serious issue they have a responsibility to address.

The "ivermectin overdoses" story was debunked.

https://twitter.com/ggreenwald/status/1434538877642027015

A report has been discredited, but the National Poison Data System states there were 459 reported cases of ivermectin overdose in the United States in August. That's a 245% jump compared to July.

There's a fair bit of exaggeration going on, in both directions. Surprise.

> Both for humans and for animals, the recommended dose of Ivermectin to treat parasites is 200 micrograms per kilogram of body weight.

I think he might have meant the dosage that it is sold in is different.

Ivermectin for treating parasites is typically supposed to be taken as a single dose. For some parasites it might need to be repeated in 3 to 12 months.

If a doctor prescribes it to treat a human I'd expect the prescription to be for the right amount of pills for your body weight to deliver that single you-sized dose.

Horse ivermectin is sold in a quantity suitable for a 1250 pound horse.

From what I've read it appears that a lot of people buy that horse-sized single dose and use it all. Worse, a lot of them seem to take it daily.

Yep. Injectable as GP shows can use same carrier, but people aren't using injectable nor do they adjust dosages from what I have seen on the net.

Meanwhile, even if ivermectin worked, it would be secondary to vaccination because you want to prevent as much as early as possible. Should any of those wonder drugs end up working, it wouldn't help ICU capacity much :-(

> specification is different, the dosages are different, and the active ingredients differ

I understood a chief issue to discriminate product X₁ for use with humans and product X₂ for use with the rest (livestock) is the quality control in production: the first is certified for some threshold of quality, the second uses more loose parameters.

(I may be wrong, I welcome corrections and clarifications.)

I call horse paste eaters horse paste eaters, those actually getting prescribed Ivermectin by their doctors aren't the ones calling poison control.

There are some studies indicating that ivermectin may be helpful in treating covid. But those studies are small, not statistically strong, and not all necessarily trustworthy. There are a few larger, more mainstream studies that don't look too promising. But ivermectin is still a candidate and deserves further study (and there are larger studies underway).

All that being said, this whole situation is basically an amplification of a problem that we already have in the US, which is the ability of pharmaceutical companies to advertise directly to the public. Social media and right wing news outlets are basically giving medical treatment recommendations to the public and at best, this information is being delivered for the most part by fringe doctors without direct expertise in treating respiratory diseases and without any knowledge of the individuals they are mass suggesting receive this treatment.

This talking directly to the public about Rx only treatment is what has led to people self medicating with the livestock version of the drug.

This Ivermectin study has all the same problems you mentioned:

https://www.scholarsresearchlibrary.com/articles/effects-of-...

But then I don't know why you would pick one bad study over another to make your decisions, so I say talk about it. I bring this up specifically because of fears about vaccines and sterility.

> But those studies are small, not statistically strong, and not all necessarily trustworthy.

All of the Ivermectin studies are small?

Yes.

>>which is the ability of pharmaceutical companies to advertise directly to the public.

Pharmaceutical companies are not advertising ivermectin directly to the public..

It's off-patent anyway, so there's no profit in it.

Why is anyone seriously talking about Ivermectin when the Moderna vaccine is 96%+ effective at preventing symptoms that require hospitalization, and 99%+ at preventing death?

Covid-19 prevention and treatment is basically a solved problem.

My limited understanding of other's reality suggests to me that people have connected deeply with a community (through identity poltics or... fun) that is no longer relevant in a post-covid world leading towards a mania where vaccines are somehow bad is the only thing that makes sense.

I'm skeptical about the efficacy of the SARS-CoV-2 vaccine over longer periods of time.

I've still not heard a reasonable explanation about why this vaccine is expected to work long-term when the flu shot clearly does not. Especially since SARS-CoV-2 mutates faster than the flu virus.

Can anyone give me an explanation of why vaccines are touted for fast-evolving viruses like the flu and SARS-CoV-2?

>Especially since SARS-CoV-2 mutates faster than the flu virus.

This doesn't jive with what I have heard, that SARS-CoV-2 mutates rather slowly, like other coronaviruses.

And that the flu is completely different, having the ability to recombine parts, which is why we have a different strain every years, aka H1N1, H2N1, H2N2, etc. Every year they have to guess which one will be prevalent, therefore the yearly flu shots.

SARS-CoV-2 has not mutated into a different strain (variants are not strains), and is not expected to. Immune system response for other coronaviruses has been observed to be long lasting (17 years for SARS-CoV-1).

There cannot be a the vaccine; obviously, SARS-CoV-2 vaccines will have to be updated. People will need boosters.

> I've still not heard a reasonable explanation about why this vaccine is expected to work long-term when the flu shot clearly does not

I don't think anyone in their right mind claims or believes such a thing, or believes that the health authorities are trying to convince them of such a thing. Depending on what we mean by "long term".

> SARS-CoV-2 mutates faster than the flu virus.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137987/

"Compared with other RNA viruses such as HIV and influenza virus, SARS-CoV-2 accumulates mutations much more slowly (15, 28)."

So that would by why you can expect more mileage from SARS-CoV-2 vaccines.

> Especially since SARS-CoV-2 mutates faster than the flu virus.

The SARS-cov-2 proofreading mechanism would like to have a word with your horribly inaccurate point

You do realize the Covid vaccine is extremely expensive in many parts of the world and not everyone will be vaccinated, correct?

It is frightening how people will apply no common sense before attacking any group of people that isn't 100% on board with their solution to a problem.

The FDA website isn't targeting the third world. It's directed at people living in America, where they are able to get the vaccine for free.

And there will be obviously be people in the USA who do not get the vaccine for various reasons who will die if better treatments are not found.

>Why is anyone seriously talking about Ivermectin

Probably because Ivermectin has gone through the rigorous process of testing/approval required for use in humans, that we haven't had time to do with the vaccine. I mean, it's completely understandable why people would seek out well-tested drugs, that are more predictable due to the scientific scrutiny they've been under, than a vaccine that got rushed into production. Are people honestly surprised by this? I mean, sure Ivermectin probably isn't a good covid treatment but if there aren't negative side-effects and it has a chance of helping then I don't see a problem with taking it under doctor supervision. I mean, we want to stop the pandemic, right? What's the big issue with looking to well-tested, scientifically-scrutinized medications as possible treatments for people who already have covid?

It looks like the whole "treatment plan" is only to scare more people into getting vaccines by letting people die.

When I had Covid I went to urgent care to get tested. They sent me home with a paper that said I had Covid and told me to take Tylenol. Everyone I know that has contracted Covid has received the same "treatment" no matter the age. This is why some people are dying.

Compare that with someone like Trump or Joe Rogan. It's not even a money thing, you have to convince doctors to even treat you for this thing. By the time you got to ER Ivermectin (or whatever the antiviral flavor of the month is) or monoclonal antibodies aren't that effective.

That stinks. Florida is offering free Monoclonal Antibody Treatments for all...

https://floridahealthcovid19.gov/monoclonal-antibody-therapy...

>Individuals 12 years and older who are high-risk, that have contracted or been exposed to COVID-19, are eligible for this treatment. Treatment is free and vaccination status does not matter.

I assume I'm not high-risk. One of the people I know that got it was probably considered high risk because he was overweight. Not obese but overweight.

Check the mode of action of ivermectin (https://en.wikipedia.org/wiki/Ivermectin#Mechanism_of_action). It blocks nerve and muscle chloride channels resulting in paralysis. Humans rely on it not crossing the blood-brain barrier to avoid killing themselves. Viruses lack such channels, as do normal human cells.

> What's the big issue with looking to well-tested, scientifically-scrutinized medications as possible treatments for people who already have covid?

Well, one word should sum it up: profit

We need a backup plan. While there a lot of drugs being developed for the treatment of Covid-19, it's easier to use a drug that has already been around for a while because the safety profile is pretty much known.

Spray and pray drug development led to our most useful drugs we use today and in the past.

Actually, I don’t think there are any drugs developed to fight COVID. Yeah, there are monoclonal antibodies developed from the initial cohort of symptomatic patients, and various anti inflammatories that have been effective in reducing the intensity of a cytokine storm. There are small molecule efforts, but these things take time. There is a delta specific vaccine in initial clinical trials but it’s bloody hard to get a placebo group together anymore.

The vaccines (of which there are both traditional and novel delivery mechanisms and payloads) represent the best way of reducing the impact of the infection. There is only a short window in most people in which there is an active COVID infection. The problem starts with the aftermath - those with a strong, active immune system zap their lungs or other organ systems. Hence the anti inflammatories.

Viruses aren’t fully alive and they lack many/most of the biological features typical drugs affect. Thus, unless there’s a fortunate side effect, the risk to the human > risk to the virus.

I assume everyone was working on treatments. My sibling works at Pfizer as a Sas programmer / manager (mostly cancer trials) and they're working on a study with an old HIV drug.

That's just one small team in a huge company.

Edit: Just got clarification it's PF-07321332. I think it's related to ritonivir? Not super sure

> Why is anyone seriously talking about [x] when the [y] vaccine is 96%+ effective at preventing symptoms

They may be reluctant towards the latter product because their goal may be exactly to avoid damages, and they had acquaintances which suffered the potential Severe Adverse Events, which made these SAE a reality to fit properly in their "world model", and they may be confused by a strong clash between the evidence of those acquaintances and some circulating narrative according to which those cases are "anecdotal" (as if irrelevant), plus another which speaks of "safety" in relative terms instead of the closer-to-absolute terms one may intend (B says "safe" for "less dangerous than atrocilinusomethingmazipan", while A with "safe" would intend "substantially non dangerous").

They probably are the kind of people that do not consider the job done until the SAE are explained, including what is to be done to minimize them statistically (as in, "more risky for those with blue eyes") or prevent them. Some people get hurt, so you have to understand why.

Those of them who can reason about risk comparison (and know the risks of the main other option) will have taken precautions (whatever they are: some managed to achieve considerable isolation).

About explanation of the damages, some steps are being done, but it is slower than desirable: on the 9th an article came out about an autoimmune response against ACE2 as a possible cause of long COVID. Maybe something similar will be understood about the exceptional but still consideration worthy sufferers of post-vaccine SAE?

See: https://news.ycombinator.com/item?id=28486930

Vaccine effectiveness is down to about 90% with the Delta variant.

https://www.cidrap.umn.edu/news-perspective/2021/09/covid-19...

That's still good, but there will continue to be many hospitalizations and deaths. So more effective antiviral treatments are still needed. That's why the NIH is sponsoring a large clinical trial of ivermectin and other drugs.

https://www.nih.gov/research-training/medical-research-initi...

It seems like just yesterday the people who are now pushing Ivermectin as the miracle cure were pushing Hydrochloroquine. You don't hear much about that from them any more. What happened?

HCQ is still considered effective for early treatment, but Ivermectin appears effective in later stages of treatment. You can read all the peer reviewed science for yourself at c19ivermectin.com and c19hcq.com

A good infograph of the two are on the front pages if you cycle through the images, but I'll link them here,

ivm: https://c19ivermectin.com/plot/ispae2.png

hcq: https://c19hcq.com/plot/spae2.png

You can see that in early stage treatment HCQ is effective, but not as much in later stage treatments. Also, Ivermectin doesn't have side effects as strong as HCQ from what I understand.

Sick people trying the human doses of Ivermectin should be the easiest risk-management decision in the history of humanity.

You have a drug that is safe in human doses, cheap, and reported to have a positive effect. You lose nothing by trying it and gaining more data.

If people are taking Ivermectin instead of a vaccine, then we as a society have a lot to lose. There is no clinically significant evidence that Ivermectin prevents COVID-19 or reduces its severity. Whereas there is abundant evidence that the vaccines do.

Ivermectin use and vaccination are not mutually exclusive.

Or are you suggesting that if anti-vaxxers were convinced to not use ivermectin, or otherwise prevented from using it, they'd be more likely to get the vaccine?

* Short of using force, most people who are hesitant about the vaccines at this point are not going to rush to vaccinate anytime soon. A non-trivial portion of the population may never choose to get it. If there is some treatment that works, it basically starts to wind Covid down today.

* Do I know if Ivermectin is effective? No, that's why I'd like sick people to have the option to try, to both attempt and save their lives, as well as gather more data. It's an easy decision.

* There is evidence that leaky vaccines can drive mutations and cause worse problems. https://www.nationalgeographic.com/science/article/leaky-vac...

If they won’t take a rapidly developed vaccine, why would they take a rapidly developed treatment? By the time things are “safely tested”, they’ll either be dead from COVID or recovered from it. Long COVID would suck, though.

> If they won’t take a rapidly developed vaccine, why would they take a rapidly developed treatment?

* Ivermectin has long since been approved for human usage. It might not treat Covid very well (this is very much unproven) but a proper dose wouldn't kill you.

* People who are resisting the vaccines are famously seeking out the version of Ivermectin made for horses. Of course there's interest in trying this out.

I recommend that everyone get vaccinated if they can, but the vaccines aren't 100% effective so we still need other treatments. Some small controlled clinical trials have shown statistically significant benefits from ivermectin. But larger studies will be needed to reach any reliable conclusions.

https://www.mdpi.com/1999-4915/13/6/989

The problem with random people taking it is that's not "more data". They're not in a study, and they're likely to not try other treatment.

Also, Merck itself still doesn't recommend it, citing:

"No meaningful evidence for clinical activity or clinical efficacy in patients with COVID-19 disease, and;

A concerning lack of safety data in the majority of studies."

https://www.merck.com/news/merck-statement-on-ivermectin-use...

Cynically, you could say they should be motivated to support this trend, as it would be more $ for them. But that hasn't happened yet.

Merck is going to receive money ($1.2 billion) from the government for an alternative treatment. There are generics of Ivermectin so even if it does work Merck would want to push their new drug instead of Ivermectin.

If this was not related to covid nobody here would be trusting Merck due to this conflict of interest.

https://www.merck.com/news/merck-announces-supply-agreement-...

Where did this cockamamie idea originate of using an antiparasitic product for a viral infection?

The National Geographic has a summary here:

https://www.nationalgeographic.com/science/article/the-shaky...

Under "What triggered the ivermectin frenzy".

Firefox Reader Mode vanquishes the nag dialog.

pretty biased article. Didn't cite the many doctors who are using it in their treatment regimen, Japan Medical Association board member endorsement, or the population studies in India and Africa that show pretty compelling evidence. Also they didn't cover the early treatment vs. late stage when discussing the study results (ivermectin doesn't help people with high viral load already in the ICU, but apparently does help people who just got the virus).

[edited to correct JMA board member, not health minister]

The person in Japan who endorsed ivermectin is not a government minister. [1]

If you're referring to the Elgazzar paper from Egypt (as the "population studies in [..] Africa"), then it has been withdrawn from pre-print distribution. [2]

And, in general, the studies that have been performed are not sufficient to support ivermectin use among the general public at this time. [3]

[1] https://factcheck.afp.com/http%253A%252F%252Fdoc.afp.com%252...

[2] https://www.theguardian.com/science/2021/jul/16/huge-study-s...

[3] https://www.the-scientist.com/news-opinion/ivermectin-still-...

Thank you for the thoughtful reply.

Ozaki is on the JMA Board https://www.med.or.jp/english/about_JMA/trustees.html

The population study I was referring to was this one: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S...

citation 3 is an opinion piece (opinion section of that magazine). And even as a persuasion piece, it still quotes Cochrane on the need for a serious study.

The National Geographic article has a point of view. This is evident from its very title "[t]he shaky science behind ivermectin as a COVID-19 cure"; we may expect the content of the article to be biased toward making the case that the hypothesis is shaky.

I posted it not because I care about its point of view, but because it was one of the first items I was able to find quickly which provides a synopsis of what I was looking for: the origins of the ivermectin hypotheses in respect to COVID.

A lot of jurisdictions are now using ivermectin as a COVID prophylaxis. Shouldn't we have data by now showing whether it's effective in that role?

Can someone debunk this study for me:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7698683/

tl;dr don't do it because we said.

I don't know how effective ivermectin is at treating covid, probably not as effective as people were hoping a couple of months ago if at all. But it has been used in humans for decades and is shown to be very safe when used in proper doses. So what's the problem? False sense of security maybe? I'd rather have a false sense of security than a heart condition.

The vaccines appear to be effective. They appear to be generally safe, in an emergency situation. The side effect rate of these vaccines though would never be approved if this weren't an emergency situation, there is a real danger to them. So if people want to choose which risk they take I don't see a problem.

Would it be unethical to start dosing Ivermectin with the Pfizer vaccine? Sort of like hiding your dog's pills in a rolled up piece of ham. The anti-vaxxers get to think they pulled one over on "them" (whoever that may be this week) and I get to leave the country again. Everyone wins!

Yes, it would be. It would be quickly discovered, and justifiably reduce public trust in whatever organization made that decision, which would likely have more negative consequences down the line.

Also, lies are bad.

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