Two days ago, the Goa government decided to administer Ivermectin to all the people above 18 years as a preventive treatment amid the COVID-19 pandemic. Ivermectin is an oral drug that is used as a prescription medication to treat parasitic infections. This has prompted questions from the medical fraternity and experts on the efficacy of the drug, with the World Health Organisation (WHO) and even the company that manufactures it cautioning against the use of the drug in COVID-19 treatment. While the drug is being used in treatments as it shows fewer side-effects, experts have said that more studies are needed to establish the rationale in administering Ivermectin to COVID-19 patients.
According to the WHO, Ivermectin is a broad-spectrum antiparasitic agent, which has been included in WHO’s essential medicines list for several parasitic diseases. It is used in the treatment of onchocerciasis (river blindness), strongyloidiasis and other diseases caused by soil-transmitted helminthiasis. It is also used to treat scabies.
The Ministry of Health and Family Welfare in India has recommended Ivermectin in treatment of patients with mild COVID-19. Last month, it issued revised guidelines for home isolation of mild/asymptomatic COVID-19 cases, which said, "If fever is not controlled with a maximum dose of tab. Paracetamol 650 mg four times a day, consult the treating doctor, who may consider advising other drugs like non-steroidal anti-inflammatory drug (NSAID) (ex: tab. Naproxen 250 mg twice a day). Tab. Ivermectin (200 mcg/kg once a day, to be taken on empty stomach) for 3 to 5 days should be considered.” The Ministry added that Ivermectin should be avoided in the case of pregnant and lactating women.
However, the WHO has said that the current evidence on the use of Ivermectin to treat COVID-19 patients is inconclusive. “Until more data is available, WHO recommends that the drug only be used within clinical trials,” the health organisation said.
“Safety and efficacy are important when using any drug for a new indication. WHO recommends against use of ‘Ivermectin’ for COVID-19 except within clinical trials,” Soumya Swaminathan, Chief Scientist of the World Health Organisation, tweeted on Tuesday.
To her tweet, she attached a statement by Merck, the company that manufactures Ivermectin, on its use during the COVID-19 pandemic.
“It is important to note that, to-date, our analysis has identified: No scientific basis for a potential therapeutic effect against COVID-19 from pre-clinical studies; 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,” Merck has said.
“We do not believe that the data available support the safety and efficacy of Ivermectin beyond the doses and populations indicated in the regulatory agency-approved prescribing information,” the statement added.
However, the drug continues to be recommended by the Health Ministry as it shows fewer side-effects. A study — published in the May-June issue of the American Journal of Therapeutics — claims that Ivermectin significantly reduces the risk of contracting COVID-19 when used regularly. The focus of the study was on the 27 controlled trials available in January 2021, 15 of which were randomised controlled trials (RCTs). The authors found large, statistically significant reduction in mortality, time to recovery and viral clearance in COVID-19 patients treated with Ivermectin.
However, the United States Food Food and Drug Administration has warned against its overuse.
“There’s a lot of misinformation around, and you may have heard that it’s okay to take large doses of Ivermectin. That is wrong,” the US FDA said in a statement. “Even the levels of Ivermectin for approved uses can interact with other medications, like blood-thinners. You can also overdose on Ivermectin, which can cause nausea, vomiting, diarrhea, hypotension (low blood pressure), allergic reactions (itching and hives), dizziness, ataxia (problems with balance), seizures, coma and even death.”