Ivermectin is a 30+ year old wonder drug that treats life- and sight-threatening parasitic infections. Its lasting impact on global health was so profound that two of the principal investigators for its discovery and development won the Nobel Prize in 2015. I have been a pharmacist for infectious diseases for over 25 years. I’ve also been able to manage patients who have delayed appropriate treatment for severe COVID-19 infections because they thought ivermectin could cure them.

Although ivermectin has changed the rules of the game for people with certain infectious diseases, it will not save patients from COVID-19 infection. In fact, it could cost them their lives. Let me tell you a short story about the history of ivermectin.

Development of Ivermectin for Animal Use Ivermectin was first identified in the 1970s during a veterinary drug screening project at Merck Pharmaceuticals. Researchers focused on discovering chemicals that could treat parasitic infections in animals. Common parasites include nematodes, such as flatworms and roundworms, and arthropods, such as fleas and lice. All of these infectious organisms are very different from viruses. Merck has partnered with the Kitasato Institute, a medical research facility in Japan. Satoshi Omura and his team isolated a group of chemicals called avermectin from bacteria found in a single soil sample near a Japanese golf course. To my knowledge, avermectin has not been found in any other soil sample in the world.

Research on avermectin has been going on for about five years. Soon the Merck Institute and the Kitasato Institute developed a less toxic form they called ivermectin. It was approved in 1981 for commercial use in veterinary medicine for parasitic infections in livestock and domestic pets with the trade name Mectizan. Developing ivermectin for human use Early trials by William Campbell and his team at Merck discovered that the drug also works against a human parasite that causes an infection called river blindness.

River blindness, also known as onchocerciasis, is the second leading cause of preventable blindness in the world. It is transmitted to humans by black flies that carry the parasitic worm Onchocerca volvulus and occurs mostly in Africa. Ivermectin underwent trials for the treatment of river blindness in 1982 and was approved in 1987. It has since been distributed free of charge through the Mectizan Donation Program to dozens of countries. Thanks to ivermectin, river blindness has been essentially eliminated in 11 Latin American countries, preventing nearly 600,000 cases of blindness.

These two decades of extensive work to discover, develop, and distribute ivermectin have helped significantly reduce human suffering from river blindness. These efforts were recognized by the 2015 Nobel Prize in Physiology or Medicine, awarded to William Campbell and Satoshi Omura for their leadership in this groundbreaking research. Reusing drugs for other uses Infectious disease researchers often try to repurpose antimicrobials and other drugs to treat infections. Drug reallocation is attractive because the approval process can take place more quickly and at lower cost because almost all of the basic research is already completed.

In the years since it was approved to treat river blindness, ivermectin has also been shown to be highly effective against other parasitic infections. This includes strongyloidosis, an intestinal infection that affects an estimated 30 to 100 million people worldwide. Another example is amphotericin B, which was originally approved to treat human yeast and mold infections. Researchers have discovered that it can also be an effective treatment for severe forms of leishmaniasis, a parasitic infection prevalent in tropical and subtropical countries.

Similarly, doxycycline is an antibiotic used for a wide range of human bacterial infections such as pneumonia and Lyme disease. It was later found to be highly effective in preventing and treating malaria. Reusing Medicines for COVID-19 Purposes Not every attempt to change the purpose of a drug works as hoped.

At the beginning of the pandemic, scientists and doctors tried to find inexpensive drugs to reuse in the treatment and prevention of COVID-19. Chloroquine and hydroxychloroquine were among those drugs. They were selected because of the potential antiviral effects documented in laboratory studies and limited anecdotal case reports from the first COVID-19 outbreaks in China. However, large clinical studies of these drugs to treat COVID-19 have not translated into any meaningful benefits. This was in part due to the serious toxic effects patients experienced before the drugs reached a dose high enough to inhibit or kill the virus. Unfortunately, the lessons learned from these failed attempts have not been applied to ivermectin. False hope about the use of ivermectin to treat COVID-19 arose from a lab study conducted in April 2020 in Australia. Although the results of this study were widely circulated, I immediately had serious doubts. The concentration of ivermectin they tested was 20 to 2,000 times higher than the standard doses used to treat human parasitic infections. In fact, several other drug experts confirmed my initial concerns within a month of the paper’s publication. These high concentrations of the drug can be significantly toxic.

Another commonly cited paper on ivermectin’s purported effects against COVID-19 was withdrawn in July 2021 after scientists found serious flaws in the study. These defects ranged from incorrect statistical analyzes to discrepancies between data collected and published results to duplicate patient records and the inclusion of subjects who died in the study prior to study entry. Even more troubling, at least two other frequently cited studies have raised significant concerns about scientific fraud. At the time of writing, two large randomized clinical trials have not shown any significant benefit from using ivermectin for COVID-19. Reputable national and international healthcare organizations, including the World Health Organization, the Centers for Disease Control and Prevention, the National Institutes of Health, the Food and Drug Administration and the Infectious Diseases Society of America, unanimously recommend that ivermectin not be used for prevention or treatment of COVID-19 unless in context of a clinical trial.

Consequences of Ivermectin Use for COVID-19 Unfortunately, many organizations with dubious intentions have continued to promote the unproven use of ivermectin for COVID-19. This has led to a spike in ivermectin prescriptions and an outpouring of calls to US Poison Control Centers for ivermectin overdose. Many of the calls were due to ingestion of large quantities of veterinary products containing ivermectin Two deaths linked to an overdose of ivermectin were reported in September 2021. When ivermectin was used correctly, it prevented millions of fatal and debilitating infectious diseases. It is only meant to be prescribed to treat infections caused by parasites. It’s not meant to be prescribed by parasites looking to snatch cash from desperate people during an epidemic. I sincerely hope that this unfortunate and tragic chapter in the amazing story of a life-saving drug will come to an end.

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