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The studies summarized below are the randomized controlled trials that have had
the greatest impact on the recommendations of the Panel of National Institutes
of Health (NIH), a part of the U.S. Department of Health and Human Services, as
clinical studies of IVM (Ivermectin) for the treatment of COVID-19. You may also
see USFDA Information and buy generic Stromectol Ivermectin online after study
of reviews for Covid-19 and scabies for humans, and also for dogs Veterinary
use.

Click here to view Table 2d. Ivermectin: Selected Clinical Data.

Read More




IVERMECTIN 3 MG 6 MG 12 MG TABLETS:

Proposed Mechanism of Action and Rationale for Use in Patients With COVID-19

Reports from in vitro studies suggest that ivermectin acts by inhibiting the
host importin alpha/beta-1 nuclear transport proteins, which are part of a key
intracellular transport process that viruses hijack to enhance infection by
suppressing the host’s antiviral response. In addition, ivermectin docking may
interfere with the attachment of the severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) spike protein to the human cell membrane. Ivermectin
is thought to be a host-directed agent, which may be the basis for its
broad-spectrum activity in vitro against the viruses that cause dengue, Zika,
HIV, and yellow fever. Despite this in vitro activity, no clinical trials have
reported a clinical benefit for ivermectin in patients with these viruses. Some
studies of ivermectin have also reported potential anti-inflammatory properties,
which have been postulated to be beneficial in people with COVID-19.

Some observational cohorts and clinical trials have evaluated the use of
ivermectin for the prevention and treatment of COVID-19. Data from some of these
studies can be found in Table 2d.

Source: www.covid19treatmentguidelines.nih.gov



RATIONALE OF IVERMECTIN IN COVID-19


Ivermectin has been shown to inhibit the replication of SARS-CoV-2 in cell
cultures.13 However, pharmacokinetic and pharmacodynamic studies suggest that
achieving the plasma concentrations necessary for the antiviral efficacy
detected in vitro would require administration of doses up to 100-fold higher
than those approved for use in humans.14,15 Even though ivermectin appears to
accumulate in the lung tissue, predicted systemic plasma and lung tissue
concentrations are much lower than 2 µM, the half-maximal inhibitory
concentration (IC50) against SARS-CoV-2 in vitro.16-19 Subcutaneous
administration of ivermectin 400 µg/kg had no effect on SARS-CoV-2 viral loads
in hamsters. However, there was a reduction in olfactory deficit (measured using
a food-finding test) and a reduction in the interleukin (IL)-6:IL-10 ratio in
lung tissues.20


Since the last revision of this section of the Guidelines, the results of
several randomized trials and retrospective cohort studies of ivermectin use in
patients with COVID-19 have been published in peer-reviewed journals or have
been made available as manuscripts ahead of peer review. Some clinical studies
showed no benefits or worsening of disease after ivermectin use,21-24 whereas
others reported shorter time to resolution of disease manifestations that were
attributed to COVID-19,25-27 greater reduction in inflammatory marker
levels,26 shorter time to viral clearance,21 or lower mortality rates in
patients who received ivermectin than in patients who received comparator drugs
or placebo.21,27


However, most of these studies had incomplete information and significant
methodological limitations, which make it difficult to exclude common causes of
bias. These limitations include:


* The sample size of most of the trials was small.
* Various doses and schedules of ivermectin were used.
* Some of the randomized controlled trials were open-label studies in which
neither the participants nor the investigators were blinded to the treatment
arms.
* Patients received various concomitant medications (e.g., doxycycline,
hydroxychloroquine, azithromycin, zinc, corticosteroids) in addition to
ivermectin or the comparator drug. This confounded the assessment of the
efficacy or safety of ivermectin.
* The severity of COVID-19 in the study participants was not always well
described.
* The study outcome measures were not always clearly defined.



Table 2d includes summaries of key studies. Because most of these studies have
significant limitations, the Panel cannot draw definitive conclusions on the
clinical efficacy of ivermectin for the treatment of COVID-19. Results from
adequately powered, well-designed, and well-conducted clinical trials are needed
to provide further guidance on the role of ivermectin in the treatment of
COVID-19.


MONITORING, ADVERSE EFFECTS, AND DRUG-DRUG INTERACTIONS




* Ivermectin is generally well tolerated. Adverse effects may include dizziness,
pruritis, nausea, or diarrhea.
* Neurological adverse effects have been reported with the use of ivermectin for
the treatment of onchocerciasis and other parasitic diseases, but it is not
clear whether these adverse effects were caused by ivermectin or the underlying
conditions.28
* Ivermectin is a minor cytochrome P 3A4 substrate and a p-glycoprotein
substrate.
* Ivermectin is generally given on an empty stomach with water; however,
administering ivermectin with food increases its bioavailability.
* The FDA issued a warning in April 2020 that ivermectin intended for use in
animals should not be used to treat COVID-19 in humans.
* Please see Table 2d for additional information.



CONSIDERATIONS IN PREGNANCY


In animal studies, ivermectin was shown to be teratogenic when given in doses
that were maternotoxic. These results raise concerns about administering
ivermectin to people who are in the early stages of pregnancy (prior to 10 weeks
gestation).29 A 2020 systematic review and meta-analysis reviewed the incidence
of poor maternal and fetal outcomes after ivermectin was used for its
antiparasitic properties during pregnancy. However, the study was unable to
establish a causal relationship between ivermectin use and poor maternal or
fetal outcomes due to the quality of evidence. There are numerous reports of
inadvertent ivermectin use in early pregnancy without apparent adverse
effects.30-32 Therefore, there is insufficient evidence to establish the safety
of using ivermectin in pregnant people, especially those in the later stages of
pregnancy.


One study reported that the ivermectin concentrations secreted in breastmilk
after a single oral dose were relatively low. No studies have evaluated the
ivermectin concentrations in breastmilk in patients who received multiple doses.


CONSIDERATIONS IN CHILDREN


Ivermectin is used in children weighing >15 kg for the treatment of helminthic
infections, pediculosis, and scabies. The safety of using ivermectin in children
weighing <15 kg has not been well established. Ivermectin is generally well
tolerated in children, with a side effect profile similar to the one seen in
adults. Currently, there are no available pediatric data from clinical trials to
inform the use of ivermectin for the treatment or prevention of COVID-19 in
children.


CLINICAL TRIALS


Several clinical trials that are evaluating the use of ivermectin for the
treatment of COVID-19 are currently underway or in development. Please see
ClinicalTrials.gov for the latest information.


REFERENCES


* Omura S, Crump A. Ivermectin: panacea for resource-poor communities? Trends
Parasitol. 2014;30(9):445-455. Available
at: https://www.ncbi.nlm.nih.gov/pubmed/25130507.
* Fritz ML, Siegert PY, Walker ED, Bayoh MN, Vulule JR, Miller JR. Toxicity of
bloodmeals from ivermectin-treated cattle to Anopheles gambiae s.l. Ann Trop Med
Parasitol. 2009;103(6):539-547. Available
at: https://www.ncbi.nlm.nih.gov/pubmed/19695159.
* Kircik LH, Del Rosso JQ, Layton AM, Schauber J. Over 25 years of clinical
experience with ivermectin: an overview of safety for an increasing number of
indications. J Drugs Dermatol. 2016;15(3):325-332. Available
at: https://www.ncbi.nlm.nih.gov/pubmed/26954318.
* Yang SNY, Atkinson SC, Wang C, et al. The broad spectrum antiviral ivermectin
targets the host nuclear transport importin alpha/beta1 heterodimer. Antiviral
Res. 2020. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32135219.
* Arévalo AP, Pagotto R, Pórfido J, et al. Ivermectin reduces coronavirus
infection in vivo: a mouse experimental model. bioRxiv. 2020;Preprint. Available
at: https://www.biorxiv.org/content/10.1101/2020.11.02.363242v1.
* Lehrer S, Rheinstein PH. Ivermectin docks to the SARS-CoV-2 spike
receptor-binding domain attached to ACE2. In Vivo. 2020;34(5):3023-3026.
Available at: https://www.ncbi.nlm.nih.gov/pubmed/32871846.
* Tay MY, Fraser JE, Chan WK, et al. Nuclear localization of dengue virus (DENV)
1-4 non-structural protein 5; protection against all 4 DENV serotypes by the
inhibitor ivermectin. Antiviral Res. 2013;99(3):301-306. Available
at: https://www.ncbi.nlm.nih.gov/pubmed/23769930.
* Wagstaff KM, Sivakumaran H, Heaton SM, Harrich D, Jans DA. Ivermectin is a
specific inhibitor of importin alpha/beta-mediated nuclear import able to
inhibit replication of HIV-1 and dengue virus. Biochem J. 2012;443(3):851-856.
Available at: https://www.ncbi.nlm.nih.gov/pubmed/22417684.
* Barrows NJ, Campos RK, Powell ST, et al. A screen of FDA-approved drugs for
inhibitors of Zika virus infection. Cell Host Microbe. 2016;20(2):259-270.
Available at: https://www.ncbi.nlm.nih.gov/pubmed/27476412.
* Zhang X, Song Y, Ci X, et al. Ivermectin inhibits LPS-induced production of
inflammatory cytokines and improves LPS-induced survival in mice. Inflamm Res.
2008;57(11):524-529. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19109745.
* DiNicolantonio JJ, Barroso J, McCarty M. Ivermectin may be a clinically useful
anti-inflammatory agent for late-stage COVID-19. Open Heart. 2020;7(2).
Available at: https://www.ncbi.nlm.nih.gov/pubmed/32895293.
* Ci X, Li H, Yu Q, et al. Avermectin exerts anti-inflammatory effect by
downregulating the nuclear transcription factor kappa-B and mitogen-activated
protein kinase activation pathway. Fundam Clin Pharmacol. 2009;23(4):449-455.
Available at: https://www.ncbi.nlm.nih.gov/pubmed/19453757.
* Caly L, Druce JD, Catton MG, Jans DA, Wagstaff KM. The FDA-approved drug
ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Res.
2020;178:104787. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32251768.
* Chaccour C, Hammann F, Ramon-Garcia S, Rabinovich NR. Ivermectin and COVID-19:
keeping rigor in times of urgency. Am J Trop Med Hyg. 2020;102(6):1156-1157.
Available at: https://www.ncbi.nlm.nih.gov/pubmed/32314704.
* Guzzo CA, Furtek CI, Porras AG, et al. Safety, tolerability, and
pharmacokinetics of escalating high doses of ivermectin in healthy adult
subjects. J Clin Pharmacol. 2002;42(10):1122-1133. Available
at: https://www.ncbi.nlm.nih.gov/pubmed/12362927.
* Arshad U, Pertinez H, Box H, et al. Prioritization of anti-SARS-CoV-2 drug
repurposing opportunities based on plasma and target site concentrations derived
from their established human pharmacokinetics. Clin Pharmacol Ther.
2020;108(4):775-790. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32438446.
* Bray M, Rayner C, Noel F, Jans D, Wagstaff K. Ivermectin and COVID-19: a
report in antiviral research, widespread interest, an FDA warning, two letters
to the editor and the authors' responses. Antiviral Res. 2020;178:104805.
Available at: https://www.ncbi.nlm.nih.gov/pubmed/32330482.
* Momekov G, Momekova D. Ivermectin as a potential COVID-19 treatment from the
pharmacokinetic point of view: antiviral levels are not likely attainable with
known dosing regimens. Biotechnology & Biotechnological Equipment.
2020;34(1):469-474. Available
at: https://www.tandfonline.com/doi/full/10.1080/13102818.2020.1775118.
* Jermain B, Hanafin PO, Cao Y, Lifschitz A, Lanusse C, Rao GG. Development of a
minimal physiologically-based pharmacokinetic model to simulate lung exposure in
humans following oral administration of ivermectin for COVID-19 drug
repurposing. J Pharm Sci. 2020;109(12):3574-3578. Available
at: https://www.ncbi.nlm.nih.gov/pubmed/32891630.
* de Melo GD, Lazarini F, Larrous F, et al. Anti-COVID-19 efficacy of ivermectin
in the golden hamster. bioRxiv. 2020;Preprint. Available
at: https://www.biorxiv.org/content/10.1101/2020.11.21.392639v1.
* Ahmed S, Karim MM, Ross AG, et al. A five-day course of ivermectin for the
treatment of COVID-19 may reduce the duration of illness. Int J Infect Dis.
2020;103:214-216. Available at: https://www.ncbi.nlm.nih.gov/pubmed/33278625.
* Chachar AZK, Khan KA, Asif M, Tanveer K, Khaqan A, Basri R. Effectiveness of
ivermectin in SARS-COV-2/COVID-19 Patients. Int J of Sci. 2020;9:31-35.
Available at: https://www.ijsciences.com/pub/article/2378. * Chowdhury ATMM,
Shahbaz M, Karim MR, Islam J, Guo D, He S. A randomized trial of
ivermectin-doxycycline and hydroxychloroquine-azithromycin therapy on COVID19
patients. Research Square. 2020;Preprint. Available
at: https://www.researchsquare.com/article/rs-38896/v1.
* Soto-Becerra P, Culquichicón C, Hurtado-Roca Y, Araujo-Castillo RV. Real-world
effectiveness of hydroxychloroquine, azithromycin, and ivermectin among
hospitalized COVID-19 patients: results of a target trial emulation using
observational data from a nationwide healthcare system in Peru. medRxiv.
2020;Preprint. Available
at: https://www.medrxiv.org/content/10.1101/2020.10.06.20208066v3.
* Hashim HA, Maulood MF, Rasheed AW, Fatak DF, Kabah KK, Abdulamir AS.
Controlled randomized clinical trial on using ivermectin with doxycycline for
treating COVID-19 patients in Baghdad, Iraq. medRxiv. 2020;Preprint. Available
at: https://www.medrxiv.org/content/10.1101/2020.10.26.20219345v1/.
* Niaee MS, Gheibi N, Namdar P, et al. Ivermectin as an adjunct treatment for
hospitalized adult COVID-19 patients: a randomized multi-center clinical
trial. Research Square. 2020;Preprint. Available
at: https://www.researchsquare.com/article/rs-109670/v1.
* Khan MSI, Khan MSI, Debnath CR, et al. Ivermectin treatment may improve the
prognosis of patients with COVID-19. Arch Bronconeumol. 2020;56(12):828-830.
Available at: https://www.ncbi.nlm.nih.gov/pubmed/33293006.
* Chandler RE. Serious neurological adverse events after ivermectin—do they
occur beyond the indication of onchocerciasis? Am J Trop Med Hyg.
2018;98(2):382-388. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29210346.
* Ivermectin [package insert]. DailyMed. 2017. Available
at: https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=847a1dd7-d65b-4a0e-a67d-d90392059dac&type=display.
* Pacque M, Munoz B, Poetschke G, Foose J, Greene BM, Taylor HR. Pregnancy
outcome after inadvertent ivermectin treatment during community-based
distribution. Lancet. 1990;336(8729):1486-1489. Available
at: https://www.ncbi.nlm.nih.gov/pubmed/1979100.
* Chippaux JP, Gardon-Wendel N, Gardon J, Ernould JC. Absence of any adverse
effect of inadvertent ivermectin treatment during pregnancy. Trans R Soc Trop
Med Hyg. 1993;87(3):318. Available
at: https://www.ncbi.nlm.nih.gov/pubmed/8236406. * Gyapong JO, Chinbuah MA,
Gyapong M. Inadvertent exposure of pregnant women to ivermectin and albendazole
during mass drug administration for lymphatic filariasis. Trop Med Int Health.
2003;8(12):1093-1101. Available
at: https://www.ncbi.nlm.nih.gov/pubmed/14641844.



Source: www.covid19treatmentguidelines.nih.gov

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