Dr Puneet Khanna on using Ivermectin drug for managing COVID 19

Ivermectin is an anti-parasitic drug, approved by the Food and Drug Administration (FDA) and is used as a prescription medication to treat certain parasitic roundworm infections. It is often used for patients with intestinal strongyloidiasis and onchocerciasis. The drug is available in tablet form as well as for topical application, depending on the disease. Recent research has shown that Ivermectin possesses strong anti-viral properties. Further, Ivermectin can be used across the severity of COVID-19. It can also be combined with other repurposed drugs for COVID-19. It is safe and may constitute a cost-effective strategy to prevent COVID-19 disease.

Why should it be taken?

Ivermectin is used in the treatment of certain worm infections. It is used to treat worm infections, blindness (onchocerciasis) and a certain type of diarrhoea (strongyloidiasis) as well. Ivermectin appears to work by paralyzing and then killing the offspring of adult worms. It may also slow down the rate at which adult worms reproduce. This results in fewer worms in the skin, blood, and eyes. Ivermectin is available only with your doctor’s prescription. It is advisable to take the drug as prescribed by the doctor. 

COVID 19 and Ivermectin

The drug can be taken if a person is suffering from COVID 19 or an asymptomatic infection, especially if the fever is not getting better with paracetamol. Consider Tab Ivermectin (200 mcg/kg once a day, to be taken empty stomach) for 3 to 5 days. Dosage is based on your weight, medical condition, and response to the treatment.

The right dosage

Ivermectin is best taken as a single dose with a full glass (8 ounces) of water on an empty stomach (1 hour before breakfast), unless otherwise directed by your doctor. To help clear up your infection, take this medicine exactly as directed. Your doctor may want you to take another dose every 3 to 12 months. Your doctor may also prescribe a corticosteroid (a cortisone-like medicine) for certain patients with river blindness, especially those with severe symptoms. This is to help reduce the inflammation caused by the death of the worms. If your doctor prescribes these two medicines together, it is important to take the corticosteroid along with ivermectin. Take them exactly as directed by your doctor. Do not miss any doses.

Who should avoid it?

1. Asthma– Patients with a history of severe asthma should receive ivermectin with caution. Occasionally, systemic ivermectin has been reported to worsen bronchial asthma.

2. Hepatic disease– Although not extensively studied, due to its extensive hepatic metabolism, ivermectin should be administered with caution in patients with significant hepatic disease.

3. Human immunodeficiency virus (HIV) infection, immunosuppression– In patients with immunosuppression (including those with human immunodeficiency virus (HIV) infection) treated for intestinal strongyloidiasis, repeated ivermectin courses may be necessary. Adequate and well-controlled clinical studies have not been conducted in such patients to determine the optimal dosing regimen. Several treatments (i.e., at 2week intervals) may be required and a cure may not be achievable. Control of extra-intestinal strongyloidiasis in these patients is difficult, however, suppressive therapy (i.e., once per month) may be helpful.

4. Pregnancy- Data with oral ivermectin use during pregnancy are insufficient to inform a drug-associated risk. Systemic exposure from topical use of ivermectin is much lower than from oral use. Four published epidemiology studies evaluated the outcomes of a total of 744 women exposed to oral ivermectin in various stages of pregnancy. In the largest study, 397 women in the second trimester of pregnancy were treated open-label with single doses of ivermectin or ivermectin plus albendazole; there was no observed difference in pregnancy outcomes between treated and untreated populations. However, these studies cannot definitely establish or exclude the absence of drug-associated risk during pregnancy, because either the timing of the administration during gestation was not accurately ascertained or the administration only occurred during the second trimester

5. Breast-feeding- After oral administration, ivermectin is excreted in human breast milk in low concentrations. Excretion in human breast milk after topical administration has not been evaluated.  According to the manufacturer, treatment with oral ivermectin in mothers who are breast. Moreover, feeding should only be undertaken when the risk of delayed treatment to the mother outweighs the possible risk to the newborn. Women who are breast-feeding while using topical ivermectin should avoid accidental transfer of ivermectin to the breast area where it might be directly ingested while nursing.

6. Children, infants– The topical administration of ivermectin to infants and children should be under the direct supervision of an adult to prevent ingestion of the lotion.

Remember that you should take this drug on an empty stomach, with a full glass of water and at a time recommended by your doctor. Store ivermectin at room temperature below 86°F (30°C) and don’t store this medication in moist or damp areas, such as bathrooms. This is a prescription based medicine, so a;ways carry your prescription along with the medication with when travelling.