So why are people taking ivermectin?
Some are self-medicating with the easy-to-find and nonprescription animal version of the medication based on misinformation gleaned from Facebook and Reddit. But others are getting off-label prescriptions of a human-appropriate version from physicians. In fact, the CDC says human prescriptions for ivermectin are sharply increasing.
It’s important to know that ivermectin is an FDA-approved drug for use in humans in the United States. But it’s equally important to know that the approved usage is for treating worms and other parasitic infections. There are healthcare professionals who are prescribing it off-label to treat and prevent COVID-19—for which is it not approved—insisting it is safe and effective.
Bruce L. Boros, MD, has been prescribing ivermectin for prevention and treatment of COVID-19 since early in the pandemic. Boros is a board-certified cardiologist and a fellow of the American College of Cardiology who currently operates three urgent care centers in the Florida Keys. (Editor’s note: Boros made headlines last year for his sharp and controversial criticism of Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.)
Boros tells Verywell he first heard of the use of ivermectin for COVID-19 through published reports of observational studies from the Dominican Republic. So far, he says he has treated at least 800 sick patients and seen “miraculous recoveries,” with patients in need of hospitalization making vast improvement in the matter of hours. He cautions ivermectin is not a cure-all, though, since it does not work 100% of the time, but only about 90% of the time, in his experience.
“I would say, in general, when you hear somebody say, ‘This is a miracle cure,’ you should run,” Gregory Poland, MD, spokesperson for the Infectious Diseases Society of America (IDSA), tells Verywell. “If ivermectin were a miracle cure, the National Institutes of Health (NIH), IDSA, and specialty physician societies would be touting it and pushing it, like they are for vaccines and for monoclonal antibodies, but they’re not.”
Boros thinks that the results seen by physicians in practice and in observational studies should be counted as evidence that ivermectin works. But his results have not been corroborated in randomized control studies, which are considered the standard for determining if a medical treatment works.
“You can search for substantial evidence of effectiveness for ivermectin and you will come up empty handed,” Peter Lurie, MD, MPH, president of the Center for Science in the Public Interest, tells Verywell. “The fact is that there are a large number of trials of ivermectin that have been done, but the great majority of them are lacking in terms of the fundamentals of clinical trial design.”
Lurie, who previously served as the associate commissioner for public health strategy and analysis at the FDA, explains that while ivermectin is considered safe in humans if dosed appropriately, a strong safety profile is not enough to warrant its use for COVID-19. Proven effectiveness is just as important for FDA authorization or approval.
“You cannot really assess the safety of the product unless you know whether or not it is efficacious, because you need to assess the one in the context of the other,” Lurie says.
A major problem with ivermectin, Lurie says, is that it’s diverting attention away from methods that are proven to safely prevent COVID-19.
“People who are taking ivermectin may feel that they need not take other evasive measures, like social distancing, like masking, and like vaccination,” he says.
What the Research Does—and Doesn’t—Say
The idea that a deworming drug could treat a viral infection like COVID-19 stems from in vitro studies that show ivermectin inhibits the growth of viruses in a laboratory. Many clinical trials are in progress to evaluate the drug’s use against viruses in people, but few studies testing the drug against the COVID-19 virus have been completed. The studies that are finished have yielded little evidence of effectiveness. Some were halted due to lack of benefit along the way. Others have been retracted.
A review of the medical literature by the Cochrane Library analyzed 14 randomized controlled clinical trials for ivermectin as a treatment for COVID-19 infections. The Cochrane Library is an organization that examines published studies of medical research to collect data and determine the best evidence-based choices for medical treatments. The 14 studies had enrolled nearly 1,700 patients and compared ivermectin use to either no treatment, a placebo, or the standard of care for a respiratory infection.
“Based on the current very low‐ to low‐certainty evidence, we are uncertain about the efficacy and safety of ivermectin used to treat or prevent COVID‐19,” the Cochrane review concluded. “The completed studies are small, and few are considered high quality.”
The Cochrane review authors noted there are nearly 50 studies of ivermectin underway or that have not published results as yet, but determined, “overall, the reliable evidence available does not support the use of ivermectin for treatment or prevention of COVID‐19 outside of well‐designed randomized trials.”
The IDSA also reviewed the medical literature and found a lack of evidence. In August, an IDSA panel issued clinical guidelines advising against ivermectin use for COVID-19 outside of a clinical trial.
“This leaves you with a modest number of studies, but even those are very poor quality, according to the system of grading the quality of studies,” Lurie says.
One Woman’s Decision to Use Ivermectin
Amelia, a 66-year-old woman living in Maryland, chose to start using ivermectin when she decided not to be vaccinated with any of the three available COVID-19 vaccines in the United States. She stresses that she is not an anti-vaxxer and has always gotten any vaccine that was recommended to her in the past.
Despite warnings on product labels, people have been admitted to emergency rooms after ingesting the topical or livestock versions of ivermectin.
When humans consume the human version of ivermectin at appropriate doses, potential side effects should be limited to fatigue, loss of appetite, nausea, vomiting, and diarrhea. When humans consume doses intended for livestock, they have experienced severe nausea, vomiting, diarrhea, low blood pressure, confusion, seizures, and even death.
“I’ve traveled to foreign countries and have always gotten all of the necessary vaccinations for these trips,” she tells Verywell. “I get the flu shot every year.”
Amelia and her doctor do not believe the currently-available COVID-19 vaccines have been tested enough. “My doctor told me to wait for the Novavax, which is a more traditional vaccine," she says.
The Novavax vaccine uses well-established technology called subunits, which expose a person’s immune system to only very specific parts of a pathogen without using any live components. The DTaP vaccine, hepatitis B vaccine, Hib vaccine, and pneumococcal vaccine each use subunit technology.
She says she will get the Novavax vaccine when and if the FDA authorizes it, based on her doctor’s recommendation.
In the meantime, Amelia’s doctor suggested ivermectin. But he did not prescribe it for her.
In her own research, Amelia came across a group called the Front Line COVID-19 Critical Care (FLCCC) Alliance, which has been promoting the use of ivermectin since early in the pandemic. The organization has created several protocols for using ivermectin, along with other drugs and vitamins, to prevent or treat COVID-19 infection.
Through the FLCCC, Amelia found a physician who prescribed ivermectin for her via a telemedicine appointment. She follows what the alliance calls the I-MASK+ protocol, which it claims prevents COVID-19 infections. The protocol consists of:
Twice-weekly dose of ivermectin at 0. 2 milligrams (mg) per kilogram of body weightDaily vitamin D3 (1,000–3,000 IU)Two daily doses of vitamin C (500–1,000 mg)Daily elemental zinc (30–40 mg)Melatonin before bedtime (6 mg)Daily quercetin (250 mg), an over-the-counter flavonoid plant pigment supplementGargle with an antiseptic mouthwash containing cetylpyridinium chloride if exposed to COVID-19
Verywell reached out to the FLCCC Alliance but could not arrange an interview by publication time.
Amelia is knowledgeable about science and medicine. She has a bachelor’s degree in biology and once worked as a medical editor. Her husband is an epidemiologist who is vaccinated against COVID-19 and does not take ivermectin, she says. Family and friends have questioned her about her decision to use ivermectin, and she gives them information from the FLCCC Alliance website and elsewhere.
“I’m taking reasonable amounts of vitamin and mineral supplements that are generally recognized as safe and taking the social measures recommended like masking, social distancing, hand washing, staying home,” she says. In addition, she has regular COVID-19 tests. “That is the course I have taken until I am comfortable with either the existing vaccines or the Novavax vaccine is approved, which is in the works.”
For Poland, this rationale does not hold up. From his perspective, the same people who are demanding more testing for vaccines are saying that ivermectin should be used, regardless of lack of studies.
“Show me the [ivermectin] studies. Show me the quality of the studies. Tell me what kind of study design was used—ask the same questions that people rightfully demand of any vaccine, antiviral drug, or monoclonal antibodies,” Poland says. “They have to live by the same scientific rules.”
Correction: A version of this article published on September 9 misstated the I-MASK+ dosage of ivermectin. It is 0.2 milligrams (mg) per kilogram of body weight.
The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.
