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A joint message about ivermectin in the prevention and treatment of COVID-19

Ivermectin is an anthelmintic approved in Canada for veterinary and human use. In humans, ivermectin is only approved for treatment of parasitic infections (oral) and rosacea (topical).

The most effective strategy for preventing COVID-19 continues to be immunization and all Saskatchewan Ministry of Health approved vaccines provide a high level of protection.

Ivermectin for prophylaxis or treatment of COVID-19 has been promoted on social media and it has been reported that some people are purchasing ivermectin from animal feed stores as well as seeking to obtain prescriptions from providers to be filled at pharmacies, products approved for veterinary use should not be used in humans and may deliver excessive doses leading to harm.

Currently, oral ivermectin (Stromectol®) is not available due to shortage from increase in demand, possibly due to inappropriate prescribing for COVID-19, and therefore unavailable for patients who need it to treat indicated conditions.

Adverse Effects

The following adverse effects have been reported in people who have been exposed to veterinary products: dizziness, asthenia, nausea, vomiting, diarrhea, seizure, ataxia, dyspnea, abdominal pain, paresthesia, and urticaria. (1)

Research

  • While there have been some studies conducted on the use of ivermectin for prevention and treatment of COVID-19, conclusions cannot be drawn because of study limitations. Limitations include small sample sizes, confounding factors, and no or inadequate controls.
  • Several groups have analyzed the available data and have concluded that a recommendation cannot be made for or against the use of ivermectin (2) and that it should not be used for COVID-19 prophylaxis or treatment outside of clinical trials (3, 4, 5). The NIH COVID-19 Treatment Guidelines include a summary of clinical trials involving ivermectin. 
  • The FDA in the United States issued a Consumer Update in March, 2021; Health Canada issued a similar Advisory on Aug. 31, 2021, to warn the public of the potential harms associated with ivermectin and to reinforce that evidence to support use for prevention or treatment of COVID-19 is currently not available.

Based on the current scientific evidence and best-practice guidelines, the College of Physicians and Surgeons (CPSS), the Saskatchewan Registered Nurses Association, the Saskatchewan College of Pharmacy Professionals, the Saskatchewan Medical Association, and the Pharmacy Association of Saskatchewan disapprove of the use of ivermectin for either treatment or prophylaxis for COVID. This opinion is further supported by the evidence from Health Canada, the World Health Organization (WHO), Alberta Health Services Covid-19 Scientific Advisory group, and the British Columbia COVID-19 Therapeutics Committee guidance document.

Physicians need to be aware of the CPSS policy on complementary medicine and must not provide care that does not meet the expected standard of the medical profession.

All Saskatchewan residents are encouraged to get immunized with approved COVID-19 vaccines as the best strategy to protect themselves, their loved ones, and the population as a whole.

SHA statement

The Saskatchewan Health Authority and the SMA previously released a statement (click here) to physicians providing information and advising against ivermedtin prescriptions for COVID-19 patients.  

 

References

1. Product monograph for Stromectol. Merck Canada, Inc. Kirkland, QC H9H 4M7. September 2018.

2. National Institutes of Health. Coronavirus disease 2019 (COVID-19) treatment guidelines. Bethesda MD: NIH; [ivermectin updated 11 Feb 2021; cited 31 Aug 2021]. Available from https://files.covid19treatmentguidelines.nih.gov/guidelines/covid19treatmentguidelines.pdf

3. COVID-19 Scientific Advisory Group. Rapid Evidence Report: Ivermectin in the Treatment and Prevention of COVID-19. Alberta Health Services; [02 Feb 2021, reaffirmed 28 Jul 2021; cited 31 Aug 2021] Available from https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-sag-ivermectin-in-treatment-and-prevention-rapid-review.pdf

4. British Columbia COVID-19 Therapeutics Committee. Clinical Practice Guidance for Antimicrobial and Immunomodulatory Therapy in Adults Patients with COVID-19. BC Centre for Disease Control; [updated 06 Jul 2021; cited 31 Aug 2021]. Available from http://www.bccdc.ca/Health-Professionals-Site/Documents/Antimicrobial-Immunomodulatory-Therapy-adults.pdf

5. Infectious Diseases Society of America. IDSA Guidelines on the Treatment and Management of Patients with COVID-19. Arlington VA: IDSA; [updated 10 Aug 2021; cited 31 Aug 2021]. Available from https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/ 

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