/IvermectinCautions
The side effects associated with Ivermectin are generally very, very mild and very rare. This page is provided to ensure that everyone makes a FULLY informed decision.
One must base the potentially minor risks associated with Ivermectin against the potential life-saving benefits.
One must base the potentially minor risks associated with Ivermectin against the potential life-saving benefits.
PRECAUTIONS:
Ivermectin can be given either by mouth or injection. It does not readily cross the blood–brain barrier of mammals due to the presence of P-glycoprotein, (the MDR1 gene mutation affects function of this protein)
"It is therefore questionable whether any of the neurological sequelae associated with administration of ivermectin are directly related to the drug and therefore it seems unlikely that any alterations in the pharmacokinetics of ivermectin for whatever reason would result in a more severe adverse reaction."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2147658/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2147658/pdf/1475-2883-2-S1-S8.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2147658/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2147658/pdf/1475-2883-2-S1-S8.pdf
| ivermectin_-_does_p-glycoprotein_play_a_role_in_neurotoxicity_.pdf |
Drugs that inhibit CYP3A4 enzymes often also inhibit P-glycoprotein transport, so the risk of increased absorption past the blood-brain barrier exists when ivermectin is administered along with other CYP3A4 inhibitors. These drugs include statins, HIV protease inhibitors, many calcium channel blockers, and glucocorticoids such as dexamethasone, lidocaine, and the benzodiazepines.
In 2018, a 13-year old boy was hospitalised in the ICU at Toulouse University Hospital for impaired consciousness having been treated preventively with ivermectin for suspected scabies. Having eliminated all the usual causes of coma, the physicians had his blood analyzed by INRAE research scientists specialized in using this drug: They found normal levels of ivermectin, so straight away it was possible to exclude the possibility of an overdose.
The patient recovered consciousness and was able to return home after 48 hours.
However, the research was pursued and the biology team at Montpellier University Hospital sequenced the boy’s P-glycoprotein (P-gp)3 gene. P-gp is a pump that enables the efflux of toxins and drugs such as ivermectin, thus protecting the brain. In this case, the gene displayed two different mutations, each inherited from one of the parents. These “nonsense” mutations generate two incomplete copies of the protein and lead to a loss of its function. Because P-gp was no longer playing its barrier role, ivermectin entered the brain of this patient and became toxic.
The mutations discovered here are extremely rare in the general population and, in fact, this is the first case of non-functional P-gp to have been described in humans.
E. Baudou, A. Lespine*, G. Durrieu, F. André, P. Gandia, C. Durand, S. Cunat*. Serious Ivermectin Toxicity and Human ABCB1 Nonsense Mutations. New England Journal of Medecine 383;8; August 20, 2020;
https://www.nejm.org/doi/full/10.1056/NEJMc1917344
The patient recovered consciousness and was able to return home after 48 hours.
However, the research was pursued and the biology team at Montpellier University Hospital sequenced the boy’s P-glycoprotein (P-gp)3 gene. P-gp is a pump that enables the efflux of toxins and drugs such as ivermectin, thus protecting the brain. In this case, the gene displayed two different mutations, each inherited from one of the parents. These “nonsense” mutations generate two incomplete copies of the protein and lead to a loss of its function. Because P-gp was no longer playing its barrier role, ivermectin entered the brain of this patient and became toxic.
The mutations discovered here are extremely rare in the general population and, in fact, this is the first case of non-functional P-gp to have been described in humans.
E. Baudou, A. Lespine*, G. Durrieu, F. André, P. Gandia, C. Durand, S. Cunat*. Serious Ivermectin Toxicity and Human ABCB1 Nonsense Mutations. New England Journal of Medecine 383;8; August 20, 2020;
https://www.nejm.org/doi/full/10.1056/NEJMc1917344
Side Effects:
Some rare and mild side effects that have been reported by patients on these medications include:
If you experience an allergic reaction (rash, hives, swelling or difficulty breathing) or visual disturbances after taking your medications you should stop the medications and seek medical attention immediately.
Many of the side effects that are listed above may be associated with a Jarisch-Herxheimer reaction. A Jarisch-Herxheimer reaction is a reaction to endotoxin-like products released by the death of harmful microorganisms within the body during antibiotic treatment. Efficacious antimicrobial therapy results in lysis (destruction) of bacterial cell membranes, and in the consequent release into the bloodstream of bacterial toxins, resulting in a systemic inflammatory response.
- Nausea and/or vomiting
- Headaches, fatigue and abdominal discomfort
- Metallic taste in the mouth
- Dizziness, muscular weakness, joint pain
- Diarrhoea
- Tender or swollen lymph nodes
- Vision changes or eye swelling/redness/pain
- Photosensitivity
- Rash-dermatitis
If you experience an allergic reaction (rash, hives, swelling or difficulty breathing) or visual disturbances after taking your medications you should stop the medications and seek medical attention immediately.
Many of the side effects that are listed above may be associated with a Jarisch-Herxheimer reaction. A Jarisch-Herxheimer reaction is a reaction to endotoxin-like products released by the death of harmful microorganisms within the body during antibiotic treatment. Efficacious antimicrobial therapy results in lysis (destruction) of bacterial cell membranes, and in the consequent release into the bloodstream of bacterial toxins, resulting in a systemic inflammatory response.
CLICK ON THE BUTTONS BELOW FOR DETAILS:
SEVERE ADVERSE EFFECTS RELATED TO LOIASIS
Analysis of severe adverse effects following community-based ivermectin treatment in the Democratic Republic of Congohttps://www.ncbi.nlm.nih.gov/pmc/articl es/PMC6697993/
The progress of mass, community-directed, treatment with ivermectin (CDTI) for onchocerciasis control was disrupted by severe adverse effects (SAE) in the Democratic Republic of Congo (DRC). Between the years 2003 and 2017, the total average population treated was around 15,552,588. Factors associated with the occurrence of SAE were: male, age over 18 years old, alcohol consumption, hemp intake and the presence of loiasis. Co-endemicity of loiasis and onchocerciasis is one of the key factors responsible for the occurrence of SAE following ivermectin treatment.
The progress of mass, community-directed, treatment with ivermectin (CDTI) for onchocerciasis control was disrupted by severe adverse effects (SAE) in the Democratic Republic of Congo (DRC). Between the years 2003 and 2017, the total average population treated was around 15,552,588. Factors associated with the occurrence of SAE were: male, age over 18 years old, alcohol consumption, hemp intake and the presence of loiasis. Co-endemicity of loiasis and onchocerciasis is one of the key factors responsible for the occurrence of SAE following ivermectin treatment.
DRUG INTERACTIONS:
EVERYONE should consult with an appropriate health care practitioner before taking ivermectin.
People who consume any of the medications listed below should be extra careful and take special precautions as these drugs are believed to interact with ivermectin.
The list below is NOT meant to be a complete list. It is simply a quick guide to alert those who take any of these medications to be extra careful.
ALCOHOL - do NOT drink alcohol in combination with ivermectin.
Analgesics
Metamizole
Antibacterials
Clarithromycin
Rifabutin
Rifampicin
Rifapentine
Telithromycin
Antiarrhythmics
Quinidine
Anti-coagulant, Anti-platelet and Fibrinolytic
Acenocoumarol
Argatroban
Dipyridamole
Fondaparinux
Heparin
Phenprocoumon
Warfarin
Antidepressants
St. John’s wort
Anticonvulsants
Carbamazepine
Eslicarbazepine
Oxcarbazepine
Phenobarbital (Phenobarbitone)
Phenytoin
Primidone
Rufinamide
Antifungals
Griseofulvin
Itraconazole
Ketoconazole
Antipsychotics/Neuroleptics
Thioridazine
Calcium Channel Blockers
Verapamil
HCV DAAs
Glecaprevir/Pibrentasvir
Ombitasvir/Paritaprevir/r
Ombitasvir/Paritaprevir/r + Dasabuvir
HIV Antiretroviral Therapies
Atazanavir + ritonavir
Atazanavir/cobicistat
Efavirenz
Elvitegravir/Cobi/Emtricitabine/TAF
Elvitegravir/Cobi/Emtricitabine/TDF
Etravirine
Nevirapine
Covid-19 Antiviral Therapies
Atazanavir
Chloroquine
Hydroxychloroquine
Lopinavir/ritonavir
Covid-19 Immune Therapies
Ruxolitinib
Hypertension / Heart Failure Agents
Bosentan
Ranolazine
Immunosuppressants
Ciclosporin
Steroids
Betamethasone
Analgesics
Metamizole
Antibacterials
Clarithromycin
Rifabutin
Rifampicin
Rifapentine
Telithromycin
Antiarrhythmics
Quinidine
Anti-coagulant, Anti-platelet and Fibrinolytic
Acenocoumarol
Argatroban
Dipyridamole
Fondaparinux
Heparin
Phenprocoumon
Warfarin
Antidepressants
St. John’s wort
Anticonvulsants
Carbamazepine
Eslicarbazepine
Oxcarbazepine
Phenobarbital (Phenobarbitone)
Phenytoin
Primidone
Rufinamide
Antifungals
Griseofulvin
Itraconazole
Ketoconazole
Antipsychotics/Neuroleptics
Thioridazine
Calcium Channel Blockers
Verapamil
HCV DAAs
Glecaprevir/Pibrentasvir
Ombitasvir/Paritaprevir/r
Ombitasvir/Paritaprevir/r + Dasabuvir
HIV Antiretroviral Therapies
Atazanavir + ritonavir
Atazanavir/cobicistat
Efavirenz
Elvitegravir/Cobi/Emtricitabine/TAF
Elvitegravir/Cobi/Emtricitabine/TDF
Etravirine
Nevirapine
Covid-19 Antiviral Therapies
Atazanavir
Chloroquine
Hydroxychloroquine
Lopinavir/ritonavir
Covid-19 Immune Therapies
Ruxolitinib
Hypertension / Heart Failure Agents
Bosentan
Ranolazine
Immunosuppressants
Ciclosporin
Steroids
Betamethasone
The above list was obtained from Covid19-DrugInteractions.org. Click on the button below for additional information.
Additional caution should also be exercised with patients who are currently taking CYP 3A4 or P-gp inhibitor drugs such as:
Amiodarone
Clarithromycin
Cobicistat
Cyclosporine
Diltiazem
Erythromycin
Indinavir
Itraconazole
Ketoconazole
Quinidine
Ritonavir
Spironolactone,
Tacrolimus
Verapamil
SOURCE:
https://clinicaltrials.gov/ct2/show/NCT04530474
Amiodarone
Clarithromycin
Cobicistat
Cyclosporine
Diltiazem
Erythromycin
Indinavir
Itraconazole
Ketoconazole
Quinidine
Ritonavir
Spironolactone,
Tacrolimus
Verapamil
SOURCE:
https://clinicaltrials.gov/ct2/show/NCT04530474
EFFECTS OF EXTREME
OVERUSE/ABUSE
OVERUSE/ABUSE
NOTE:
Even after serious overuse/abuse of ivermectin, the symptoms subsided after the patients stopped abusing the medication.
Even after serious overuse/abuse of ivermectin, the symptoms subsided after the patients stopped abusing the medication.
| encephalopathy_due_to_prolonged_misuse_of_ivermectin.pdf |
CAUTION:
KEEP AWAY FROM HOUSEHOLD PETS:
KEEP AWAY FROM HOUSEHOLD PETS:
Dogs with defects in the P-glycoprotein gene (MDR1), often collie-like herding dogs, can be severely poisoned by ivermectin.
Some dog breeds (especially the Rough Collie, the Smooth Collie, the Shetland Sheepdog, and the Australian Shepherd) have a high incidence of a certain mutation within the MDR1 gene (coding for P-glycoprotein). Affected animals are particularly sensitive to the toxic effects of ivermectin.
MDR1 gene variant-Ivermectin hypersensibility ***
Avermectins are a class of natural products with broad antiparasitic activity. Ivermectin, a prominent member of the avermectin family, is a drug that is used extensively in veterinary medicine to treat infections caused by nematode and arthropod parasites.
Although ivermectin is generally safe for use in domestic animals, in the 1980s a number of clinical cases with neurological manifestation have been reported after ivermectin treatment. Neurotoxic symptoms include mydriasis, tremors, ataxia and anorexia.
These symptoms occur at doses that are 1/200th of the dose required to cause toxicity in other dogs. Neurological manifestations of ivermectin in susceptible dogs also include hypersalivation, blindness, coma respiratory compromise and death.
Dogs with the MDR1 gene defect suffer from multiple intolerance of drugs. An interaction with the multi-drug-resistence-transporter (MDR1) has been proven for more than 100 drugs.
https://vcahospitals.com/know-your-pet/multidrug-resistance-mutation-mdr1
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Clinical evidence suggests kittens are susceptible to ivermectin toxicity.
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Ivermectin is sometimes used as an acaricide (anti-tick, anti-mite) in reptiles, both by injection and as a diluted spray. While this works well in some cases, care must be taken, as several species of reptiles are very sensitive to ivermectin.
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Use in turtles is particularly contraindicated.
Children Under 15 Kg (33 pounds)
"Of 170 infants and children weighing < 15 kg who were treated for scabies with oral ivermectin, there were only seven reported mild adverse events and no serious ones. Our results show that ivermectin is effective in treating scabies in 85% of patients. Efficacy is higher when the received dose exceeds 200 μg kg-1 and when the delay between the two doses is < 10 days."
Ivermectin Safety in Infants and Children Under 15 Kg Treated for Scabies: A Multicentric Observational Study
https://pubmed.ncbi.nlm.nih.gov/31344258/
https://pubmed.ncbi.nlm.nih.gov/31344258/
