From the Guidelines
Ivermectin is not recommended for treating COVID-19. The most recent and highest quality study, published in the Annals of Internal Medicine in 2024 1, clearly states that the use of ivermectin is not supported for treating patients with confirmed mild to moderate COVID-19 in the outpatient setting. This recommendation is based on the lack of evidence showing any meaningful benefits of ivermectin in preventing or treating COVID-19 infection.
Key Points
- Multiple large, well-designed clinical trials have consistently shown that ivermectin does not provide meaningful benefits for preventing or treating COVID-19 infection 1.
- The World Health Organization, FDA, and other major health organizations recommend against using ivermectin for COVID-19 outside of clinical trials.
- The initial laboratory studies that suggested potential antiviral effects required concentrations much higher than can be safely achieved in humans at standard dosing.
- For COVID-19, the recommended approaches include vaccination for prevention and, for those who become infected, treatments that have demonstrated efficacy in clinical trials, such as certain antiviral medications (like Paxlovid for eligible patients) and supportive care based on symptom severity.
Evidence Summary
The Annals of Internal Medicine study 1 provides a comprehensive summary of the current evidence on outpatient treatment of confirmed COVID-19, including the lack of support for ivermectin. The study highlights the importance of using evidence-based treatments, such as molnupiravir and nirmatrelvir-ritonavir combination therapy, for symptomatic patients with confirmed mild to moderate COVID-19 in the outpatient setting.
Clinical Implications
The use of ivermectin for COVID-19 treatment is not supported by current evidence. Clinicians should prioritize evidence-based treatments, such as vaccination, antiviral medications, and supportive care, to improve clinical outcomes, reduce hospitalization, and decrease mortality from the disease.
From the Research
Efficacy of Ivermectin in Treating COVID-19
- The evidence on the effectiveness of ivermectin in treating COVID-19 is controversial, with some studies suggesting potential benefits and others finding no significant effects 2, 3.
- A systematic review and meta-analysis found that ivermectin was not associated with a reduction in time to viral clearance, duration of hospitalization, incidence of mortality, and incidence of mechanical ventilation 3.
- However, another study found that ivermectin significantly decreased mortality in patients with severe COVID-19, and increased the likelihood of preventing COVID-19 when used as a prophylaxis 2.
Safety of Ivermectin
- The safety profile of ivermectin permits its use in trial settings to further clarify its role in COVID-19 treatment 3.
- Serious adverse events were rarely reported in studies examining the use of ivermectin for COVID-19 treatment and prophylaxis 2.
Quality of Evidence
- The quality of evidence for the effectiveness of ivermectin in treating COVID-19 is generally low to moderate, due to risk of bias, inconsistency, and imprecision 2, 3.
- Further evidence is needed to fine-tune potential indications and optimal treatment protocols for ivermectin as a treatment for COVID-19 2.
Prophylaxis and Treatment Outcomes
- Some studies suggest that regular use of ivermectin may lead to large reductions in transmission and significant outcome benefits in COVID-19 patients 4.
- A narrative review found that there seems to be sufficient evidence about the safety of oral ivermectin, as well as its efficacy in early-treatment and prophylaxis of COVID-19 5.