Is it safe to use ivermectin in patients with hypertension?

Safety of Ivermectin in Patients with Hypertension

Ivermectin can be safely used in patients with hypertension as it does not significantly affect blood pressure in standard therapeutic doses, but caution is warranted in patients with severe cardiovascular disease or those taking multiple antihypertensive medications.

Ivermectin and Cardiovascular Effects

Ivermectin is primarily an antiparasitic medication used for various parasitic infections. When examining its cardiovascular profile:

• Standard antiparasitic doses (typically 150-200 μg/kg) have not been shown to cause significant changes in blood pressure in most patients
• Ivermectin is not listed among medications known to exacerbate hypertension in major hypertension guidelines 1
• It is not included in the list of drugs to avoid in patients with hypertension or heart failure 1

Safety Considerations

Cardiovascular Monitoring

While generally safe, some precautions should be observed:

• Recent research indicates that ivermectin may have some cardiac effects at very high doses, including:
  • QT interval prolongation in a dose-dependent manner 2
  • Potential for decreased heart rate at concentrations far exceeding therapeutic levels 2
  • Possible detrimental effects in cardiac ischemia models based on experimental studies 3

Special Patient Populations

For patients with hypertension, consider these factors:

1. Patients with controlled hypertension:

   • Standard dosing of ivermectin is generally safe
   • No specific dose adjustments needed based on hypertension status alone

2. Patients with uncontrolled hypertension:

   • Monitor blood pressure before and after administration
   • Consider delaying treatment until better blood pressure control is achieved if non-urgent

3. Patients with heart failure and hypertension:

   • Use with caution as limited data exists on ivermectin's effects in this population
   • The 2016 AHA scientific statement does not list ivermectin among medications to avoid in heart failure patients 1

4. Patients with severe cardiovascular disease:

   • Exercise caution due to rare reports of postural hypotension 4
   • Consider monitoring for orthostatic changes in blood pressure

Administration Guidelines

When administering ivermectin to hypertensive patients:

• Take with water, but note that high-fat food increases bioavailability by 2.5 times 1
• Be aware that azithromycin can significantly increase serum ivermectin concentration 1
• Use with caution in patients with reduced hepatic function 1
• Consider obtaining a baseline ECG in patients with multiple cardiovascular risk factors or known cardiac disease

Conclusion

Ivermectin is generally safe for use in patients with hypertension at standard therapeutic doses. The medication does not appear on lists of drugs that exacerbate hypertension or that should be avoided in hypertensive patients. However, monitoring is recommended in patients with severe cardiovascular disease, uncontrolled hypertension, or those taking multiple medications that may interact with ivermectin.