What is the recommended dose and frequency of ivermectin for Covid-19 treatment?

Ivermectin is Not Recommended for COVID-19 Treatment at Any Dose or Frequency

The Infectious Diseases Society of America (IDSA) strongly recommends against using ivermectin for the treatment of COVID-19 in both hospitalized and outpatient settings due to lack of proven efficacy for reducing mortality or improving clinical outcomes. 1, 2

Evidence Summary

Efficacy Data

• High-certainty evidence shows ivermectin does not reduce mortality in outpatients (RR: 0.83; 95% CI: 0.50,1.37) 2
• Moderate-certainty evidence indicates ivermectin fails to demonstrate meaningful effect on mortality in hospitalized patients (RR: 0.54; 95% CI: 0.28,1.03) 1
• No significant improvement in:
  • Need for mechanical ventilation (RR: 0.40; 95% CI: 0.13,1.27; low certainty) 1
  • Symptom resolution (RR: 1.07; 95% CI: 0.69,1.65; very low certainty) 1
  • Hospitalization rates (RR: 0.85; 95% CI: 0.65,1.11; moderate certainty) 1
  • Time to recovery (ACTIV-6 trial showed HR: 1.09; 95% CI: 0.98,1.22) 1, 2

Safety Concerns

• Potential for serious adverse events in hospitalized patients (RR: 3.10; 95% CI: 0.54,17.89; moderate certainty) 1
• Risk of toxicity from inappropriate dosing, particularly when obtained through veterinary sources 2
• Diversion from proven therapies with established efficacy 2

Dosing Considerations

While no dosing regimen is recommended for COVID-19 treatment, it's important to understand what has been studied:

• Trials used various dosing regimens ranging from 100-400 mcg/kg/day for durations of 1-7 days 1
• The 2024 Sri Lanka trial used 24 mg daily for five days but still found no significant clinical benefit despite modest viral load reduction 3
• Even when higher blood levels were achieved (>100 ng/mL), no significant clinical improvement was observed 3

Why Ivermectin Should Not Be Used for COVID-19

1. Lack of clinical benefit: Multiple high-quality studies and guidelines consistently show no meaningful improvement in important clinical outcomes
2. Potential harm: Risk of adverse events and diversion from effective therapies
3. Consensus among authorities: IDSA provides a conditional recommendation against ivermectin use for hospitalized patients and a strong recommendation against ivermectin use for outpatients 1, 2

Common Pitfalls to Avoid

• Overreliance on in vitro data: Laboratory studies showing antiviral activity used concentrations exceeding what is safely achievable in humans 2
• Citing lower-quality evidence: Some early meta-analyses suggested benefit 4, 5, but these have been superseded by higher-quality trials and guidelines
• Self-medication: Patients may attempt to obtain veterinary formulations, risking toxicity 2
• Delay in seeking proven treatments: Using ivermectin may cause patients to delay treatments with established efficacy 2

Despite some studies showing modest viral load reduction 3, the overwhelming evidence from high-quality trials and current guidelines indicates that ivermectin should not be used for COVID-19 treatment at any dose or frequency.