Ivermectin Is Not Effective Against COVID-19
Ivermectin should not be used for the treatment of COVID-19 in either hospitalized or ambulatory patients due to lack of proven efficacy and potential risks. 1, 2
Evidence Against Ivermectin Use
The Infectious Diseases Society of America (IDSA) provides clear recommendations regarding ivermectin use for COVID-19:
- For hospitalized patients: Conditional recommendation against ivermectin use (very low certainty of evidence) 2
- For ambulatory patients: Strong recommendation against ivermectin use (moderate certainty of evidence) 2
These recommendations are based on substantial evidence showing:
- No significant improvement in mortality for hospitalized patients (RR: 0.54; 95% CI: 0.28,1.03) or outpatients (RR: 0.83; 95% CI: 0.50,1.37) 1
- No meaningful effect on need for mechanical ventilation (RR: 0.40; 95% CI: 0.13,1.27) 1
- No significant improvement in symptom resolution (RR: 1.07; 95% CI: 0.69,1.65) 1
- No reduction in hospitalization rates (RR: 0.85; 95% CI: 0.65,1.11) 1
Recent High-Quality Evidence
The most recent high-quality evidence from the PRINCIPLE trial (2024) further confirms ivermectin's lack of efficacy:
- While there was a statistically significant reduction in time to recovery (2.06 days), the probability of a clinically meaningful effect was only 19.2% 3
- No reduction in COVID-19-related hospitalizations or deaths (OR: 1.02; 95% CI: 0.63 to 1.62) 3
- No significant difference in long-term outcomes at 6 months 3
The authors concluded that "ivermectin for COVID-19 is unlikely to provide clinically meaningful improvement in recovery, hospital admissions, or longer-term outcomes" and that "further trials of ivermectin for SARS-CoV-2 infection in vaccinated community populations appear unwarranted." 3
Pharmacological Considerations
Despite ivermectin showing in vitro activity against SARS-CoV-2, this occurs at concentrations significantly higher than those achievable in human plasma and lung tissue with standard dosing 2. The concentrations required to reach the in vitro IC50 are not attainable with safe dosing in humans.
Common Pitfalls to Avoid
Relying on lower-quality evidence: Some early observational studies and meta-analyses suggested benefits 4, 5, but these have been superseded by higher-quality randomized controlled trials that show no meaningful benefit.
Self-medication risks: Patients seeking ivermectin outside medical supervision may obtain veterinary formulations, risking toxicity 1.
Opportunity cost: Using ivermectin may delay implementation of proven therapies with established efficacy 1.
Alternative Evidence-Based Approaches
Instead of ivermectin, clinicians should use treatments with established efficacy:
- For high-risk outpatients: FDA-approved antivirals or monoclonal antibodies 1
- For hospitalized patients requiring oxygen: Dexamethasone and other proven therapies 1
Conclusion
The highest quality and most recent evidence demonstrates that ivermectin does not provide clinically meaningful benefits for COVID-19 patients. The IDSA guidelines strongly recommend against its use in outpatient settings and conditionally recommend against its use in hospitalized patients. Clinicians should follow evidence-based guidelines and use treatments with proven efficacy for COVID-19.