Can ivermectin cause atrial flutter?

Ivermectin and Atrial Flutter: Potential Cardiac Effects

Ivermectin does not have a well-established association with atrial flutter, but it can potentially cause cardiac arrhythmias in certain populations, particularly in elderly patients or those with pre-existing cardiac conditions. 1

Cardiac Effects of Ivermectin

• Ivermectin has been reported to cause sinus tachycardia and asthma in elderly patients, suggesting potential cardiac effects that warrant caution 1
• Recent research (2024) indicates that ivermectin pre-treatment may have detrimental effects in cardiac ischemia by exacerbating cardiac arrhythmias and myocardial dysfunction 2
• While specific cases of atrial flutter have not been prominently documented, ivermectin has been associated with cardiac dysfunction in certain populations 1

Risk Factors for Cardiac Complications

• Elderly patients appear to be at higher risk for cardiovascular adverse effects from ivermectin 1
• Pre-existing cardiac conditions may increase susceptibility to potential arrhythmogenic effects 2
• Patients with myocardial ischemia may be particularly vulnerable to adverse cardiac effects from ivermectin 2

Evidence on Cardiac Safety

• A 1990 study in elderly men with baseline ECG abnormalities found no significant ECG changes after ivermectin administration, suggesting relative cardiac safety in some populations 3
• However, more recent evidence (2024) suggests potential cardiac risks that weren't captured in earlier studies 2
• In animal studies, ivermectin has been shown to affect cardiac function, including contractility and relaxation parameters 2

Clinical Considerations

• Patients with Wolff-Parkinson-White (WPW) syndrome with atrial flutter/atrial fibrillation should be carefully evaluated before receiving medications that might affect cardiac conduction 4
• Patients with existing arrhythmias or at risk for arrhythmias should be monitored closely if ivermectin is administered 1
• The potential for drug interactions should be considered, as ivermectin may interact with other medications that affect cardiac function 4

Monitoring Recommendations

• For patients with cardiac risk factors receiving ivermectin, consider baseline ECG evaluation 1
• Monitor for symptoms such as palpitations, chest discomfort, or shortness of breath during treatment 2, 1
• In high-risk patients, consider cardiac monitoring during and after administration 1

Clinical Pitfalls to Avoid

• Assuming ivermectin is completely cardiac-safe in all populations - recent evidence suggests potential cardiac effects 2
• Failing to consider age-related risk factors when prescribing ivermectin - elderly patients may be more susceptible to cardiac adverse effects 1
• Overlooking potential drug interactions that could compound cardiac risks 4

While direct evidence linking ivermectin to atrial flutter specifically is limited, the medication has demonstrated potential cardiac effects that warrant caution, particularly in elderly patients and those with pre-existing cardiac conditions.