Is long-term use of ivermectin safe for patients with ischemic heart disease and stents?

Ivermectin Use in Patients with Ischemic Heart Disease and Stents

Long-term use of ivermectin is not recommended for patients with ischemic heart disease and stents due to potential detrimental effects on cardiac function, particularly in the setting of myocardial ischemia. 1

Cardiac Risks of Ivermectin in Ischemic Heart Disease

• Recent research demonstrates that ivermectin pre-treatment has detrimental effects in cardiac ischemia, including exacerbation of cardiac arrhythmias, myocardial dysfunction, and increased cardiac hypertrophy 1
• Ivermectin has been shown to decrease left ventricular contractility and relaxation in experimental models, which could worsen cardiac function in patients with existing ischemic heart disease 1
• These negative effects are particularly concerning for patients with coronary stents who already have compromised cardiac perfusion 1

Medication Management for Patients with Ischemic Heart Disease and Stents

Instead of ivermectin, patients with ischemic heart disease and stents should focus on evidence-based medications that improve outcomes:

• Antiplatelet therapy is crucial for patients with coronary stents, with aspirin (75-100 mg daily) recommended indefinitely 2
• P2Y12 inhibitors (clopidogrel, ticagrelor, or prasugrel) are typically recommended for 12 months after stent placement, with duration based on individual bleeding and thrombotic risk 2
• Beta-blockers are recommended for all patients who can tolerate them, regardless of blood pressure or left ventricular function 2
• ACE inhibitors or ARBs should be considered in all patients without contraindications 2
• Statins should be initiated in all patients without contraindications, regardless of cholesterol levels 2

Special Considerations for Patients with Stents

• Patients with coronary stents require careful medication management to prevent stent thrombosis 2
• Adding medications with potential cardiac effects (like ivermectin) should be approached with extreme caution 2
• The risk of drug interactions is particularly high in patients on dual antiplatelet therapy (DAPT) or anticoagulants 2
• Factors that increase ischemic/thrombotic risk include advanced age, diabetes mellitus, left ventricular ejection fraction <40%, and certain stent characteristics (small diameter, greater length, bifurcation stents) 2

Alternative Approaches if Antiparasitic Treatment is Needed

If antiparasitic treatment is absolutely necessary for a patient with ischemic heart disease and stents:

• Consultation with both cardiology and infectious disease specialists is essential before initiating ivermectin 3
• Short-term, closely monitored courses may be considered only when benefits clearly outweigh risks 3
• Alternative antiparasitic agents with less cardiac impact should be explored 3
• If ivermectin must be used, careful cardiac monitoring including ECG and assessment of hemodynamic parameters is recommended 1, 3

Conclusion

The evidence strongly suggests avoiding long-term ivermectin use in patients with ischemic heart disease and stents due to potential detrimental effects on cardiac function. The focus should remain on established guideline-directed medical therapy for ischemic heart disease, including antiplatelet agents, beta-blockers, ACE inhibitors/ARBs, and statins 2. Any consideration of ivermectin use in these patients should involve careful risk-benefit assessment and close cardiac monitoring 1.