Ivermectin Does Not Help Recovery from Flu or Other Respiratory Viral Infections
Ivermectin should not be used for influenza or other respiratory viral infections—it has no proven antiviral activity against these pathogens and is ineffective for this indication.
Evidence Against Ivermectin for Respiratory Viruses
No Activity Against Influenza or Common Respiratory Viruses
- Ivermectin has no activity against influenza viruses, and antivirals effective against influenza (neuraminidase inhibitors like oseltamivir) work through completely different mechanisms 1.
- Older influenza antivirals like amantadine and rimantadine are also completely ineffective against parainfluenza and other non-influenza respiratory viruses 1.
- There is no evidence supporting ivermectin use for any respiratory viral infection including influenza, parainfluenza, RSV, or other common respiratory pathogens 2.
COVID-19 Evidence Does Not Support Use
While COVID-19 is also a respiratory viral infection, the evidence against ivermectin is particularly strong and relevant:
- The Infectious Diseases Society of America (IDSA) strongly recommends against ivermectin for COVID-19 in both hospitalized patients (conditional recommendation) and outpatients (strong recommendation) based on moderate to very low certainty evidence 2.
- Multiple high-quality randomized controlled trials show ivermectin provides no meaningful benefit for viral respiratory infections 3, 4, 5, 6.
- The ACTIV-6 trial, a large double-blind RCT with 1,591 participants, found ivermectin did not improve time to recovery compared to placebo (median 12 vs 13 days; HR 1.07,95% CI 0.96-1.17) 4.
- A Cochrane systematic review concluded the reliable evidence does not support ivermectin use for treatment or prevention of COVID-19, with very low to low certainty evidence 3.
What Actually Works for Influenza
Neuraminidase Inhibitors Are the Proven Treatment
- Oseltamivir (Tamiflu) is the appropriate antiviral for influenza, reducing illness duration by 1-1.5 days when started within 48 hours of symptom onset 7.
- Oseltamivir reduces pneumonia risk by 50% and provides significant mortality benefit in hospitalized patients (OR 0.21 for death within 15 days) 7.
- Treatment should be initiated immediately in high-risk patients (age >65, immunocompromised, chronic medical conditions) even beyond 48 hours of symptom onset 7.
- Standard dosing is 75 mg twice daily for 5 days in adults, with dose reduction to 75 mg once daily if creatinine clearance <30 mL/min 2, 7.
Other Respiratory Viruses Require Supportive Care
- Parainfluenza, RSV, and most other respiratory viruses have no specific antiviral treatment and require supportive care including hydration, oxygen supplementation, and monitoring for complications 1.
- Acyclovir is indicated only for varicella-zoster virus (VZV) or herpes simplex virus (HSV) pneumonia 2.
Critical Clinical Pitfalls to Avoid
- Do not delay appropriate influenza treatment with oseltamivir while considering ivermectin—this wastes the critical 48-hour window for maximum benefit 7.
- Rapid diagnostic testing should distinguish influenza from other respiratory viruses, as management differs significantly (oseltamivir for influenza, supportive care for most others) 1.
- Do not use ivermectin based on its in vitro antiviral activity—concentrations required to inhibit SARS-CoV-2 in vitro are considerably higher than achievable human plasma levels 2.
- Empiric antibiotics are not routinely needed for viral respiratory infections unless there is evidence of bacterial superinfection (new consolidation on imaging, purulent sputum, clinical deterioration) 2, 7.
Bottom Line
Ivermectin is an antiparasitic medication with no proven efficacy for influenza or other respiratory viral infections. For influenza specifically, oseltamivir is the evidence-based treatment that reduces illness duration, complications, and mortality when initiated promptly. For other respiratory viruses like parainfluenza and RSV, supportive care remains the standard approach, as no specific antivirals are available for immunocompetent adults.