The Drug and Therapeutics Advisory Community of Practice (DaTA CoP) has advised against the use of ivermectin in COVID-19 treatment.
The use of ivermectin for COVID-19 has been in the media off and on throughout COVID-19 and there has been recent attention given to a regimen consisting of ivermectin, zinc and doxycycline and promotion of this ‘triple therapy’ regimen for use in the older population.
The DaTA CoP has discussed the lack of evidence for the use of ivermectin in COVID-19.
It is asking health practitioners to monitor for any reports of use or consumer interest in ivermectin given its wide availability for treating animals.
If there is apparent inappropriate use, the Chief Pharmacist is able to intervene, for example, with regulatory changes. You can notify the NSW Therapeutic Advisory Group via nswtag@stvincents.com.au if any signals emerge that ivermectin might be being used.
Advice to the Ministry of Health
Professor Sarah Hilmer, the Clinical Lead of the DaTA CoP, Head of Department Clinical Pharmacology and Senior Staff Specialist Aged Care, Royal North Shore Hospital, has provided the following advice to the NSW Ministry of Health following the media attention regarding ivermectin:
‘Ivermectin has not been demonstrated to be safe or effective in prevention or treatment of COVID-19 in people of any age group. Therefore, it should not be used outside of a clinical trial.
In the early days of the pandemic, international experience demonstrated the outcomes of using hydroxychloroquine, which looked promising in the laboratory, but when used in haste to treat COVID-19, led to deaths from side effects without benefit. We now have effective systems to investigate potential treatments, some effective treatments for people with severe COVID-19 requiring oxygen in hospital, as well as effective public health measures.
There are several steps between demonstrating effects of a drug on a virus in a laboratory and determining whether it is effective or safe in people with COVID-19. The first is working out whether the drug could be delivered at a dose that could kill the virus and still be tolerated by a patient.
Use of ivermectin triple therapy in aged care proposed in the media is of particular concern. Older people are particularly vulnerable to the side effects of drugs. Use of drugs without known benefit with known increased risk of harm is not recommended. Some known common side effects of ivermectin that could be very serious in frail older people are gastrointestinal side effects (which can lead to dehydration and malnutrition); and sedation and dizziness (which can lead to delirium and falls). The side effect profile in frail older people and in people who are sick with COVID-19 may be different. Furthermore, ivermectin is cleared by the liver, and the livers of frail older people do not clear drugs as well, on top of the potential effects of COVID-19 on the liver, which could result in drug accumulation and further toxicity. Frail older people also use a lot of other medications, putting them at risk of drug interactions with ivermectin, especially if used as part of a ‘triple therapy’.’