If you have ever experienced certain parasitic infections, you must be keen to know about the most common antiparasitic drug Ivermectin. It is a prescription medication that is used to treat parasitic infections including strongyloidiasis and onchocerciasis.

A lot of people are not aware or confused about the side effects of this drug. In this blog, we will discuss the side effects of Ivermectin so keep reading below.

Ivermectin Overview

• Ivermectin for humans is an approved drug to treat infections caused by parasitic worms, and head lice and for treating skin conditions (rosacea).
• FDA-approved drug Ivermectin is prescribed for treating or preventing Covid 19 in humans or animals.
• Currently, there is not enough data to indicate the effectiveness of Ivermectin against Covid 19. Clinical trials for the same are ongoing.
• Ivermectin intended for animals should not be used by humans as it can be harmful.

What is Ivermectin And Why Is It Used?

The prescription drug Ivermectin comes in the form of an oral tablet, topical cream, and lotion. Ivermectin is available as a generic drug as well as brand-name medication. Ivermectin tablet is used for the treatment of parasitic infections including the infections of intestinal tract, skin, and eyes.

How Does It Combat And Treat Parasitic Infections?

Ivermectin medicine is a short-term treatment. Ivermectin tablet binds to the internal parts of the parasite. It paralyzes and kills the parasite this way and prevents adult parasites from making larvae. This way Ivermectin combats the parasite and treats infection.

Ivermectin Side Effects

Now let’s talk about the side effects of Ivermectin. Almost every medicine may cause side effects. Ivermectin side effects are not very common if you use this medication exactly as prescribed by your healthcare professional.

Patients who used Ivermectin reported just a few side effects. Side effects also depend on the condition that is being treated with Ivermectin.

Common Side Effects

The most common side effects reported by patients when they used Ivermectin for the treatment of strongyloidiasis include diarrhea, nausea, dizziness, and itchiness.

The common side effects reported by patients when they used Ivermectin for the treatment of onchocerciasis include low blood pressure, increased heart rate, headache, muscle pain, and swelling in arms, face, and legs.

Mild Side Effects

Most people who experienced side effects of Ivermectin reported mild side effects. Mild side effects of this drug while treating strongyloidiasis include stomach pain, fatigue, nausea, vomiting, diarrhea, dizziness, sleepiness, decreased appetite, tremor, constipation, skin rash, itchiness, or mild allergic reaction.

Mild side effects experienced by patients during the treatment of onchocerciasis with Ivermectin include headache, muscle pain, fever, mild eye issues (swelling in the eye), skin rash, itchiness, swollen lymph nodes, joint pain, swelling of face, arms or legs or mild allergic reactions.

Most of the time, these side effects are temporary, easily manageable, and get better in a few days. In case these side effects do not go away or bother you consult your doctor as soon as possible. Also, do not stop taking Ivermectin medication unless your healthcare provider asks you to do so.

Serious Side Effects

Although the serious side effects of Ivermectin are rare, people may develop severe side effects of this drug. These side effects include liver damage, increased heart rate, severe allergic reactions (Stevens-Johnson syndrome and toxic epidermal necrolysis), low blood pressure, serious eye problems (loss of vision), and neurological issues (sleepiness or confusion).

If you experience any of these or any other serious side effects of this medication, talk to your doctor. In case you develop any life-threatening side effects or in case of a medical emergency seek immediate help.

Does Ivermectin Cause Cardiac Or Kidney Side Effects?

Ivermectin medication is not known to cause kidney-associated side effects. It may cause mild cardiac-associated side effects such as increased heart rate or low blood pressure however it is not known to cause severe cardiac-related issues.

Moreover, parasitic infections that necessitate Ivermectin treatment can cause kidney-associated or heart-related problems. That is why if you notice any kind of symptoms associated with kidney problems including fluctuation in the way you usually urinate, low energy, etc., contact your healthcare professional right away.

Can Ivermectin Develop Long-Term Adverse Effects?

In very rare cases Ivermectin can cause long-term adverse reactions including liver damage, joint swelling or pain, serious eye problems, or neurological issues such as confusion. If you are concerned about developing long-term side effects of this drug, consult your doctor. Discuss the benefits and possible risks of using ivermectin with your healthcare professional.

Can Taking Too Much Ivermectin Cause Overdose Symptoms?

Taking too much Ivermectin medication can result in overdose symptoms and these can be dangerous or even fatal. You should not take any prescription medication such as ivermectin unless your doctor prescribes you. Moreover, if your doctor has prescribed you Ivermectin, stick to the dosage instructions.

Additionally, humans should not consume Ivermectin medication meant for animals. Ivermectin for animals is extremely different from Ivermectin for humans and it is available in extremely high doses that can be fatal for humans.

Ivermectin overdose or taking too much Ivermectin can result in symptoms including sleepiness, headache, swelling, skin rash, dizziness, confusion, disorientation, trouble breathing, seizures, stomach pain, and coma.

Ivermectin Cautions

Ivermectin medication may not be suitable for you if you are suffering from certain medical conditions. Talk to your doctor about your medical history before beginning with Ivermectin treatment. Inform your doctor about any prescription or non-prescription drugs, or herbal supplements you are taking.

Immune system problems

Ivermectin may not work well when used by patients having immune system conditions. Tell your healthcare professional if you have any conditions such as HIV which may influence your immune system.

Allergic reaction

If you have or ever had an allergic reaction to Ivermectin or its ingredients you should tell your doctor. In that case, your doctor will not prescribe Ivermectin.

Liver conditions

In very rare cases, Ivermectin may cause liver damage. In patients with existing liver problems, it may worsen them. Tell your doctor if you have or had liver conditions, before starting the treatment.

Ivermectin Interactions With Other Medications

Ivermectin oral tablet may interact with other drugs, herbs, or vitamins if you take them at the same time. Drug interactions happen when a substance alters the way a medication works. It can harm the patient or even prevent the medicine from working as it should. Your healthcare provider must be aware of your medications, vitamins, or any such stuff you are taking to avoid interactions.

The most common drug that can interact with Ivermectin is Warfarin. It is a blood-thinning medication. Combining Ivermectin and Warfarin can thin your blood too much resulting in dangerous bleeding. In case you have to take both these drugs necessarily, your healthcare professional will have to monitor your international normalized ratio.

A Propensity Score Analysis Concerning Administration Of Ivermectin Is Associated With Lower Gastrointestinal Complications And Increased Ventilator-Free Days In Ventilated Covid-19 Patients

Study Overview

Covid-19 patients have reportedly experienced digestive issues. Ivermectin drug has been used in Covid-19 patients. The purpose of this study was to determine whether Ivermectin impacts gastrointestinal complications and ventilator-free days in ventilated patients with Covid 19.

The severe acute respiratory syndrome coronavirus 2 pandemic was an emergency situation across the world. Dexamethasone has been used as an effective anti-inflammatory drug however Dexamethasone weakens host immunity.

Remdesivir antiviral drug is a nucleoside analog prodrug that is used to treat various viral infections and reduces the time to clinical improvement in adults suffering from COVID-19. However, there is limited information on patients with mechanical ventilation.

Ivermectin has been used to treat parasitic infections including onchocerciasis and lymphatic filariasis across the world for over 30 years. Ivermectin demonstrates in vitro activity against a wide range of viruses including Zika virus, influenza virus, dengue, HIV, and also SARS-CoV-2.

Clinical research found that Ivermectin treatment was linked with lower mortality in 280 Covid 19 patients in a propensity score-matching study. In another randomized clinical trial involving 400 patients with mild Covid 19, Ivermectin administration did not reduce the time to resolution of symptoms within 21 days. Thus the impacts of Ivermectin are controversial and there is insufficient clinical data on intubated Covid 19 patients in the ICU.

Covid 19 causes gastrointestinal symptoms including vomiting, nausea, loss of appetite, and diarrhea as suggested in a systemic review. There is just a little research on establishment treatment for these symptoms. The objective of this study was to assess whether Ivermectin improves gastrointestinal symptoms and respiratory conditions in mechanically ventilated patients with Covid 19.

Methods Used

In this study, mechanically ventilated covid 19 patients in ICU were involved. The patients who were administered Ivermectin within 3 days after admission were designated to the Ivermectin group and other patients were designated to the Control group.

Ivermectin group patients received Ivermectin 200 μg/kg through a nasal tube. The occurrence of gastrointestinal complications and ventilator-free days within 4 weeks after admission were assessed as clinical results using a propensity score with an inverse probability weighting method.

Interventions

Ivermectin use has been approved for treatment of scabies and strongyloidiasis in Japan. The off-label use of Covid 19 was approved in Osaka University Hospital (Department of Traumatology and Acute Critical Medicine) in 2021. The ventilated covid 19 patients who had given informed consent for Ivermectin use within 3 days after admission received Ivermectin and were designated to the Ivermectin group and patients who did not receive Ivermectin within 3 days were designated to the Control group.

Ivermectin group patients received Ivermectin 200 μg/kg per two weeks through a nasal tube. Antibiotics were given under the same policy during the entire period of this study. This study was approved by the Institutional Review Board of Osaka University. Informed consent was attained from the family of each patient.

Outcome Variables

Diarrhea was defined as the acute onset of continuous liquid stools happening more than twice. Vomiting was defined as reflux volume from the gastric tube of over 300mL/day. Gastrointestinal complications were defined as regurgitation or diarrhea.

Ventilator-free days were defined as the number of days free of mechanical ventilation within 4 weeks from admission. The primary outcome was VFD. The secondary results included regurgitation, diarrhea, and GI complications within 4 weeks after admission.

Statistical Investigation

All patient features are concise using medians with interquartile ranges and proportions with counts for constant variables and categorical variables. The variations in distributions of covariates between Ivermectin and Control groups were evaluated using standardized mean differences.

Estimated the collective event-free probabilities of the first occurrence of diarrhea, vomiting, and GI issues using the Klpan-Meier method. Then it is estimated that the impact of Ivermectin use of these events using Cox proportional-hazard regression models.

Moreover, it evaluated the effect of Ivermectin use of VFD and the amount of ICU-free days within 28 days after ICU admission using proportional-odds logistic regression models. To lessen the preconceptions that were introduced by the imbalances of the distributions of the covariates between the groups, the contrary probability weighing method.

The likelihood of getting Ivermectin is referred to as propensity score was assessed by a multivariable logistic regression model considering covariates of sex, age, P/F ratio, extracorporeal membrane oxygenation, use of concomitant medications and comorbidities.

The evade variance inflation because of the extreme weights which were introduced by extremely high and low estimated propensity scores the propensity scores were trimmed in the un-overlapped area of propensity score distributions in both groups. All statistical inferences were made with two sided 5% significance level using R software.

Study Outcomes

88 patients were included in this study. 39 patients were categorized into the Ivermectin group and 49 patients were categorized into the Control group. The threat ratio for gastrointestinal complications in the Ivermectin group in comparison to the Control group was 0.221 in a Cox proportional hazard regression model. The odds ratio for ventilator-free days in comparison to the Control group was 1.920 in a proportional odds logistic regression model.

All patients tolerated Ivermectin with no clear adverse events. The Ivermectin group contained 39 patients and Control group comprised 49 patients. Ivermectin group patients had significantly lower age and less chronic kidney disease in comparison to those in the Control group. Propensity score through the IPW method was used to adjust for sex, age respiratory condition, concomitant drugs (Dexamethasone, Favipiravir, Remdesivir), and comorbidities (diabetes mellitus, hypertension, chronic obstructive pulmonary disease, cardiovascular disease).

Most patients were cannulated on admission and the median time after admission to intubation demonstrated no significant differences between the Ivermectin group and the Control group. No significant variations were found in blood test reports except for serum creatinine.

The frequencies of regurgitation, diarrhea, and gastrointestinal complications in the Ivermectin group were significantly reduced than in the Control group. The intubation period was significantly lesser and the amount of VFD was significantly greater in Ivermectin versus the Control group.

The mortality within 28 days did not differ pointedly between both groups however the mortality in the entire ICU stay was significantly lesser in the Ivermectin group as compared to the Control group.

In a Cox proportional-hazard regression model the hazard ratio for gastro complications in the Ivermectin group as compared to the Control Group was 0.221 after adjustment for covariates with propensity score with IPW method. In the proportional odds logistic regression model, the odds ratio for VFD in comparison to the control group was 1920 after using the same method.

Discussion

This study demonstrated that Ivermectin administration decreased the occurrence of gastro complications and increased VFD in covid 19 patients undergoing mechanical ventilation. Concerning clinical research, in a meta-analysis of 9 randomized controlled trials in 1788 COVID-19 patients, Ivermectin was linked with decreased mortality. However, these researches do not assess gastro issues and VFD.

Additionally, most patients were not intubated during Ivermectin administration. It shows that even the patients with worse conditions and needed mechanical ventilation, Ivermectin administration through a nasal tube could lessen gastrointestinal complications and reduce the duration of the intubation period.

Ivermectin has been demonstrated to constrain the viral replication of SARS-CoV in vitro. In a clinical study, fecal viral loads were detected and digestive histologic and immunofluorescent staining showed gastrointestinal infection in covid 19 patients. Previous reports suggest that GI complications happened in around 15% of COVID-19 patients which mainly included non-ventilated patients.

In the current study, 51.2% of covid 19 patients on ventilation in the Control group experienced gastro complications. The ventilated patient had a higher occurrence of gastrointestinal complications in comparison to non-ventilated patients thus the effect modification of Ivermectin could be expected to be different.

It might be tough to determine the effect of Ivermectin in non-ventilated patients due to the fewer occurrences of GI complications. These outcomes show that Ivermectin could decrease SARS-CoV-2 infection in the intestine and reduce the symptoms of diarrhea and regurgitation.

Concerning respiratory function,  intestinal injury caused by SARS-CoV-2 can cause inflammation in the intestines and changes in the gut microbiota that may lead to the progression of respiratory disease noticed with Covid 19.

Ivermectin can have a direct impact on the intestine and prevention of SARS-CoV-2-associated gastrointestinal problems may also be linked with the increased VFD noticed in the current study. The mortality in the entire ICU was significantly lower in this study and further randomized controlled study needed to demonstrate that.

Anti-inflammatory drugs are effective and vital however Dexamethasone affects immune cells and is like a double-edged sword, particularly in aged patients with decreased immunity who have difficulty in upregulating immunity under steroid therapy.

Such patients with covid 19 have been reported to suffer from fungal disease and severe cytomegalovirus infection. It may be essential to combine an antiviral drug and an anti-inflammatory drug to combat the SARS-CoV-2 virus in the early stage of infection to prevent prolonged respiratory failure and lessen the accumulated steroid dose.

This study has some confines. An imbalance in the age of patients between the treatment groups remained after weighting. The administration of Ivermectin improved gastrointestinal issues and VFD in ventilated covid 19 patients. The advantageous influence of Ivermectin on the intestines can improve outcomes in these patients. Further research is required to examine the mechanism and effects of Ivermectin Treatment.

Conclusions of Study

Ivermectin treatment improved gastrointestinal complications and the number of ventilator-free days in severe patients undergoing mechanical ventilation. Prevention of gastrointestinal symptoms by SARS-Cov-2 might be linked with Covid-19 outcomes.

National Strategy To Diagnose Coronavirus Disease Associated Invasive Fungal Disease In ICU

Fungal infection is a noticed complication of respiratory virus infections encouraging mortality and morbidity but can be readily treated when diagnosed early. The goal of this study was to assess the incidence, risk factors, and effect of invasive fungal disease in adult covid 19 patients with severe respiratory distress.

135 adults were screened. The incidence was 26.7%. The complete mortality rate was 38%, 53%, and 31% in patients with and without fungal disease. The mortality rate was decreased by the use of antifungal therapy in patients receiving therapy vs 90% in patients not getting therapy. The use of corticosteroids and a history of chronic respiratory disease amplified the likelihood of aspergillosis.

Fungal disease happens frequently in COVID-19 patients who are critically ill and mechanically ventilated. The survival advantage noticed in patients getting antifungal treatment shows that the proposed diagnostic and defining criteria are suitable. Screening using a strategic diagnostic approach and antifungal prophylaxis of patients involving risk factors will enhance the management of covid 19 patients.

A Systematic Review and Meta Analysis Concerning Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19

In this, various published studies performed between Jan 2020 to April 2020 were systematically researched. Major journals were also included for the research. The studies which reported the epidemiological and clinical outcomes of Covid 19 and the prevalence of gastrointestinal findings in patients worsened and studies related to any kind of coronavirus associated illnesses were involved. moreover raw data were pooled from various studies to evaluate GI complications.

The study demonstrated that digestive symptoms and liver injury are quite common in covid 19 patients. More attention needs to be paid to take care of these kind patients.

Closing Words

Various studies and researches have been performed to assess the side effects of Ivermectin particularly during covid times. Some studies have shown that combining both an antiviral drug and anti inflammatory drug in the early stage of SARS-COV-2 can prevent prolonged respiratory failure and decrease the accumulated dose of steroid.

As in many covid 19 patients gastrointestinal complications occurred (diarrhea and vomiting), the researchers used an antiviral oral drug for intestinal prophylaxis. And because ivermectin possess antiviral and anti inflammatory properties, Ivermectin was choose for this purpose.

Inferring the results from these studies some researchers states that Ivermectin could be among the promising antiviral drugs in covid 19 treatment. Many studies have been performed and many are going on. Still there are no sufficient evidence available.

It is recommended not to use Ivermectin without consulting your healthcare provider. Always use this drug exactly as suggested by your doctor. Make sure you talk about the possible side effects of Ivermectin before you begin with it.