Ivermectin is an FDA approved medication for parasitic infections. Ivermectin is widely available, due to its inclusion on the WHO model list of essential medicines.

Ivermectin opens glutamate-sensitive chloride channel currents in helminths, and it widely believed that this is how it kills certain parasites.

Its the drug of choice for the treatment of onchocerciasis and strongyloidiasis.

Ivermectin is effective against several intestinal nematodes including ascariasis, trichuriasis, enterobiasis, and cutaneous larva migrans, Wuchereriabancrofti, Brugiamalayi, Mansonellaozzardi, and Loa loa.

Its also effective against scabies and head lice.

So why might Ivermectin work against SARS-CoV-2?

Once the virus gains entry into the cells of the body, using the ACE2 receptor, the virus releases its messenger RNA into the cell. The cell starts to translate the mRNA from the virus, which starts to make viral proteins, and that’s how new virus forms.

Some of these viral proteins that are freshly made then enter into the nucleus of the cell, or are at least thought to do so by many scientists, and this probably impairs our cell’s ability to fight off the infection. The way that these viral proteins are thought to gain entry into the nucleus of our cells is through specific channels that are made out of a different protein, called importin. Not important, importin. There is importin type alpha, importin beta. Or Imp for short, so imp alpha, imp beta.

And this is where ivermectin comes in because ivermectin inhibits the passage of these viral proteins into the nucleus. It does so by binding to these protein channels and effectively blocking the transport of molecules through them.

So this is why scientists started studying ivermectin.

And here we have this article that just came out April 3rd, in the journal Antiviral Research. This is a pre-proof article, meaning they have been peer-reviewed, but the final publication is still pending.

What these scientists found is that ivermectin significantly inhibits the SARS-2-CoV viral proteins in their passage from the cytoplasm into the nucleus of cells…… in vitro.

In vitro means this was done in a test tube, or outside of a living organism.

A single dose of Ivermectinhad∼5000-fold reduction in virus levels at 48h in cell culture.

So this drug has a huge impact on this virus in vitro.

And that is why the authors of this study conclude that these drugs need to be studied in COVID-19 patients, meaning in clinical trials. The same way that other drugs are being looked at in clinical trials for COVID-19, such as remdesivir, chloroquine, and hydroxychloroquine.

So because Ivermectin is generally considered a safe drug and is already FDA approved for other diseases, it can be repurposed for COVID-19, as long as it is shown to be safe and effective for COVID-19 patients in clinical trials.

If this drug turns out to be the miracle drug for COVID-19, the next question will become, when should we start taking it. Because for the patients with COVID-19 who get very sick, they usually get sick very quickly. So this ivermectin may have to be given prophylactically, or at the first onset of symptoms.

The other question, is what are the side effects, or adverse reactions?

Well, base on what we already know about ivermectin, this is what I can tell you.

The most common adverse reaction,is the Mazzotti reaction.

But this only happens when ivermectin is used to treat onchocerciasis, a parasitic infection.

What is The Mazzotti reaction, you ask?

It was first described in 1948. It’s a symptom complex seen in patients after undergoing treatment of nematode infestation, particularly with the medication diethylcarbamazine (DEC), but with ivermectin as well.

Mazzotti reactions can be life-threatening and are characterized by fever, hives, generalized swelling, swollen lymph nodes, fast heart rate, low blood pressure, hypotension, joint pain, and abdominal pain.

There is a 25% chance of Mazzotti reaction when ivermectin is used to treat onchocerciasis, but not other parasitic infections. So if a COVID19 patient took ivermectin, this would not happen.

So, otherwise, Ivermectin is very safe, and side effects are uncommon. Diarrhea occurs in 2% of people taking it.

Also, Ivermectin should not be administered to pregnant or lactating women, and its safety in children <15 kg is not known.

Dr. Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine

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