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 https://doi.org/10.47488/dhrp.v1iS4.28 

  
 

http://dhrproceedings.org 17 © DHR Health Institute for Research and Development 
 

 

EDITORIAL 

Insufficient Scientific Evidence Supporting the Use of Ivermectin in the  
Prevention and Treatment of COVID-19 

 
Ivermectin– a drug obtained following fermentation 
of Streptomyces avermitilis, was discovered in 1975 
and was approved for medical use in 1981. Its 
discovery was hailed as an innovation in medicine 
resulting in the conferring of the 2015 Nobel Prize 
in Physiology or Medicine to William Campbell 
and Satoshi Ōmura for its discovery and 
applications.  In humans, U.S. Food and Drug 
Administration (FDA) has approved Ivermectin for 
the treatment of parasite infestations which includes 
head lice, scabies, river blindness, lymphatic 
filariasis, strongyloidiasis, trichuriasis and 
ascariasis. In veterinary medicine, Ivermectin is 
used to prevent and treat heartworm and acariasis, 
among other diseases. 

The anti-parasitic mode of action of Ivermectin has 
been well-defined. It acts by binding to the Gamma-
aminobutyric acid (GABA) receptors which results 
in increased influx of Chloride ion with 
consequential hyperpolarization and paralysis. On 
the contrary, its mode of action in SARS-CoV-2 
infection is debatable. While the conclusions of this 
manuscript are currently under reconsideration and 
are subject to serious scientific criticism, Zaidi and 
Dehgani-Mobaraki have suggested that in addition 
to inhibiting host importin alpha/beta-1 nuclear 
transport proteins, which are part of a key 
intracellular transport process that viruses hijack to 
enhance infection by suppressing the host’s 
antiviral response, Ivermectin also acts by 
inhibiting the binding of SARS-CoV-2 to ACE-2 
receptors (1). A recent study showed Ivermectin 
had proven effective as an inhibitor of COVID-19, 
however the experiments conducted in the study 
were in vitro and the trials had yet to be conducted 
in humans (2). 

Despite these contradictory observations and in the 
face of the lack of an approved drug treatment for 
COVID-19, many patients resorted to the use of 
Ivermectin for both the prevention and the treatment 

of infection with SARS-CoV-2. An extremely 
controversial manuscript that was initially 
published in January 2021 and subsequently 
withdrawn by the editors of the Frontiers in 
Pharmacology had undesirable consequences (3). 
The editors concluded that this manuscript 
contained unsubstantiated claims and violated the 
journal’s editorial policies. Unfortunately, despite 
of its withdrawal, this manuscript was used by many 
providers to justify the use of Ivermectin for the 
prevention and treatment of COVID-19. In an 
independent review of available literature, the 
author’s concluded that “Based on the current very 
low‐ to low‐certainty evidence, we are uncertain 
about the efficacy and safety of Ivermectin used to 
treat or prevent COVID‐19. The completed studies 
are small, and few are considered high quality. 
Several studies are underway that may produce 
clearer answers in review updates. Overall, the 
reliable evidence available does not support the 
use of Ivermectin for treatment or prevention of 
COVID‐19 outside of well‐designed randomized 
trials” (4). 

Regrettably, despite overwhelming scientific 
evidence denouncing the use of Ivermectin for 
prevention and treatment of COVID-19 supported 
by strong FDA denunciation, the use of this drug for 
this indication has not abated (5). A recent study 
examining trends in Ivermectin dispensing from 
outpatient retail pharmacies in the United States 
during the COVID-19 pandemic showed an 
increase from an average of 3,600 prescriptions per 
week at the pre-pandemic baseline (March 16, 
2019–March 13, 2020) to a peak of 39,000 
prescriptions in the week ending on January 8, 
2021. Since early July 2021, outpatient Ivermectin 
dispensing has again begun to rapidly increase, 
reaching more than 88,000 prescriptions in the 
week ending August 13, 2021. This represents a 24-
fold increase from the pre-pandemic baseline. (6). 



DHRP, 2021, Vol. 1 (S4) 17-19  Editorial 

  
 

http://dhrproceedings.org 18 © DHR Health Institute for Research and Development 
    
 

The recent use of Ivermectin that has been 
formulated for veterinary use has created additional 
challenges. Self-administering of the drug for 
SARS-CoV-2 infections have led to an 
unprecedented increase in calls to the Texas Poison 
Center Network. The Texas Department of State 
Health Services has issued a health advisory over 
the improper use of Ivermectin to treat or prevent 
COVID-19 after calls to the Texas Poison Center 
Network for people exposed to the drug increased 
150% (7). This is a nation-wide observation as most 
hospitals have reported similar toxicity profiles due 
to iniquitous use of Ivermectin for the prevention 
and treatment of COVID-19. 

In addition to the FDA and the U.S. Centers for 
Disease Control and Prevention, organizations such 
as American Medical Association and American 
Pharmacist Association have also strongly opposed 
the ordering, prescribing, or dispensing of 
Ivermectin to prevent or treat COVID-19 outside of 
a clinical trial (8). National Institutes of Health has 
designed double-blinded randomized placebo-
control clinical trials to ascertain the safety and 
effectiveness of Ivermectin and other repurposed 
drugs in the prevention and treatment of COVID-
19. DHR Health Institute for Research and 
Development is involved in these studies, and it 
is expected that the results of these prospective 
clinical trials would unequivocally establish the 
benefit (or otherwise) of these agents. 

Considering the available scientific evidence, it is 
strongly recommended that Ivermectin should not 
be prescribed and/or self-administered for the 
prevention or treatment of COVID-19.  
Additionally, it must be stressed that vaccination 
remains the most effective approach for the 
prevention of COVID-19 and informing the public 
about proper treatment options is the apposite 
course of action towards ending this global 
pandemic. 

References  

1. Zaidi, A.K., Dehgani-Mobaraki, P. The mechanisms of action 
of Ivermectin against SARS-CoV-2: An evidence-based clinical 
review article.  J Antibiot (2021). 
https://doi.org/10.1038/s41429-021-00430-5 

2. Caly, L., Druce, J.D., et.al. The FDA-approved drug Ivermectin 
inhibits the replication of SARS-CoV-2 in vitro. Antiviral Res. 
2020; 178:104787. 

3. Offord, C. Frontiers Pulls Special COVID-19 Issue After 
Content Dispute. The Scientist. 2021. https://www.the-
scientist.com/news-opinion/frontiers-pulls-special-covid-19-
issue-after-content-dispute-68721 

4. Popp, M., Stegemann, M., et. al. Ivermectin for preventing and 
treating COVID-19. Cochrane Database of Systematic Reviews 
2021, Issue 7. Art, No: CD015017. DO1: 
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.
CD015017.pub2/full   

5. Why You Should Not Use Ivermectin to Treat or Prevent 
COVID-19. 2021. https://www.fda.gov/consumers/consumer-
updates/why-you-should-not-use-ivermectin-treat-or-prevent-
covid-19 

6. U.S. Centers for Disease Control & Prevention. Emergency 
Preparedness and Response. Rapid Increase in Ivermectin 
Prescriptions and Reports of Severe Illness Associated with Use 
of Products Containing Ivermectin to Prevent or Treat COVID-
19. 2021. 
https://emergency.cdc.gov/han/2021/han00449.asp?ACSTracki
ngID=USCDC_511-
DM64535&ACSTrackingLabel=HAN%20449%20-
%20General%20Public&deliveryName=USCDC_511-
DM64535 

7. Texas Poison Center Calls Triple for People Treating COVID-
19 With Ivermectin. 2021. https://www.msn.com/en-
us/health/medical/texas-poison-center-calls-triple-for-people-
self-treating-covid-19-with-ivermectin/ar-AANP5wz   

8. AMA, APhA, ASHP statement on ending use of Ivermectin to 
treat COVID-19. 2021. https://www.ama-assn.org/press-
center/press-releases/ama-apha-ashp-statement-ending-use-
ivermectin-treat-covid-19     

 

Sohail Rao, MD, MA, DPhil 

Executive Vice President, DHR Health, 5501 S. McColl 
Road, Edinburg, Texas 

President & Chief Executive Officer, DHR Health 
Institute for Research & Development, 5323 S. McColl 
Road, Edinburg, Texas 

Corresponding author email: s.rao@dhr-rgv.com 

Disclosures: None 

ORCID: Sohail Rao: https://orcid.org/0000-0001-5027-
9992 

Alec Vasquez-Kanhere 

DHR Health Institute for Research & Development, 
5323 S. McColl Road, Edinburg, Texas 

Disclosures: None 

ORCID: Alec Vasquez-Kanhere: 
https://orcid.org/0000-0002-2566-1724 

 

https://doi.org/10.1038/s41429-021-00430-5
https://www.the-scientist.com/news-opinion/frontiers-pulls-special-covid-19-issue-after-content-dispute-68721
https://www.the-scientist.com/news-opinion/frontiers-pulls-special-covid-19-issue-after-content-dispute-68721
https://www.the-scientist.com/news-opinion/frontiers-pulls-special-covid-19-issue-after-content-dispute-68721
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015017.pub2/full
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD015017.pub2/full
https://www.fda.gov/consumers/consumer-updates/why-you-should-not-use-ivermectin-treat-or-prevent-covid-19
https://www.fda.gov/consumers/consumer-updates/why-you-should-not-use-ivermectin-treat-or-prevent-covid-19
https://www.fda.gov/consumers/consumer-updates/why-you-should-not-use-ivermectin-treat-or-prevent-covid-19
https://emergency.cdc.gov/han/2021/han00449.asp?ACSTrackingID=USCDC_511-DM64535&ACSTrackingLabel=HAN%20449%20-%20General%20Public&deliveryName=USCDC_511-DM64535
https://emergency.cdc.gov/han/2021/han00449.asp?ACSTrackingID=USCDC_511-DM64535&ACSTrackingLabel=HAN%20449%20-%20General%20Public&deliveryName=USCDC_511-DM64535
https://emergency.cdc.gov/han/2021/han00449.asp?ACSTrackingID=USCDC_511-DM64535&ACSTrackingLabel=HAN%20449%20-%20General%20Public&deliveryName=USCDC_511-DM64535
https://emergency.cdc.gov/han/2021/han00449.asp?ACSTrackingID=USCDC_511-DM64535&ACSTrackingLabel=HAN%20449%20-%20General%20Public&deliveryName=USCDC_511-DM64535
https://emergency.cdc.gov/han/2021/han00449.asp?ACSTrackingID=USCDC_511-DM64535&ACSTrackingLabel=HAN%20449%20-%20General%20Public&deliveryName=USCDC_511-DM64535
https://www.msn.com/en-us/health/medical/texas-poison-center-calls-triple-for-people-self-treating-covid-19-with-ivermectin/ar-AANP5wz
https://www.msn.com/en-us/health/medical/texas-poison-center-calls-triple-for-people-self-treating-covid-19-with-ivermectin/ar-AANP5wz
https://www.msn.com/en-us/health/medical/texas-poison-center-calls-triple-for-people-self-treating-covid-19-with-ivermectin/ar-AANP5wz
https://www.ama-assn.org/press-center/press-releases/ama-apha-ashp-statement-ending-use-ivermectin-treat-covid-19
https://www.ama-assn.org/press-center/press-releases/ama-apha-ashp-statement-ending-use-ivermectin-treat-covid-19
https://www.ama-assn.org/press-center/press-releases/ama-apha-ashp-statement-ending-use-ivermectin-treat-covid-19
https://orcid.org/0000-0001-5027-9992
https://orcid.org/0000-0001-5027-9992
https://orcid.org/0000-0002-2566-1724


DHRP, 2021, Vol. 1 (S4) 17-19  Editorial 

http://dhrproceedings.org 19 © DHR Health Institute for Research and Development 

Manish Singh, MD, FACS 

Chief Executive Officer, DHR Health, 5501 S. McColl 
Road, Edinburg, Texas 

Disclosures: None 

ORCID: Manish Singh: https://orcid.org/0000-0003-
4146-3282  

 

 

https://orcid.org/0000-0003-4146-3282
https://orcid.org/0000-0003-4146-3282

