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• Maintain sharp vigilance on adverse reactions of ivermectin
  Jianghui Cai, Mi Tang and Jie Tang
  Published on: 20 October 2020

• Published on: 20 October 2020

  Maintain sharp vigilance on adverse reactions of ivermectin

  • Jianghui Cai, Clinical Pharmacist Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China
  • Other Contributors:
    • Mi Tang, Pediatrician
    • Jie Tang, Clinical Pharmacist

  To the Editor:
  We read with great interest the editorial by Dr. James J DiNicolantonio and colleagues.1 In their editorial, the authors have expressed their opinions that ivermectin may be a clinically useful anti-inflammatory agent for late-stage COVID-19. However, we want to highlight some concerns about the use of ivermectin for late-stage COVID-19.
  First, we do agree with the authors that ivermectin can be a potential drug for late-stage COVID-19 considering its anti-inflammatory effects. The authors stated that it is reasonable to suspect that, in doses at or modestly above the standard clinical dose, ivermectin may have important clinical potential for managing disorders associated with life-threatening respiratory distress and cytokine storm—such as advanced COVID-19.
  Second, a usual dose or modestly above the standard clinical dose of ivermectin may induce neurologic disorders, which can be fatal.2 Encephalopathy and coma are well-known side effects of ivermectin treatment in animals. But few cases of neurologic disorders after ivermectin treatment have been reported in humans.3 Neurologic disorders may include coma, ataxia, pyramidal signs, and binocular diplopia. Thus, the seriousness of the adverse reaction in humans implies that caution is warranted regarding medical prescriptions of ivermectin.
  We declare no competing interests.
  Contributors: All authors contributed to the final manuscript.

  Funding: The authors have...

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  To the Editor:
  We read with great interest the editorial by Dr. James J DiNicolantonio and colleagues.1 In their editorial, the authors have expressed their opinions that ivermectin may be a clinically useful anti-inflammatory agent for late-stage COVID-19. However, we want to highlight some concerns about the use of ivermectin for late-stage COVID-19.
  First, we do agree with the authors that ivermectin can be a potential drug for late-stage COVID-19 considering its anti-inflammatory effects. The authors stated that it is reasonable to suspect that, in doses at or modestly above the standard clinical dose, ivermectin may have important clinical potential for managing disorders associated with life-threatening respiratory distress and cytokine storm—such as advanced COVID-19.
  Second, a usual dose or modestly above the standard clinical dose of ivermectin may induce neurologic disorders, which can be fatal.2 Encephalopathy and coma are well-known side effects of ivermectin treatment in animals. But few cases of neurologic disorders after ivermectin treatment have been reported in humans.3 Neurologic disorders may include coma, ataxia, pyramidal signs, and binocular diplopia. Thus, the seriousness of the adverse reaction in humans implies that caution is warranted regarding medical prescriptions of ivermectin.
  We declare no competing interests.
  Contributors: All authors contributed to the final manuscript.

  Funding: The authors have not declared a specific grant for this letter from any funding agency in the public, commercial or not-for-profit sectors.

  Patient consent for publication: Not applicable.

  References
  1. DiNicolantonio JJ, Barroso J, McCarty M. Ivermectin may be a clinically useful anti-inflammatory agent for late-stage COVID-19. Open Heart 2020;7(2):e001350.
  2. Mealey KL. Therapeutic implications of the MDR-1 gene. Journal of veterinary pharmacology and therapeutics 2004;27(5):257-264.
  3. Baudou E, Lespine A, Durrieu G, André F, Gandia P, Durand C, Cunat S. Serious Ivermectin Toxicity and Human ABCB1 Nonsense Mutations. New England Journal of Medicine 2020;383(8):787-789.

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  Conflict of Interest:
  None declared.

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