key: cord-0946914-aubk4suf
authors: Molento, Marcelo Beltrão
title: COVID-19 and the rush for self-medication and self-dosing with ivermectin: A word of caution
date: 2020-06-24
journal: One Health
DOI: 10.1016/j.onehlt.2020.100148
sha: 1e78e6b28080418e8a0e0d401bb7cb29eecfde63
doc_id: 946914
cord_uid: aubk4suf

nan

The drug, and its drug family, is well tolerated to all its hosts, being largely excreted by feces, having rare lethal human cases [1] . However, neurological adverse events of IVM (i.e. confusion, tremors, seizure, local swelling, vomiting), may happen in patients that could last for a week [2] .

Since its commercial release, IVM has been extensively used, representing alone the largest margin of sales to the livestock/companion animal sector, as it continuously gave exceptionally high rates of parasiticide efficacy. But as with any other drug, the chemical benefit of IVM was not perennial. Although parasite infection saw a large reduction worldwide (by two to three -fold), due to the long-acting protection of IVM, the animals were challenged by a new and more adapted parasite populations. Short treatment intervals, sometimes in a frequency of less than 2 weeks (this is extremely short in veterinary practice), seems to be one of the most dangerous factors for drug failure and parasite selection for resistance. Thus, this came with a high cost, as companies saw IVM use being reduced in sheep, horses, dogs (some isolates appear to be refractory to IVM), and gradually to cattle due to the spread of resistance [3] . Mass treatment is practiced to control human parasites as well, and drug resistance is one of the major concerns for the continuation of large-scale parasite eradication programs (i.e. Onchocerciasis).

IVM has also the reputation of having antiviral effects (i.e. for Dengue), being well accepted in the medical practice. The drug can act at different binding sites of proteins, reducing viral replication [4] . With the arrival of COVID-19, IVM has made the international headlines again with evidences of its in vitro activity against the virus [5] . Unauthorized people are prescribing these methods over broad audiences at official pharmaceutical homepages, YouTube channels, and TV interviews. To make matters worse, there has been a rush to drug stores where people are adopting self-medication and more concerningly, self-dosing, as IVM is sold without prescription. This immediately followed pointless prophylaxis, prevention and treatment protocols of COVID-19. And although IVM is well known for its good margin of safety, this may not be sufficient if people start taking it on a regular basis. The risk could also be potentiated by unknown drug-drug interactions, which may affect the central nervous system (blood-brain barrier) physiology, rendering potential harmful health effects.

Therefore, a word of caution is more than required and opportune specially for the use of IVM. Although available data are coming from front-line medical personnel, and official sources, most of the evidences are based on entirely empirical facts. We are going through very difficult times and its common sense that we need to look for therapy alternatives to better face some of the In Brazil, and other countries with major structural, personnel, and finance difficulties, we must use great caution at every step we take. 

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