Ivermectin is an anti-parasitic drug approved in humans for treatment of certain tropical diseases. For humans, ivermectin tablets are approved at very specific doses to treat some parasitic worms, and topical (on the skin) formulations are used for head lice and skin conditions like rosacea.
Ivermectin is not approved for use to treat COVID-19.
According to the U.S. Food and Drug Administration (FDA), certain animal formulations of ivermectin are approved in the U.S. to treat or prevent parasites in animals.
Medications formulated or intended for use in animals should not be used by humans. Veterinary forms of this medication are highly concentrated for large animals and pose a significant toxicity risk for humans.
AMA opposes off-label use of ivermectin for COVID-19
Ivermectin is reportedly being prescribed off label to treat those who have the COVID-19 virus. The AMA, American Pharmacists Association and American Society of Health-System Pharmacists strongly oppose the ordering, prescribing or dispensing of ivermectin to prevent or treat COVID-19 outside of a clinical trial.
Use of ivermectin for the prevention and treatment of COVID-19 has been demonstrated to be harmful to patients and causes adverse events, according to the CDC Health Advisory. Calls to poison control centers due to ivermectin ingestion have increased five-fold from their pre-pandemic baseline.
In the Sept. 9, 2021, AMA COVID-19 video update, John Farley, MD, MPH, director, Office of Infectious Diseases in the Center for Drug Evaluation and Research’s Office of New Drugs, FDA, discusses why patients should not use ivermectin for COVID-19.
Dr. Farley cautions that physicians must consider the “…side effects from the drug itself and that could be worse in some patients and need to be monitored. These include stomach problems, skin rash and itching, and nervous system problems, including dizziness and tremors.”
Further, “…physicians also know with any drug, there are potential interactions with other drugs the patient might be taking and there's some patients who require a special kind of risk-benefit consideration when considering ivermectin.”
Prescribing medications responsibly
Physicians are expected to prescribe drugs “based solely on medical considerations, patient need, and reasonable expectations of effectiveness for the particular patient,” according to the AMA’s Code of Medical Ethics.
When prescribing off label, however, physicians must determine what count as “reasonable expectations” under conditions of greater than usual uncertainty given the absence of relevant data for the intended use, in addition to determining appropriate dose and route of administration.
Responsibly prescribing an approved medication for a novel, off label use requires that the physician reflect critically on the evidence that is available, seek input from knowledgeable colleagues or other medical professionals, and attend carefully to minimizing the risks to the patients.
—(Opinion 1.2.11, “Ethically Sound Innovation in Medical Practice,” AMA Code of Medical Ethics).
The most effective ways to limit the spread of COVID-19 are to get vaccinated, wear a face mask, stay at least six feet from others in public places and wash hands frequently.
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Explore other AMA resources on COVID-19
The AMA’s COVID-19 resource center has evidence-based news, guidance, videos, podcasts, research highlights and more on the pandemic. Read about the latest on COVID-19 vaccines.
Other key COVID-19 resources include:
- JAMA Network™ coronavirus resource center
- AMA Ed Hub™ coronavirus education center
- AMA Journal of Ethics COVID-19 Ethics resource center
- Prescribing medications responsibly in a pandemic
Reviewed by: Andrea Garcia, JD, MPH, director of science, medicine & public health, AMA
Reviewed on: December 10, 2021
