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Fact check: What are the potential side effects of using ivermectin for Covid-19 treatment?
Executive Summary
The evidence from pharmacovigilance reports, toxicology case series, and poison center data shows a consistent signal that ivermectin use for COVID-19 has been associated with a range of adverse effects, including gastrointestinal, neurological, cardiac, respiratory, and skin disorders, and occasional fatal outcomes reported in serious cases [1] [2] [3]. Multiple analyses and case reports emphasize that many harms arise when ivermectin is used off-label, at higher-than-recommended doses, or in veterinary formulations, and authoritative toxicology groups have documented severe toxicity from such unapproved use [4] [5] [6].
1. Rising reports: Why safety data surged during the pandemic and what it reveals
Pharmacovigilance databases recorded a marked increase in reports of ivermectin-associated adverse drug reactions beginning in 2020, with gastrointestinal and neurological effects most frequently noted; among identified serious cases there were respiratory, cardiac, and neurologic disorders, overdoses, and several deaths, indicating the global surveillance signal moved from rare to concerning [1] [2]. A systematic review of VigiBase flagged over two thousand suspected serious adverse reactions connected to ivermectin, with common System Organ Classes including general disorders, nervous system disorders, and skin conditions, which corroborates that reported harms are multidimensional and not limited to one organ system [3]. These data show both an absolute rise in adverse-event reporting and a change in the profile of reported events during heightened off-label use for COVID-19.
2. Neurological harm: Repeated signals and biologic plausibility
Case series and pharmacovigilance analyses identified numerous serious neurological adverse events temporally linked to ivermectin exposure, including confusion, ataxia, seizures, and documented presence of ivermectin in brain tissue in at least one postmortem case, supporting a plausible causal relationship for neurotoxicity at supratherapeutic exposures [7] [6]. Recurrent symptoms upon re-exposure in several reports provide additional evidence consistent with a drug-related effect [7]. Toxicology-focused clinical series during the pandemic similarly describe predominantly older male patients ingesting higher-than-recommended doses who developed neurologic symptoms alongside gastrointestinal and musculoskeletal complaints, reinforcing that misuse and overdosing substantially increase the risk of severe neurologic injury [5].
3. Clinical toxicology and real-world poison center experience
Regional poison centers and clinical toxicology reports documented spikes in calls and cases of ivermectin toxicity linked to COVID-19, with symptoms ranging from gastrointestinal distress and hypotension to severe neurologic sequelae and hospitalizations, demonstrating real-world morbidity from self-medication and veterinary product use [6] [5]. The American College of Medical Toxicology summarized multiple instances of severe toxicity and morbidity from unapproved ivermectin use for COVID-19 and emphasized the absence of an approved indication for this use, highlighting the institutional concern among toxicologists and emergency clinicians about the trend [4]. These frontline data illustrate how population-level misuse translated quickly into clinical harm in emergency settings.
4. Serious-but-rare outcomes: deaths, overdoses, and reporting limits
Pharmacovigilance reports include overdoses and deaths among the serious cases reported to global databases, underscoring that while many adverse effects are reversible, a minority progress to fatal outcomes [2]. The datasets have limitations: passive reporting systems like VigiBase capture suspected associations and may underreport incidence, and confounding illnesses or co-exposures can complicate causality assessments, yet the consistency across independent data sources—the WHO database, poison centers, and clinical case series—strengthens the inference that ivermectin misuse poses real risks [3] [6] [7]. These constraints mean reported counts understate true harm, but concordant signal patterns across methods point to a substantive safety concern.
5. What this means for patients, clinicians, and policy—sharp conclusions from multiple angles
Taken together, the evidence compels a clear clinical message: ivermectin is associated with gastrointestinal, neurologic, cardiac, respiratory, and dermatologic adverse effects when used for COVID-19, especially at excessive doses or in nonhuman formulations, and has produced serious toxicity and deaths in some reported cases [1] [2] [4] [3] [6] [5]. Public health and toxicology bodies have cautioned against off‑label use; clinicians should explicitly counsel patients about documented harms and report adverse events to pharmacovigilance systems. Policymakers and clinicians must weigh these safety data against the lack of an established therapeutic indication for COVID-19 and prioritize evidence-based treatments while monitoring and mitigating misuse that drives preventable harm [4] [3].