Ivermectin Is Back in the Conversation—But What Should Healthcare Teams Know?
From renewed OTC access in some states to persistent online claims, ivermectin is once again popping up in patient conversations—and bringing plenty of confusion with it.
In this episode, Don and Steve dig into what’s driving the buzz and what the evidence actually shows across a surprisingly wide range of uses. From viral misinformation to emerging global health research, they explore where ivermectin fits… and where it doesn’t.
Along the way, they tackle one of the biggest challenges in practice: how to respond when patients ask about therapies fueled more by headlines than high-quality data—and how to keep those conversations grounded, practical, and patient-centered. Featuring insights from an oncology specialist on real-world patient scenarios.
- 🦠 Is ivermectin still being used for COVID-19—and what does the latest evidence really show?
- 🧬 How should pharmacists respond to patients asking about ivermectin for cancer?
- 💊 When might oral ivermectin make sense for conditions like rosacea?
- 🌍 Could ivermectin help reduce malaria transmission—and why does context matter?
Let’s worm through the data and track down what holds up—and what doesn’t.
They put these claims under the microscope:
- Ivermectin prevents and cures COVID-19.
- Ivermectin prevents and cures cancer.
- Oral ivermectin may improve rosacea.
- Ivermectin can reduce malaria transmission.
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TRC Healthcare Editor Hosts:
- Stephen Small, PharmD, BCPS, BCPPS, BCCCP, CNSC
- Don Weinberger, PharmD, PMSP
Guest:
- Leslie Gingo, PharmD, BCPS
CE Information:
None of the speakers have anything to disclose.
TRC Healthcare offers CE credit for this podcast for subscribers at our platinum level or higher. Log in to your Pharmacist’s Letter, Pharmacy Technician’s Letter, or Prescriber Insights account and look for the title of this podcast in the list of available CE courses.
The clinical resources mentioned during the podcast are part of a subscription to Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights:
- Chart: COVID-19 Vaccines
- Chart: Managing Cough and Cold
- CE Course: Supplements During Cancer Treatment
- CE Course: Lifestyle and Cancer Risk
- Chart: Treatments of Rosacea
- CE Course: Managing Common Travel-Related Illnesses
- Chart: Resources for Discussing Medical Misinformation
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Transcript:
This transcript is automatically generated.
00:00:05 Narrator
Welcome to Rumor vs Truth, your trusted source for facts, where we dissect the evidence behind risky rumors and reveal clinical truths.
00:00:13 Narrator
Today we’ll debug the buzz and renewed interest in ivermectin.
00:00:20 Steve Small
So Don, did you hear that my state, Iowa, recently, along with a few others, made ivermectin over the counter?
00:00:27 Don Weinberger
You know, I did.
00:00:29 Don Weinberger
So talking about ivermectin is right up your alley today, literally.
00:00:32 Don Weinberger
Are you going to be our correspondent on the ground for this episode then?
00:00:36 Steve Small
Only if on the ground means grounded in science, Don.
00:00:39 Steve Small
And I’m Steve the pharmacist, live from the field.
00:00:41 Don Weinberger
And I’m Don the pharmacist, ready to dig into the situation around this anti-parasitic.
00:00:46 Steve Small
At the right time too, because purported off-label indications seem to be going mite-y faster than our CE course catalog for this.
00:00:54 Don Weinberger
So speaking of CE…
00:00:56 Don Weinberger
This podcast offers continuing education credit for pharmacists, pharmacy technicians, prescribers, and nurses.
00:01:02 Steve Small
And just log into your pharmacist letter, pharmacy technician’s letter, or prescriber insights account and look for the title of this podcast in the list of available CE courses.
00:01:10 Don Weinberger
And for purposes of disclosure, none of the speakers have anything to disclose.
00:01:16 Steve Small
Now, before we get into our claims, let’s review what ivermectin is first.
00:01:20 Steve Small
It’s a well-established anti-parasitic for humans FDA approved for specific worm infections in people like strongyloidiasis and onchocerciasis.
00:01:31 Don Weinberger
I’m starting to itch as we talk.
00:01:33 Don Weinberger
This drug’s already under my skin.
00:01:35 Don Weinberger
Do you feel itchy yet, Steve, as well.
00:01:36 Steve Small
I’m getting there.
00:01:38 Don Weinberger
So anyways, our ivermectin works by disrupting parasite nerve and muscle function, essentially paralyzing them.
00:01:45 Don Weinberger
For us nerds out there, it specifically activates chloride channels and parasite neurons, which then stops them from firing.
00:01:53 Steve Small
Yep, and essentially the paralyzed parasite can’t eat and dies.
00:01:57 Steve Small
And I really can’t say I have any sympathy, Don.
00:01:59 Don Weinberger
Aw, poor parasite, yeah.
00:02:01 Steve Small
And when I used to think of ivermectin, I usually thought about it as veterinary uses, like deworming livestock and other animals typically.
00:02:09 Steve Small
But since the COVID pandemic, this barnyard mainstay has gone mainstream in humans, gaining online attention for off-label uses.
00:02:17 Steve Small
And several states, Iowa included, have voted to make this prescription med OTC to expand access, increasing patient interest, right?
00:02:28 Don Weinberger
But speaking of interest, is that based on facts or fads?
00:02:32 Don Weinberger
Is ivermectin a stable treatment, or is it just horsing around?
00:02:36 Steve Small
Yay or nay, right?
00:02:39 Steve Small
And that’s the $1,000,000 question, right?
00:02:41 Steve Small
And as clinicians, you’ll likely see renewed interest, and that’s what we’re here to talk about.
00:02:45 Steve Small
Today, we’ll worm our way through what’s real, what’s not, and how to guide patients through all the noise so nothing parasites on your clinical judgment.
00:02:55 Don Weinberger
All right, folks, let’s get to that first claim.
00:02:58 Don Weinberger
Sounds like a blast from the past, but it’s a viral claim that still resonates today and might be making an encore.
00:03:05 Don Weinberger
And that claim is ivermectin prevents and cures COVID-19.
00:03:11 Steve Small
So we’re jumping all the way back to the early days of the COVID-19 pandemic, an era I’m sure we’d all like to forget, but I do remember early lab studies at the time showing ivermectin could inhibit viral replication in test tubes, right?
00:03:25 Don Weinberger
Yeah. When human-formulated supplies were running low due to demand spikes, people were even purchasing veterinary ivermectin products.
00:03:33 Steve Small
Yes, which we do not advise due to the safety risks.
00:03:36 Steve Small
Just want to emphasize that.
00:03:38 Don Weinberger
Yeah. Thank you for that.
00:03:39 Don Weinberger
So now those early studies used high ivermectin concentrations, which, you know, did show some effect.
00:03:45 Don Weinberger
But keep in mind, again, this was in test tubes.
00:03:48 Don Weinberger
And we know lab studies don’t always translate the benefits in actual humans.
00:03:53 Don Weinberger
And some initial studies had to be retracted due to major flaws.
00:03:57 Steve Small
Yeah, and looking at the retraction watch website that actually tracks papers that were removed due to flaws or other issues, their current running tally for papers with COVID and ivermectin is about 16, which is significant.
00:04:11 Don Weinberger
Yeah, I agree. Now we’ve had many human clinical trials since then.
00:04:16 Don Weinberger
When human studies are pulled together and look at the meta-analyses,
00:04:19 Don Weinberger
Ivermectin showed no meaningful benefit compared to control groups.
00:04:24 Steve Small
And was that with prevention or treatment here?
00:04:27 Don Weinberger
That is with both.
00:04:29 Don Weinberger
Patients didn’t have lower rates of infection when taking it as a prophylaxis.
00:04:33 Don Weinberger
When they came to using ivermectin for treatment, there was no reduction in outcomes in things we truly care about, you know, such as hospitalization rates or even death.
00:04:42 Steve Small
Yeah, those are important outcomes.
00:04:44 Steve Small
And something that also worries me here is what you talked about with the high doses needed then, since there appears to be no benefits.
00:04:51 Steve Small
I’d be worried that using high doses might then just increase toxicity risks and nothing else.
00:04:55 Don Weinberger
Yeah, exactly.
00:04:57 Don Weinberger
You know, normal doses of ivermectin can cause minor side effects such as diarrhea and dizziness, but also severe skin reactions like Stevens-Johnson syndrome or even seizures in rare cases.
00:05:08 Don Weinberger
And keep in mind these COVID studies use high doses such as 0.4 to 1.2 milligrams per kilogram per day.
00:05:16 Don Weinberger
And to put that in perspective, typical dosing for other indications, usually between 0.1 to 0.2 milligrams per kilogram per day.
00:05:23 Steve Small
Yeah, that’s quite the difference.
00:05:25 Steve Small
Plus, when I looked up FDA recommendations just now, they haven’t changed their recommendation against using it for COVID because of the lack of evidence and the risks.
00:05:34 Don Weinberger
Yep, So that recommendation is still the case, you know, all these years later.
00:05:38 Don Weinberger
So going back to that claim, which is ivermectin prevents and cures COVID-19.
00:05:44 Don Weinberger
The verdict is.
00:05:49 Don Weinberger
Rumor.
00:05:51 Steve Small
So a good approach here is if a patient is curious about using ivermectin for COVID-19, note that high quality studies show no benefits and patients may just experience side effects instead of relief.
00:06:03 Steve Small
Plus we have other options for prevention and treatment that I think about.
00:06:07 Don Weinberger
Yes, and we have our COVID-19 vaccines and managing cough and cold charts to help compare those options.
00:06:14 Don Weinberger
Plus regularly checking CDC guidance for info on evidence-based treatments.
00:06:19 Steve Small
Nice. And you know, Don, I hate to bring this up, but while we are on the topic of viruses, I’m sure audience might be getting patient questions about if ivermectin can be used for Hantavirus.
00:06:31 Don Weinberger
Oh yeah. So Hantavirus is something that’s on many people’s minds based on current outbreaks and news.
00:06:38 Don Weinberger
So it’s important to specify that this is a different virus than COVID.
00:06:43 Don Weinberger
Patients typically get it from exposure to infected mouse droppings and urine.
00:06:47 Don Weinberger
The straight-up answer is no, we don’t have any strong clinical data right now that ivermectin prevents or treats Hantavirus.
00:06:55 Steve Small
So I would say advise against using ivermectin for Hantavirus until we have more evidence and stay alert for Hantavirus updates from public health authorities.
00:07:04 Steve Small
Okay, well that’s enough horse grooming on that topic, Don.
00:07:07 Steve Small
But let’s move into a claim around oncology, which is kind of unique, and where the stakes are higher.
00:07:13 Steve Small
And the claim is that ivermectin prevents and cures cancer.
00:07:19 Don Weinberger
High stakes indeed, Steve.
00:07:21 Don Weinberger
We’re seeing claims about this more online, and ivermectin is an attractive target since repurposing an existing drug means it’s more accessible and considered already safe.
00:07:31 Steve Small
Right, good point.
00:07:32 Steve Small
And I’m no oncology expert, so I enlisted the help of one of our specialty consultants, Dr. Leslie Gingo, PharmD BCPS.
00:07:39 Steve Small
She’s an assistant professor of clinical oncology at University of Pittsburgh School of Pharmacy.
00:07:44 Steve Small
And we asked her what the evidence actually shows in oncology.
00:07:51 Steve Small
Thank you so much for joining us today, Leslie, to answer this question.
00:07:54 Steve Small
And we’re hearing that patients with cancer are curious about using ivermectin for treatment and even maybe prevention for cancer.
00:08:02 Steve Small
But what’s the data behind this?
00:08:04 Steve Small
I’d love to get your thoughts.
00:08:06 Leslie Gingo
Right. Well, there’s very little human data out there at this point.
00:08:11 Leslie Gingo
There is a very small clinical trial that reported prelim data, and that was looking at women who had triple negative breast cancer.
00:08:22 Leslie Gingo
And they were also receiving, it’s an investigational anti-PD-1 immune checkpoint inhibitor.
00:08:30 Leslie Gingo
It’s called balstilimab.
00:08:33 Leslie Gingo
And basically they had eight patients that they were reporting results for.
00:08:39 Leslie Gingo
So not a lot to go on.
00:08:43 Leslie Gingo
Yeah, that study is still recruiting.
00:08:46 Leslie Gingo
And as of last month, they have 34 patients enrolled.
00:08:50 Leslie Gingo
And this is out of California.
00:08:53 Leslie Gingo
So it is something that’s going on in the United States, which is sort of promising.
00:09:00 Leslie Gingo
But as far as those eight patients that they reported data for, one of them ended up with stable disease.
00:09:08 Leslie Gingo
Six had progression of their disease and one had a partial response.
00:09:12 Leslie Gingo
So not really a lot to go on there, but I did find it helpful as far as how should we dose ivermectin.
00:09:21 Leslie Gingo
How can we help patients use ivermectin safely.
00:09:25 Leslie Gingo
And so the doses that they were using were 30 milligrams, 45 milligrams, or 60 milligrams.
00:09:33 Leslie Gingo
And they were doing that once a day on days one through three, and then again, days 8 through 10, and then the following week, days 15 through 17.
00:09:46 Leslie Gingo
So basically three days every week, every 21 days is how the cycles went.
00:09:53 Steve Small
And these are milligrams, correct?
00:09:55 Steve Small
We’re not talking micrograms like usual.
00:09:58 Leslie Gingo
That’s right. These are milligrams.
00:09:59 Leslie Gingo
So little bit bigger doses than we’re used to seeing with the antihelminthic dosing.
00:10:06 Steve Small
Interesting. So it sounds like the data, we’re still trying to figure this out.
00:10:11 Steve Small
It’s very early in humans and trials are ongoing.
00:10:15 Steve Small
And despite this evidence, I’m sure you’ve encountered patients with cancer who maybe are curious about ivermectin.
00:10:21 Steve Small
How should we go about that if patients are curious?
00:10:24 Steve Small
Do we completely steer them away?
00:10:26 Steve Small
What advice do you give?
00:10:28 Leslie Gingo
Right, so it’s difficult to steer patients away, especially if they’ve already kind of gotten it in their mind that they want to try ivermectin.
00:10:40 Leslie Gingo
Maybe they had a family friend who suggested it based on a cousin or some family member who tried it and had some success.
00:10:51 Leslie Gingo
So it’s all very anecdotal.
00:10:53 Leslie Gingo
So it’s really hard to argue against that.
00:10:57 Leslie Gingo
I will tell you our patients kind of run the gamut.
00:11:00 Leslie Gingo
So sometimes they’ll ask and then we kind of say that there’s really limited data.
00:11:06 Leslie Gingo
As much as I wish that I could suggest ivermectin as a possibility, there’s just not much to go on.
00:11:16 Leslie Gingo
And some patients are really okay with that.
00:11:19 Leslie Gingo
Other patients, you can sort of see them almost shutting down, like they don’t want to hear that.
00:11:26 Leslie Gingo
They really are hanging on to hope.
00:11:28 Leslie Gingo
And so I recently did have a patient like that who has been progressing through everything that we’ve tried to give her.
00:11:37 Leslie Gingo
She has very aggressive adrenal tumor and she was very curious about wanting to add ivermectin to her current chemotherapy.
00:11:48 Leslie Gingo
She felt like it maybe helped a little bit before she started systemic chemotherapy treatment, and so she was curious about wanting to go back to that.
00:11:58 Leslie Gingo
So rather than just shutting her down and really taking away that hope that she had, I decided that the best thing to do for her was to meet her in the middle, so really to think about the safety of doing that.
00:12:13 Leslie Gingo
Because the truth is, even when we tell them that it’s not a good idea, patients can easily get these medications even through like a pharm supply store or online.
00:12:26 Leslie Gingo
So they’re going to do what they want to do.
00:12:28 Leslie Gingo
And so we need to do our due diligence to make sure that if they decide to do it, they at least are doing it as safely as possible.
00:12:37 Steve Small
Yeah, I completely agree.
00:12:38 Steve Small
Any tips that you emphasize regarding safety or side effects that they should watch out for, especially with the dosing maybe we mentioned earlier?
00:12:46 Leslie Gingo
Right, right. So the number one thing that I suggest is making sure that we’re double checking for drug interactions.
00:12:55 Leslie Gingo
And so that was something that I did for this patient.
00:12:58 Leslie Gingo
Fortunately, there aren’t too many drug interactions for ivermectin, but it’s still always a good idea to check for those.
00:13:08 Leslie Gingo
The other important piece is really you want to use a reputable source.
00:13:13 Leslie Gingo
So you don’t want patients to be going online looking for this because who knows what’s in that formulation.
00:13:20 Leslie Gingo
Likewise, you don’t want patients to go to the veterinary products that are out there.
00:13:27 Leslie Gingo
Those are very difficult to dose.
00:13:30 Leslie Gingo
A lot of them are topical, so it doesn’t make a whole lot of sense translating that to human use.
00:13:36 Leslie Gingo
And then I think probably the most important piece is really helping them understand that this isn’t something that you’re gonna take every single day.
00:13:46 Leslie Gingo
Because the half-life of ivermectin is about 18 hours, it’s really important that we don’t just continuously take the ivermectin.
00:13:55 Leslie Gingo
So I often will say, you know, it’s a good idea if you wanna try to take it, maybe try one to two days a week and see how that goes.
00:14:03 Leslie Gingo
Maybe every other day at the most, but really don’t wanna take it continuously every single day.
00:14:14 Leslie Gingo
And then as far as side effects go, I always warn them about neurotoxicity.
00:14:19 Leslie Gingo
So things that can happen with higher doses of ivermectin would be like confusion, decreased level of consciousness.
00:14:30 Leslie Gingo
Sometimes muscle weakness can happen.
00:14:34 Leslie Gingo
And at the very worst end of things, you can end up with a coma.
00:14:43 Leslie Gingo
So I really warn patients to watch for that, especially their family members.
00:14:47 Leslie Gingo
I really make sure that the family members are able to watch for that for our patients.
00:14:53 Steve Small
That’s great.
00:14:54 Steve Small
And I love that we’re kind of minimizing risk as best we can given these tricky situations.
00:15:00 Steve Small
And I really appreciate your input on this.
00:15:01 Steve Small
So I’m excited to share this with Don, see what we think, and hopefully we can provide more perspective on that for our audience.
00:15:07 Steve Small
So thank you so much.
00:15:09 Leslie Gingo
Thank you. Thanks for having me.
00:15:14 Don Weinberger
It’s really great to have an oncology specialist consultant help us with this.
00:15:18 Don Weinberger
In looking at other lab and animal studies, they suggest ivermectin may affect tumor signaling and cancer cell growth.
00:15:27 Don Weinberger
But like Dr. Gingo said, human data are limited to case reports and a small trial is still ongoing, not published randomized trials that we can pretty much hang our hat on.
00:15:37 Steve Small
Exactly. And this is tricky, right?
00:15:39 Steve Small
Because patients are hearing about this and they may want to try it anyway.
00:15:42 Steve Small
But cancer is serious stuff.
00:15:44 Steve Small
We’re talking potentially life and death decisions here.
00:15:48 Steve Small
And using unproven therapies could delay effective treatments or even cause harm.
00:15:52 Steve Small
So when it comes to this claim that ivermectin prevents and cures cancer, the verdict is rumor.
00:16:04 Steve Small
The bottom line here is that if it’s not proven in humans, it shouldn’t replace cancer therapy.
00:16:09 Don Weinberger
Yeah. This is a good reminder that pharmacy staff should loop in a patient’s oncologist when any med, OTC, herbal, or supplement is added to their regimen.
00:16:19 Don Weinberger
You look carefully at interactions and weigh benefits and risks.
00:16:22 Steve Small
Definitely. And at the same time, these conversations aren’t always going to be black and white.
00:16:27 Steve Small
Some patients may still be interested in trying something like ivermectin.
00:16:30 Steve Small
So our role is to guide them with the best available evidence and keep safety front of mind, right?
00:16:36 Steve Small
And if patients still want to use ivermectin in this case, we can help check things like dosing and interactions.
00:16:42 Don Weinberger
Yeah, exactly. You can find more guidance on having these situations in our supplements during cancer treatment CE course.
00:16:51 Steve Small
Plus, it’s always a good time to offer cancer prevention strategies that actually have benefits based on evidence.
00:16:57 Steve Small
Check out our lifestyle and cancer risk CE course for practical ways to reduce risk, like cutting back on alcohol, quitting smoking, and obviously using sunscreen.
00:17:06 Don Weinberger
So before we get into our next claim.
00:17:09 Steve Small
If this episode is helping you cut through the noise, here’s something to make your professional life a little bit easier.
00:17:14 Don Weinberger
Already a subscriber, don’t forget to claim CE credit for this episode.
00:17:18 Steve Small
And not subscribed yet or thinking about upgrading, access more trusted clinical insights and save 10% with our exclusive listener promo code RVT1026 at checkout.
00:17:30 Don Weinberger
Details and links are in the show notes. Don’t miss out.
00:17:34 Don Weinberger
All right, moving on to our next claim.
00:17:36 Don Weinberger
I’m glad you mentioned sunscreen a moment ago, Steve, because let’s see if the data on this next claim is only skin deep.
00:17:45 Don Weinberger
Claim is oral ivermectin may improve rosacea.
00:17:49 Don Weinberger
So going back a little bit, rosacea is a chronic inflammatory skin condition where skin, usually on the nose and cheeks, are red, rashy, and possibly with pustules.
00:18:00 Don Weinberger
I’ll have a heart producer put that image so everything can kind of look at how lovely that is.
00:18:05 Don Weinberger
But some patients might also have eye irritation and rosacea sometimes comes and goes or flares up.
00:18:11 Steve Small
And it’s important to say here, topical 1% ivermectin is FDA approved for rosacea, right?
00:18:18 Don Weinberger
And it’s considered a first sign option for papulopustular rosacea.
00:18:23 Don Weinberger
I think I have these puff guards here, all these p’s flowing around.
00:18:27 Don Weinberger
Now the audience is probably wondering why an anti-parasitic topical med may work here.
00:18:32 Don Weinberger
There’s evidence to say that tiny demodex mites in the skin are associated with more rosacea inflammation.
00:18:37 Don Weinberger
Again, a producer can actually put a lovely picture up for that.
00:18:42 Don Weinberger
And ivermectin can kill demodex mites, decreasing their inflammatory effect.
00:18:47 Steve Small
And it might, I think this thing kind of looks cute.
00:18:50 Steve Small
It’s a little pudgy, right?
00:18:51 Steve Small
But I’m not comfortable with it crawling on my face.
00:18:55 Steve Small
And I love when these claims are both fascinating and frightening.
00:18:58 Steve Small
So it helps these, it helps stop these microscopic invaders topically, but then I’m wondering where does oral ivermectin fit in here, Don?
00:19:06 Don Weinberger
Yeah, good question.
00:19:07 Don Weinberger
Well, a handful of small studies suggest oral ivermectin may reduce Demodex mite counts and improve symptoms too, but they are limited.
00:19:16 Don Weinberger
We have no data comparing topical to oral regimens to say which one’s better.
00:19:21 Steve Small
Plus, we have to acknowledge here that giving ivermectin systemically now exposes the whole body to the drug when we really just need it on the affected areas, like of the face.
00:19:30 Steve Small
So why might patients want to take oral instead of topical then?
00:19:34 Don Weinberger
Right, so it just may partly come down to convenience, you know, studies using oral ivermectin for rosacea.
00:19:40 Don Weinberger
usually give a dose every one to two weeks for two-day doses.
00:19:44 Don Weinberger
And on the other hand, topical ivermectin needs to be applied to the phase daily, which can be an inherent issue for some folks.
00:19:54 Don Weinberger
All right, so let’s go ahead and go back to that claim, which is oral ivermectin may improve rosacea.
00:20:01 Don Weinberger
The verdict is true with conditions.
00:20:08 Steve Small
Based on that, I would say that if a patient wants to use ivermectin for rosacea, start with topical therapy first since it has more data.
00:20:15 Don Weinberger
Yeah, I agree. Not all true claims should change practice.
00:20:18 Don Weinberger
Consider oral ivermectin if patients have trouble keeping up with using daily topical ivermectin, or they can’t use or afford other approved options such as topical metacycline, azelaic acid, and others.
00:20:31 Steve Small
And we’re just scratching the surface here when it comes to rosacea treatment.
00:20:34 Steve Small
You can find more details and product comparisons using our Treatments of Rosacea chart online.
00:20:39 Steve Small
And with that, let’s move to our final claim, which is creating buzz in terms of global health.
00:20:45 Steve Small
The claim is that ivermectin can reduce malaria transmission.
00:20:50 Don Weinberger
Ah malaria. We don’t see that flying around too much here in North America.
00:20:55 Steve Small
True. And it’s important to keep it that way, Don.
00:20:58 Steve Small
And we should point out this claim is specifically about giving ivermectin broadly to a community to prevent malaria from spreading, not giving it to individual travelers, which we may more encounter in the pharmacy.
00:21:10 Steve Small
And also giving to a community might sound a little bit more counterintuitive.
00:21:14 Steve Small
But malaria is caused by Plasmodium protozoa that are transmitted into our blood by infected mosquitoes when they bite us.
00:21:21 Steve Small
And some patients may only have flu symptoms after that, such as fever, chills, or headache.
00:21:26 Steve Small
But some infections can actually be fatal.
00:21:30 Don Weinberger
Yeah, we tend to forget about that since we really don’t see it.
00:21:33 Don Weinberger
And I guess this means you could say that mosquitoes, they are the deadliest animal in the world.
00:21:38 Steve Small
Yeah, I could agree with that.
00:21:39 Steve Small
And thankfully we have prophylaxis meds to prevent it.
00:21:42 Don Weinberger
Right. I’m sure some of our audience may have patients that come into the pharmacy to get prophylaxis meds like chloroquine or mefloquine before they travel to countries where malaria is a problem such as in Africa or Asia.
00:21:55 Steve Small
Yeah, and you know a big problem right now is with malaria that resistance to those meds is growing and we are slowly running out of options here.
00:22:03 Steve Small
So since ivermectin works against parasites, there is a thought that maybe it could be a prophylaxis alternative at the community scale.
00:22:11 Don Weinberger
So my favorite question to you, Steve, does it have any evidence?
00:22:16 Steve Small
We do have some early study data in humans.
00:22:20 Steve Small
For example, one large cluster randomized controlled trial in Kenya that I found was published in 2025, and it compared giving Albendazole versus Ivermectin doses once monthly for three months to a large community.
00:22:33 Steve Small
So again, it’s different than the individual patient prevention we’re used to seeing.
00:22:38 Don Weinberger
Albendazole, that’s an interesting control med to actually give.
00:22:43 Don Weinberger
So why do they do that?
00:22:45 Steve Small
Yeah, for comparison, that’s a good point.
00:22:47 Steve Small
So albendazole doesn’t work against malaria, but it does have deworming benefits like ivermectin.
00:22:54 Steve Small
So that helped make a more balanced comparison there.
00:22:57 Steve Small
And the researchers found a 26% drop in malaria incidence in the folks who were getting ivermectin when the entire community was treated.
00:23:06 Don Weinberger
Interesting. So they saw a decrease.
00:23:09 Don Weinberger
Next question is, what about adverse effects?
00:23:12 Steve Small
There were more adverse effects in the ivermectin group, about 6% versus 4%, though, so keep that in mind.
00:23:19 Steve Small
And there was no difference in serious adverse events between the two groups, which is important.
00:23:24 Steve Small
Now, other studies looking at this question showed actually no benefit, but they had limitations, such as small sample size and using several antimalarials at once.
00:23:35 Steve Small
It’s hard to piece that together.
00:23:36 Steve Small
So, when it comes to this claim that ivermectin can reduce malaria transmission, the verdict is true.
00:23:50 Don Weinberger
So early studies support that this is true, only when ivermectin is given to an entire community.
00:23:56 Don Weinberger
It’s important to say that it’s not for individual prophylaxis yet.
00:24:01 Steve Small
Right. People shouldn’t be going over to their pharmacy grabbing OTC ivermectin before they go on a trip.
00:24:05 Steve Small
We need more data and recommendations from global health authorities first.
00:24:10 Steve Small
And after all, another interesting thing is this study only analyzed data in the kids used in the study.
00:24:16 Steve Small
And it was also part of that mass public health campaign in countries where malaria is endemic, not for individual adult travelers from the United States or Canada going to other countries.
00:24:26 Don Weinberger
That’s a good point.
00:24:27 Don Weinberger
And this is a good time to remind folks to refer to CDC’s Yellow Book for updated guidance on travel medicine considerations.
00:24:33 Don Weinberger
Plus, you can fly on over to our Managing Common Travel-Related Illness CE course for more info.
00:24:40 Don Weinberger
It covers conditions such as malaria, traveler’s diarrhea, and more.
00:24:45 Steve Small
And the bottom line here, folks, is that the evidence matters.
00:24:48 Steve Small
And with ivermectin, it really depends on the indication.
00:24:52 Don Weinberger
Exactly. And in practice, that means avoiding assumptions if we see an ivermectin prescription.
00:24:57 Don Weinberger
And ask open-ended questions, acknowledge where patients are coming from, and guiding them towards therapies that are actually supported by solid data.
00:25:06 Steve Small
Right, and explain what the evidence does and doesn’t show, and then redirect towards safer, proven options when appropriate.
00:25:12 Steve Small
And for higher risk situations like cancer we talked about, make sure to loop in the patient’s oncologist before adding anything new, including OTC meds, supplements, or herbals.
00:25:22 Don Weinberger
You could need extra support in navigating these conversations.
00:25:25 Don Weinberger
Check out our resources for discussing medical misinformation chart.
00:25:29 Don Weinberger
It’s packed with practical tips and links you can use with patients.
00:25:34 Don Weinberger
And continue to trust us with your medication-related questions and answers.
00:25:37 Don Weinberger
Go claim your CE credit and also access our evidence-based resources from pharmacist letter, pharmacy technician’s letter, or prescriber insights.
00:25:45 Steve Small
And again, if you’re not already a subscriber or want to upgrade, you can save 10% with our exclusive listener code RVT1026 at checkout, and there’s an easy link in the show notes.
00:25:55 Don Weinberger
If you’re a subscriber, tap the claim credit link in the show notes or search your see organizer for this episode.
00:26:02 Don Weinberger
And now, mailbag time.
00:26:05 Don Weinberger
We got our audience question from the last episode about gabapentin.
00:26:08 Don Weinberger
Specifically, they asked us about gabapentin toxicity in pets.
00:26:12 Steve Small
And we’re able to reach out to one of our specialty consultants, a veterinary toxicologist, to fetch us the answer about gabapentin here.
00:26:21 Don Weinberger
So if you’re curious, just scroll your feed for the bonus mailbag and you’ll find out our full answer there.
00:26:27 Steve Small
And if you’d like to have your ivermectin question about this episode answered for our next bonus mailbag, send us a message.
00:26:33 Don Weinberger
E-mail us at [email protected] or send us fan mail right from the podcast show notes.
00:26:41 Don Weinberger
We also use your suggestions and feedback to plan our episodes.
00:26:45 Steve Small
And join us next time where we’ll unclog a backlog of claims we are hearing about laxatives.
00:26:50 Don Weinberger
I can’t wait. And Steve, you went there.
00:26:54 Don Weinberger
Let’s hope it becomes our number one episode, but it may be a #2 episode.
00:27:00 Don Weinberger
Thank you for joining us on Rumor vs Truth, your trusted source for facts, where we dissect the evidence behind risky rumors and reveal clinical truths.
00:27:08 Steve Small
See you next time.
Rumor vs Truth
