What a review can add, and what it cannot
A flattering nickname is not a current safety guarantee. The adverse reactions that change a decision sit on the Stromectol label now in force, including the Loa loa warning.
Cancer is not a Stromectol indication. The labeled uses are the two parasitic infections below. A cancer essay does not create a dose.
A price page does not supply the cure rates below, and a dermatology essay does not either. A laboratory finding about viral particles in a dish is not a human trial, and it is not a reason to take this tablet for a virus.
The virus row on this page is the Hernandez meta-analysis of outpatient COVID-19 trials. It is not empty of studies. It is empty of a benefit those studies were able to show.
What the Stromectol label's own trials measured
DailyMed indicates Stromectol for intestinal strongyloidiasis due to Strongyloides stercoralis, not for disseminated disease. The label says 64-100% of infected patients were cured after a single dose of about 200 mcg per kilogram in the studies it cites. Activity against that worm is limited to the intestinal stages. In general, additional doses are not necessary, but follow-up stool examinations should verify that the infection is gone. In a study in France, where reinfection was unlikely, Strongyloides larvae reappeared in stool as long as 106 days after ivermectin. A review that stops at "one dose cured it" has skipped that clock.
In immunocompromised patients, including people with HIV, the label says repeated courses may be required, at intervals of about two weeks, and cure may not be achievable. That limit is part of the evidence, not a footnote to ignore because the cure range looks wide.
Onchocerciasis is the other labeled row. The drug is active against the tissue microfilariae of Onchocerca volvulus but not against the adult form. Treatment with Stromectol does not kill the adult Onchocerca parasites, so repeated follow-up and retreatment are usual. In the label's account of one study, skin microfilariae fell 83.2% at 3 days and 99.5% at 3 months after a single dose, and a reduction of more than 90% was maintained for up to 12 months. Mass programs commonly repeat at 12 months. For an individual patient, retreatment may be considered at intervals as short as 3 months. Those percentages are about larvae in the skin. They are not a cure of the adult worm in the nodule.
The count that follows from these two rows, including the 70 kg split of five tablets versus four, is the dosing note. The purchase check for the 3 mg tablet is the ivermectin monograph.
The outpatient COVID review
Hernandez and colleagues searched five databases through 17 October 2023 and included 12 randomized trials, 7,035 adults with COVID-19 who were not hospitalized. Ivermectin was compared with placebo, standard care, or an active drug. The primary outcomes were hospitalization, death from any cause, and adverse events.
Ivermectin did not reduce hospitalization. The relative risk was 0.81, with a 95% confidence interval of 0.64 to 1.03, from 8 trials, and the authors graded that evidence as low quality. The interval includes "no reduction." It is not a demonstrated benefit. All-cause mortality was a relative risk of 0.98 (0.73 to 1.33) across 9 trials, also low quality. Adverse events were not reduced either, and that evidence was graded very low quality. Secondary outcomes, including mechanical ventilation, getting worse, getting better, and clearing the virus, did not move in ivermectin's favor. The authors rated those as very low quality.
Their conclusion uses a blunt sentence: in non-hospitalized COVID-19 patients, ivermectin did not have an effect on clinical, non-clinical, or safety outcomes versus controls, and it should not be recommended as treatment for that group. This note does not stretch that sentence to people already in hospital. The review was not about them.
The FDA update is a different kind of statement, and it is broader. The FDA has not authorized or approved ivermectin for preventing or treating COVID-19 in humans or animals. It says currently available clinical trial data do not demonstrate that ivermectin is effective against COVID-19 in humans. The same page says a clinician may, with few exceptions, prescribe an approved human drug for an unapproved use when they judge that use medically appropriate for one patient. That is one prescriber's judgment. It is not a finding that the outpatient trials succeeded, and it is not permission for a website to ship tablets for a virus.
Animal formulations stay out of this row. The FDA says never to use medications intended for animals on yourself or other people.
What a review title cannot do
Praise for the drug does not retire the Loa loa hold. Anyone with significant exposure to Loa loa-endemic areas of West or Central Africa needs pretreatment assessment for loiasis before ivermectin, for any reason the drug is being considered. Cancer is not an indication on the carton. A laboratory finding about viral particles does not overturn the outpatient trials or the FDA statement.
Adaeze Nwankwo files the parasite rows as the evidence that earned the tablet, and the 2024 outpatient review as the evidence that did not earn a COVID-19 use. The dosing arithmetic stays on the other library page. This one is the reason those tables exist, and the reason a virus search does not get a table of its own.