What started as a quest to learn about the potential use of ivermectin in treating COVID-19 has spiraled into an alarming trend across multiple states. Thinking it can be used as a substitute for ivermectin intended for humans, many people are flocking to farm supply stores to purchase ivermectin meant for animals.

First licensed as a veterinary product in 1981, the drug is approved for use in preventing heartworm disease in small animals like dogs, and for treating certain internal and external parasites in cattle, swine, sheep, goats, and horses. The FDA approved ivermectin for human use to combat a variety of parasitic diseases (both internal and external) in 1996.

While Alvin Bronstein, a member of the AAPCC Board of Directors, says they cannot say with accuracy how the concept of using ivermectin to treat COVID-19 started, many believe a research paper out of Australia may have been the glimmer of hope people were looking for during the pandemic, setting off the ivermectin craze. Released in April 2020, the paper (The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro) documents how the virus that causes COVID-19 responded to ivermectin when exposed in a petri dish. Because it was not given to people or animals, additional testing was needed to determine whether ivermectin might be safe or effective in preventing or treating COVID-19. Yet, it didn’t stop the idea from lighting up social media.

“There is still a lot we don’t know about how effective a treatment ivermectin really is for COVID-19,” says Soren Rodning, an Auburn University associate professor of animal sciences. “Specifically, they have not been proven safe for use by people through clinical drug trials.”

What we do know, he adds, is that the concentration of ivermectin in these products or some of the inactive ingredients used in the animal formulations may not be safe for humans. 

“The bottom line – do not self-medicate with animal ivermectin products,” Rodning says. “I cannot emphasize this enough.” 

From January to August 2019, the American Association of Poison Control Centers (AAPCC) recorded 402 cases of human exposure to ivermectin across the U.S. The following year there was a slight increase for the same time frame, with 435 cases reported. In 2021, the Center saw a sharp spike, with the figure jumping to 1,125 cases. “Cases began increasing in July 2021,” Bronstein says. “We assume this is COVID-19 related.”

People are purchasing various highly concentrated animal ivermectin drug formulations such as pour-on, injectable, paste, and drench intended for horses, cattle, and sheep.

The rise also triggered multiple admonitions from federal agencies and state health officials alike. “You are not a horse or a cow. Seriously, y’all. Stop it,” tweeted the FDA on August 21.

The Alabama Poison Information Center – Children’s of Alabama has fielded more than two dozen ivermectin exposure calls in recent months. Most of those calls were related to COVID-19.

The Arkansas Poison and Drug Information Center says it has received 24 ivermectin calls recently. “Of those 24 cases, 23 are an individual taking a veterinary product as a prophylactic or as a treatment for COVID-19,” says Howell Foster, the center’s director. While that number may not seem like a lot, the combined total for the past four years is only 25 calls. 

While Ed Boetti says the Iowa Poison Control Center has received a few reports related to ivermectin use, calling is not a requirement. 

“Even though we cover the entire state, no one is required to give us a call,” says Boetti, medical director, Iowa Poison Control Center.

The center uses what is called passive surveillance, a system where reports are received from hospitals, clinics, or other sources. “It’s possible there are more cases out there that we’re just not hearing about,” he says. “When we do get a call, one of the questions asked is what product the person affected has taken. In every call we’ve fielded, the animal version is what has been taken, and he or she has developed symptoms.”

Some of the symptoms associated with ivermectin toxicity include confusion, decreased consciousness, rash, nausea, vomiting, abdominal pain, and diarrhea. 

As the department lead in farm for Theisen’s, Cole Steenhoek says he can usually tell when someone is trying to purchase ivermectin for personal use. “It’s pretty clear by the way they talk about the product and the questions they ask,” he says. 

The Ames, Iowa, location has seen a handful of customers try to buy ivermectin recently. The most requested item – an ivermectin oral paste used to treat worms in horses. The store also sells an injectable liquid as well as a drench, which is like the paste but in liquid form.

“I did have one customer try to buy the injectable because we were out of the paste,” he says. “I told him definitely not.”

To date, Steenhoek has turned away about seven customers.

“When I have had to deny selling it to a customer, it’s because he told me outright that he plans to use the product to treat COVID-19. At that point, I can no longer sell it to him,” he says, adding that the store recently posted a sign warning about the use of animal ivermectin for human consumption. 

Fleet Farm has also posted signs in its stores alerting customers. In a statement, the company noted that in recent weeks, it has not seen an increase in sales of ivermectin products.

While Steenhoek and Fleet Farm may not be overwhelmed with requests, others like Tractor Supply are reportedly feeling the effects. Aside from people potentially harming themselves, there may also be unintended consequences that could impact the animal industry.

“If shelves are cleared of ivermectin by people using it as a prophylactic against COVID-19, it could impact animal health because it wouldn’t be available for animal husbandry practices like deworming,” Rodning says.

Since it is an ingredient in heartworm tablets for dogs, a shortage could also potentially affect the supply of ivermectin to manufacturers.

The FDA’s Center for Veterinary Medicine is asking veterinarians and animal caretakers who are having difficulty obtaining ivermectin for animal use to let them know by emailing AnimalDrugShortage@fda.hhs.gov.

“I know people are looking for hope. They want something that will help treat or prevent COVID-19 but taking ivermectin meant for animals is not the answer,” Boetti says. “You are not a cow or a horse with an intestinal parasite, so please do not use it.”

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