Ivermectin Blood Thinners: The Reality of Ivermectin The Interaction of IVM With Blood Thinners

 Executive Summary

• One of the few Ivermectin drug interactions is with blood thinners. This article will address what those taking blood thinners who are currently taking or wanting to take Ivermectin should do.

Introduction

As Ivermectin is also a blood thinner, one of the few interactions of Ivermectin with other drugs is with blood thinners.

Fear Mongering to Limit Ivermectin Usage

As has been covered in several articles on this site and is certainly known by many, if not most, subscribers to the site, the problem with information from the medical establishment on Ivermectin is that it is geared toward minimizing the use of the drug, so far more profitable items can be proposed instead. The interaction with blood thinners is one of these areas where the medical establishment has pushed fear where it would be easy to make a simple adjustment. The following quote from the article What is Ivermectin, from GoodRX, another medical website that does not disclose that it receives nearly all of its funding from drug companies, is a good example.

COVID-19 aside, ivermectin tablets should be taken with caution if you’re also taking blood thinners. These medications may interact if they’re combined.

Ivermectin can make your blood thinner. This can raise your risk of bleeding. Talk to your healthcare provider if you’re taking a blood thinner like warfarin (Coumadin, Jantoven) and have been prescribed ivermectin.

Here is the problem with the last sentence in this quote. If you “talk to your healthcare provider if you are taking a blood thinner,” the healthcare provider has been instructed to talk the patient out of using Ivermectin. What, of course, is not mentioned is that this deprives the patient of the benefits of Ivermectin. The healthcare provider will do this using the logic of the drug interaction, but the side of the road leaves a comprehensive view of the patient’s health.

A self-evident solution is to cut down on the blood thinner dosage. However, this is never a recommendation by the health care provider.

The Size Effect of Ivermectin with Blood Thinners

Neither the NIH nor drug manufacturers have any interest in funding studies of any kind with Ivermectin. However, I found this study titled A Case of Ivermectin-Induced Warfarin Toxicity: First Published Report that showed the interaction between Ivermectin and blood thinners.

Data Point #1: A Proposed Large Effect of Ivermectin Drug Interaction With Warfarin

Notice that the quote begins with the statement that there is a shortage of data on human Ivermectin utilization.

Numerous warfarin drug interactions are well documented. However, there is a paucity of data that exist on ivermectin utilization in humans.

I have never heard of the term “utilization” used in a paper like this. Typically the term is efficacy or effectiveness. Utilization could mean many things. However, there are many studies on the efficacy of Ivermectin against various ailments.

Also, Warfarin has numerous drug interactions, and what is not discussed is that Warfarin is a dangerous drug.

So, this phrasing appears misleading.

and virtually none with the concomitant use of warfarin.

Yes, that is true. And the reason is that neither the NIH nor the pharmaceutical industry are interested in this research topic.

Ivermectin is an antiparasitic medication, primarily used in veterinary medicine, with a broad spectrum of activity but very limited data on utilization in humans.

This is an entirely false presentation of Ivermectin and a good indication that the author is going to be providing more false or misleading information about Ivermectin.

Ivermectin won the Nobel Prize in 2015 for its use in humans and has been prescribed billions of times and taken without a prescription in many countries billions of times. And it is been shown to be beneficial for many things outside of antiparasite uses. Pfizer could have written this paragraph as it illustrates zero independence from the pharmaceutical industry.

Ivermectin binds to nerve cells of microfilaria which causes an increase in cell membrane permeability leading to hyperpolarization causing paralysis and cell death.

Microfilaria are early-stage nematodes. However, the article should point out that as humans have a different nervous system than nematodes, the drug does not have this effect on humans. This is why Ivermectin is so effective against parasites while not having this effect on us. It appears very likely that this author does not know this.

Ivermectin has been shown, in vitro, to antagonize the same vitamin K–dependent clotting factors that warfarin does (II, VII, IX, and X).

That would mean that Ivermectin can replace Warfarin, which would be perfect as Warfarin has a far worse safety profile than Ivermectin.

But the question is “how much” is Ivermectin’s effect versus Warfarin? The author does not address how powerful this effect is.

To our knowledge, this is the first case report to discuss an adverse event associated with concomitant warfarin and ivermectin use.

A Case Study into Ivermectin Interactivity

A 68-year-old man presented to a critical access emergency department (ED) with a massive hematoma under his tongue which pushed his tongue to the roof of his mouth (Figure 1). His medical history included coronary artery bypass grafting, mechanical aortic and mitral valve replacements, atrial fibrillation, stroke, and scabies. The patient denied alcohol and tobacco use and maintained a relatively strict diet which included minimal foods with a high vitamin K content. Due to his valve replacement and atrial fibrillation, he is chronically anticoagulated with warfarin.

Prior to his presentation to the outlying ED, he recently had been prescribed 2 doses of ivermectin for suspected scabies infection. The patient was instructed to take 3 mg of ivermectin initially, and repeat 3 mg in 1 month if the scabies symptoms had not resolved. One week prior to the first dose of ivermectin, his INR was 3.1 on warfarin at 5 mg daily. One week after the first dose of ivermectin, his INR had risen to 4.2 for which he was instructed to hold 2 doses and then reinitiate warfarin at 5 mg daily. Per discussion with the patient, his INR decreased back down to 2.7 after 1 week of holding his 2 doses.

What should be noted here is that this is a tiny dosage of Ivermectin. The idea that such a low dosage of Ivermectin caused what followed is a bit difficult to believe.

One month after his initial ivermectin dose, and 2 days prior to his ED admission, the patient was still experiencing symptoms and therefore, as instructed, took his second 3-mg dose of ivermectin. No other additional medications were taken outside the patient’s chronic therapy. The patient woke the next morning with a large mass under his tongue. He could barely swallow but was not short of air. He proceeded to go to the ED where his INR was found to be >20. He was given 2.5 mg of vitamin K subcutaneously and then transferred to a tertiary care facility due to the complexity of his case.

In this case, the patient had a positive temporal relationship between the developments of warfarin toxicity induced by ivermectin.

While there is a paucity of data that exist on ivermectin utilization in humans, prescribers, pharmacists, and patients must be cognizant of all potential drug-drug interactions that exist with warfarin. There currently do not exist any best practices on the concomitant use of warfarin and ivermectin together; however, based on this case report, prophylactic dose reduction or increased INR monitoring would not be unreasonable.

This case report is consistent with the rest of the little literature that exists on ivermectin’s anticoagulant properties by exhibiting prolonged prothrombin time. Although no permanent harm was sustained to our patient, it does highlight the importance of continued monitoring for drug-drug interactions and performance of high-quality medication reviews by prescribers, pharmacists, and patients themselves.

This case study made it seem as if the effect or potential effect (as they don’t know the cause of the issue) is enormous and in reaction to a mere 3 MG of Ivermectin, infrequently taken, led to several hematomas — with the proposal that this 3 MG of Ivermectin and Warfarin were the cause. However, this other study does not support such a significant effect. If this were true, then with the dosages that we take, we should develop hematomas without taking Wayfarin at all — again, as the claims are, Ivermectin has a powerful anticoagulant effect. 

One question that comes to mind is that Ivermectin and Warfarin are widely used drugs. Furthermore, Ivermectin is taken for many ailments beyond parasites, even though the medical establishment opposes this. Why are such side effects not common knowledge at this point with good documentation if even an intermittent dose of 3 MG of Ivermectin was the cause of the problems in this case study?

Also, aren’t we constantly told by the medical establishment that one should not conclude anecdotes? However, when the medical establishment wants to suppress a drug, it turns out that a single anecdote based upon fragile evidence (again, just review the dosage of Ivermectin that was apparently the cause of this hematoma), is sufficient for the medical establishment to conclude the topic. Another logical question would be that if Ivermectin is such a powerful anticoagulant, why not simply drop Wayfarin entirely — as it is quite dangerous, and use the near zero side effect Ivermectin but at much higher dosages than 3 MG per day? The answer is straightforward. First, this association claimed in the anecdote is false, and second, the entire purpose of this anecdote is to come up with any excuse to get people to stop taking Ivermectin. Furthermore, how are all the benefits of Ivermectin to be replaced once Ivermectin (the 3 MG dose per day, which is barely enough for anything really) is ceased.

Data Point #2: A Proposed Small Effect of Ivermectin as an Anticoagulant

The following study Coagulation Abnormalities and Ivermectin, provides an order of magnitude for the effect of Ivermectin as an anticoagulant — and thus is the potential danger in an adverse drug reaction with blood thinners.

Let us review what it says.

Prothrombin ratios were measured 13-16 days after treatment in 148 subjects from Sierra Leone taking part in a double-blind placebo-controlled trial of ivermectin.

The prothrombin ratio measures how long it takes a clot to form.

Prolonged prothrombin ratios were observed more frequently in the ivermectin group, although this difference was not significant and no patients suffered bleeding complications.

Further investigation of these patients failed to reveal any abnormality of liver function, although factor VII and II levels were reduced in most affected individuals, suggesting interference with vitamin K metabolism.

Ivermectin has a minimal effect on coagulation and concern about mass treatment for this reason appears to be unjustified.

Ivermectin had minimal effect in the study. And there are a good number of test subjects in this study.

Would I love to recommend people stop taking dangerous anticoagulants or blood thinners and move to Ivermectin? Of course. Would I love to develop a calculator specifically for using Ivermectin as an anticoagulant, which would help get so many subscribers off of anticoagulants? Again, the answer is yes again. However, I see no evidence that Ivermectin is an anticoagulant replacement.

Conclusion

The exact degree to which Ivermectin functions as an anticoagulant is not exactly known. However, it appears to produce a very small reduction in clotting. Health authorities have exaggerated this small effect to scare people from taking Ivermectin.

Secondly, both blood thinners and Ivermectin were widely taken medications. If this were as large of an issue as is claimed by medical authorities and drug companies and the websites like WebMD and GoodRX that they entirely control, there would be far more reports of adverse reactions, and they would publish on this. But they can barely find any and have created a mountain out of a molehill.

• We have Ivermectin dosage calculators based on research studies and for all the different uses of Ivermectin.
• We are the only web source offering an Ivermectin dosage calculator in addition to different dosage estimates for different cancer types.
• All of our calculators are easy to use (see our dosage calculator listing). Each person enters their personalized information into the calculator and receives our recommended extensively researched dosage estimate automatically and immediately calculated.
• We also cover the broader problems with dosage calculation in medicine at the article The Problem With Dosage Calculation in Medicine, as this is an issue much larger than for one drug. 

About Our Ivermecting Testing Program and Recommended Ivermectin Source of Supply

• We performed pharmaceutical testing on Ivermectin to find a lower-cost version that also matched Merck's original Ivermectin in bioequivalence.
• You can read about the details of our Ivermectin testing in this article, Our Ivermectin Bioequivalence Testing.
• We got Summit Products to carry this version of Ivermectin, which passed our bioequivalence testing. 

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