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, although it is highly exaggerated.
• This article will address what individuals taking blood thinners who are currently taking or considering taking 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 our site, the problem with information from the medical establishment on Ivermectin is that it is geared toward minimizing the use of the drug, so that far more profitable items can be proposed instead.

GoodRX on This Issue

The following quote from the article What is Ivermectin? on GoodRx, another medical website that does not disclose 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.

What GoodRx does not tell its readers is that the healthcare provider has been instructed to discourage the patient from using Ivermectin.

• What, of course, is not mentioned is that this deprives the patient of the benefits of Ivermectin.
• Additionally, the healthcare provider will likely have no specialized knowledge of the interaction between Ivermectin and a blood thinner and will repeat the recommendation provided by the pharmaceutical company, advising against taking Ivermectin.

A self-evident solution when one drug has a complementary or duplicate effect is to reduce the dosage of the blood thinner (as we will see, even this is not particularly necessary).

However, this is never a recommendation from the healthcare provider.

A Brief Diversion into Diuretics and Potassium Depletion and Supplementation

To understand how the medical establishment addresses items that duplicate the effect of a drug, I will briefly discuss the duplicative and supportive effects of potassium on diuretic medications.

The Effect of Potassium on Water Removal

The two most essential minerals in the body that regulate water retention are sodium and potassium. Salt causes the body to retain water, whereas potassium has the opposite effect. As potassium has a diuretic effect (with no side effects compared to diuretic drugs), pharmacists often deter patients from taking potassium by stating there is an interaction with it. There is no instruction on reducing the dosage of the diuretic, and the pharmaceutical industry places no effort into this topic; instead, it issues instructions to discontinue use of any item that has a duplicate effect. I’ve spoken to many subscribers who are aware of this interaction between potassium and diuretic drugs, and I’ve never found a case where the pharmacist explains the mechanism of interaction between potassium and the diuretic drug.

Supplementing Diuretic Drugs With Potassium?

The topic is even more complicated than potassium having a duplicating effect, because many diuretics deplete potassium levels in the body. Diuretic drugs that do this to a lower degree are called “potassium sparing.” A common one of these is called spironolactone.

The mechanism by which many diuretics promote potassium depletion is explained in the quote from the following article Low potassium levels from diuretics.

But if you’re taking a diuretic, your potassium levels need to be watched.

These drugs direct the kidneys to pump water and sodium into the urine. Unfortunately, potassium also slips through the open floodgates. A low potassium level can cause muscle weakness, cramping, or an abnormal heartbeat, which is especially dangerous for people with heart problems.

Potassium depletion was a significant issue with the first diuretic drugs developed, as explained in the following quote from the article The Invention of Diuretics.

All the new diuretics caused undesirable potassium loss, so there was a search for agents to rectify that, including returning to drugs shelved earlier for the same reason. Spironolactone (1961) and Triamterene (1964) were followed by Amiloride (1968).

*By the way, the first diuretics developed around 1920 were just toxic mercury injections. 

As most of the population is potassium deficient, a more accurate response is that some diuretics should include potassium supplementation; however, this is rarely, if ever, recommended by any medical entity or MD, and there is very little written on the topic of potassium supplementation.

You have to wonder why potassium-sparing diuretics were developed in the first place — when a more straightforward solution would have been to supplement potassium. However, if you supplement with potassium, there is no opportunity to obtain a new patent for a potassium-sparing diuretic drug.

Now that we have more context about how the medical establishment handles any item that either assists a drug or provides a duplicate function of a drug, let us move on to the topic of the effect of Ivermectin on blood thinners.

The Size of the Effect of Ivermectin with Blood Thinners

Case Study #1: A Proposed Large Effect of Ivermectin Drug Interaction With Warfarin

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

Let us review some of the essential points from this study.

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, numerous studies have investigated the efficacy of Ivermectin against various ailments. Also, Warfarin has multiple drug interactions, and what is not discussed is that Warfarin is a dangerous drug. So, this phrasing appears misleading.

The next part of the quote describes the lack of research into the combination of Ivermectin and Warfarin.

..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 is 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 misleading presentation of Ivermectin, and it is a good indication that the author will likely provide 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.

It has also been shown to be beneficial for various purposes beyond its antiparasitic uses. Pfizer could have written this paragraph, as it illustrates a lack of 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 highly likely that this author is unaware of this, yet leaves this out of his explanation to maximize the fear produced in the reader. For example, if Ivermectin leads to hyperpolarization, causing paralysis and cell death in human cells, then why is Ivermectin one of the most beneficial drugs ever produced, and why has it been so globally accepted and used?

The quote continues.

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 discuss the magnitude of this effect.

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

Warfarin and Ivermectin are both widely taken drugs, which means that many people have and are taking both. If this is the only reported case of an adverse event, then how strong is this supposed negative drug interaction?

Let’s now read the case study of the claimed negative interaction.

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—3 mg per month for two months. This averages 0.1 mg per day for each month.

At no point does the author explain what a small dose of Ivermectin this is, and how so many people who take Warfarin and other blood thinners are on far larger doses of Ivermectin.

The idea that such a low dosage of Ivermectin caused what followed is somewhat difficult to believe and moves into the realm of the laughable. I did begin laughing while reading this, laughing at the author for apparently having no idea how low this Ivermectin dosage is.

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 is again an illogical conclusion. The author entirely leaves out the reality that a large number of people, including our subscribers, are taking far higher doses of ivermectin, taking that ivermectin daily, as well as on various blood-thinning or anticoagulant drugs.

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. The author appears to have limited knowledge about Ivermectin, including its usage, the scope of its application, and other key factors. I would allow him to understand how infeasible the conclusions he’s making in this paper.

If this were true, then with the dosages we take, we should develop hematomas daily, even without taking Warfarin. Again, as the claims suggest, Ivermectin has a powerful anticoagulant effect. I should be bleeding internally every day of the week.

Also, aren’t we constantly told by the medical establishment that one should not conclude from anecdotes? However, when the medical establishment wants to suppress a drug, it turns out that a single anecdote based upon weak evidence (again, review the dosage of Ivermectin that was the cause of this hematoma), and all of a sudden, it becomes sufficient for the medical establishment to conclude the topic.

Another logical question would be that if Ivermectin is such a potent anticoagulant, why not simply drop Warfarin entirely — as it is pretty dangerous, and use the near-zero side effect Ivermectin, but at much higher dosages than 3 MG per day? Wouldn’t that make sense to take advantage of this powerful blood-thinning effect? This is a rhetorical question. We disagree with taking ivermectin as a blood thinner because there is no evidence to support its use as a blood thinner. I am asking what would be a natural question if the author of this paper thought what they wrote was true.

Study #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 the time it takes for 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 substantial number of test subjects in this study. Furthermore, this study was published in 1992, while the previous case study I first analyzed was published in 2018. However, the 2018 article does not reference the 1992 article.

Would I love to recommend people stop taking dangerous anticoagulants or blood thinners and move to Ivermectin? Of course I would. I would love to develop a calculator specifically for using Ivermectin as an anticoagulant, which would help many subscribers discontinue their use of anticoagulants.

However, I see no evidence that Ivermectin is a replacement for anticoagulants.

I also see no evidence to suggest that people should adjust their blood thinners based on taking Ivermectin.

Conclusion

• The exact degree to which Ivermectin functions as an anticoagulant is not precisely known.
• However, it appears to produce a very small reduction in clotting, indicating that the factor is small.
• Health authorities have exaggerated this small effect to scare people from taking Ivermectin.
• 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.
• However, they cannot find any evidence, but that has not stopped them from using this false claim to discourage patients from taking Ivermectin, all while hiding the actual effect of Ivermectin on blood thinning.

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.