Where to Buy Ivermectin for Humans in Malaysia?

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Ivermectin is an FDA-approved anti-parasitic drug widely used for treating several neglected tropical diseases, including onchocerciasis, strongyloidiasis and helminthiasis for more than four decades. 

The “off-label” use of Ivermectin gained global attention due to some promising results by case studies and clinical trials. The US FDA has not approved Ivermectin for use in treating or preventing COVID-19 in humans, and the WHO only recommends the use of Ivermectin in the setting of clinical trials, in which patients are monitored closely by experienced clinicians and researchers for safety and efficacy. 

There is an on-going need for adequately powered, well-designed, and well-conducted clinical trials for evidence-based guidance on the role of Ivermectin in the treatment of COVID-19.

Under the circumstances, the Ministry of Health Malaysia and the Institute for Clinical Research (ICR) have initiated a multicentre open-label randomized controlled trial. The Ivermectin Treatment Efficacy in COVID-19 High Risk Patients (I-TECH Study) headed by Infectious Disease (ID) Physician at Hospital Raja Permaisuri Bainun, Ipoh and a team of specialists and Clinical Research Centres (CRC) at 12 MOH hospitals. 

For the list of 12 MOH participating hospitals, check out I-TECH study hospitals.

The trial was approved by Medical Research and Ethics Committee (MREC), MOH on 25 May 2021.  The First-Patient-In (FPI) was on 31 May 2021, and to date 8 patients have been enrolled. The study is expected to be completed by September 2021.

Is ivermectin available in Malaysia? According to the Health Ministry, hospitals are allowed to apply to the Drug Control Authority to use Ivermectin for off-label use including treating Covid-19 patients:

“Like any other medicine, including Lopinavir and Kitonavir, if there is a strong indication that it can be used, hospitals can apply to the Drug Control Authority for off-label use,” the ministry said. But the use of off-label medication, the ministry said, must be done in a monitored environment.

Should you buy ivermectin from online sources? A simple google search will reveal that many online sites are selling ivermectin. However, the public should not purchase it from online sources as fake medications are common in the online black market space.

Note: Please consult with a qualified doctor and only use human ivermectin. Ivermectin for animals contain excipients (binding and storage compounds such as ethylene glycol) that are known to cause liver failure in high doses. 


McCullough et al. Reviews in Cardiovascular Medicine, 2020

The off-label use of Ivermectin to treat COVID-19 is only for clinical trials

The Health Ministry has denied a viral message claiming that they are allowing usage of the anti-parasitic drug Ivermectin to treat Covid-19 upon request by patients in hospitals.

"The off-label use of Ivermectin to treat Covid-19 is only for clinical trials – not on the request of patients in hospital," it said in a Facebook post on Saturday (July 10).

The post claimed that the Ministry was allowing the use of Ivermectin for those who ask for it.



Ivermectin and FLCCC

In October 2020, FLCCC (Front Line COVID-19 Critical Care) Alliance added ivermectin as a core medication in the prevention and treatment of COVID-19. FLCCC regard ivermectin as a core medication in the prevention and treatment of COVID-19. For comprehensive information on ivermectin please refer to their Review of the Emerging Evidence Supporting the Use of Ivermectin in the Prophylaxis and Treatment of COVID-19 and the included references.

In addition, check out the summary of evidence on Ivermectin versus COVID-19 from Ivmmeta.com (constantly updated).


FLCCC (Front Line COVID-19 Critical Care) Protocol

The initial MATH+ protocol was released in April 2020. In early July and August, it was updated to include quercetin and a number of optional nutrients and drugs, not only for critical care but also for prophylaxis and mild disease being treated at home (I-MASK+ protocol).

FLCCC I-MASK+ Protocol (Prevention)

For prevention, the Front Line COVID-19 Critical Care Working Group (FLCCC) I-MASK+ protocol recommends (September 24, 2021 version):
  • Gargle mouthwash: 2 x daily – gargle (do not swallow) antiseptic mouthwash with cetylpyridinium chloride or povidone/iodine 1 % solution as alternative.
  • lvermectin
    • Chronic Prevention: 0.2 mg/kg per dose (take with or after a meal) — twice a week for as long as disease risk is elevated in your community 
    • Post COVID-19 Exposure Prevention: 0.4 mg/kg per dose (take with or after a meal)  — one dose today, repeat after 48 hours
  • Vitamin D3: 1000–3000 IU/day. (Lazada)
  • Vitamin C: 500 - 1,000 mg BID (twice daily) (Lazada)
  • Quercetin: 250 mg daily.  (Lazada)
  • Zinc: 30 - 40 mg/day (elemental zinc). Zinc lozenges are preferred. (Lazada)
  • Melatonin: 6 mg before bedtime (causes drowsiness). 
Notes:
  • High risk Individuals: > 60 years with co-morbidities (hypertension, diabetes, chronic lung disease, chronic kidney disease), obesity, long term care facilities, etc.
  • Post COVID-19 exposure: To use if a household member is COVID-19 positive, or you have prolonged exposure to a COVID-19 positive patient without wearing a mask.
  • Precautionary Note: Ivermectin has a number of potentially serious drug-drug interactions. Please check for potential drug interaction at Ivermectin Drug Interactions - Drugs.com. The most important drug interactions occur with cyclosporin, tacrolimus, anti-retroviral drugs, and certain anti-fungal drugs. 
  • Due to the possible drug interaction between quercetin and ivermectin (may increase ivermectin levels), these drugs should not be taken simultaneously (i.e. should be staggered morning and night). 
  • Ivermectin is also lipophilic and therefore, bioavailability is maximised on a full stomach; or best to be taken with meal.
  • Vitamin D3 RDA (Recommended Daily Allowance) is 800–1000 IU/day. The safe upper-dose daily limit is likely < 4000 IU/day. Vitamin D deficiency has been associated with an increased risk of acquiring COVID-19 and from dying from the disease. Vitamin D supplementation may therefore prove to be an effective and cheap intervention to lessen the impact of this disease, particularly in vulnerable populations, i.e. the elderly and obese.
  • It is likely that vitamin C and quercetin have synergistic prophylactic benefit. Quercetin should be used with caution in patients with hypothyroidism and TSH levels should be monitored.
  • Please consult with a qualified doctor and only use human ivermectin. Ivermectin for animals contain excipients (binding and storage compounds such as ethylene glycol) that are known to cause liver failure in high doses. 
  • Be aware that most supplements have two categories of dosages: i.e. 
    1. treatment (therapeutic) dosages are normally higher than the RDA dosages and 
    2. 'maintenance' or 'preventive' dosages that are normally based on the recommended dietary allowance (RDA).
  • You should ideally supplement your micro-nutrients from healthy and wholesome foods, fruits and vegetables. Be aware that most of the 'treatment' dosages for nutrients are above the recommended dietary allowance (RDA) and therefore such dosages should NOT be maintained on a long term basis. 

FLCCC I-MASK+ Protocol (Early Treatment)

For early outpatient protocol (COVID-19 positive), the Front Line COVID-19 Critical Care Working Group, FLCCC I-MASK+ protocol recommends (updated September 24, 2021):

1. First line agents (use any or all medicines; listed in order of priority/importance)

Anti-Virals
  • Ivermectin: 0.4–0.6 mg/kg per dose (take with or after meals) — one dose daily, take for 5 days or until recovered. Use upper dose range if:  1) in regions with more aggressive variants; 2) treatment started on or after day 5 of symptoms or in pulmonary phase; or 3) multiple comorbidities/risk factors.
  • Nitazoxanide: 500 mg 2 x daily for 5 days after meals. Combine with ivermectin (preferred) or substitute if ivermectin is not available.
Anti-Septic Anti-virals
  • Antiviral mouthwash: Gargle 3 x daily (do not swallow; must contain chlorhexidine,  povidone-iodine, or cetylpyridinium chloride). 
  • Iodine Nasal Spray: Use 1 % povidone iodine commercial product as per instructions 2–3 x daily. If 1 %-product not available, must first dilute the more widely available 10 %-solution and apply 4–5 drops to each nose every 4 hours. (No more than 5 days in pregnancy.)
Anti-Coagulants + Immune Fortifying
  • Aspirin: 325 mg/day unless contraindicated. (Lazada)
  • Vitamin D3: 5,000 IU daily. Preferred forms if available: Calcitriol (Rocaltrol) 0.5 mcg on day 1, then 0.25 mcg daily for 7 days – or Calcifediol 0.5 mg on day 1, then 0.2 mg on days  3 + 7, then 0.2 mg weekly until recovered.
  • Melatonin: 10 mg before bedtime (causes drowsiness). 
Adjunctive / Synergistic Therapies
  • Vitamin C: 500 - 1,000 mg BID (twice daily)  (Lazada)
  • Quercetin: 250 mg twice a day.  (Lazada)
  • Zinc: 100 mg/day. Zinc lozenges are preferred. (Lazada)
Nutritional Therapeutics (New)
  • Curcumin (turmeric) 500mg 2 x daily for 14 days
  • Nigella Sativa 80mg/kg daily for 14 days 
  • Honey 1gram/kg daily for 14 days
Pulse Oximeter

FLCCC also recommend monitoring your oxygen saturation with a pulse oximeter and to go to the hospital if you get below 94%. (Lazada)

2. Second line agents (listed in order of priority /importance)

Add to first line therapies above if: 
1) ≥5 days of symptoms; 
2) Poor response to therapies above; 
3) Significant comorbidities

Dual anti-androgen Therapy
  1. Spironolactone 100 mg 2 x daily for ten days
  2. Dutasteride 2 mg on day 1, followed by 1 mg daily for 10 days. If dutasteride is not available, use finasteride 10 mg daily for 10 days.
Fluvoxamine

Fluvoxamine: 50 mg twice daily for 10 days. 
Consider fluoxetine (Prozac) 30mg daily for 10 days as an alternative (it is often better tolerated).
Avoid if patient is already on an SSRI.

Monoclonal antibody therapy

Casirivimab/imdevimab: 600 mg each in a single subcutaneous injection for patients with one or more risk factors as follows: Age > 65y; obesity; pregnancy; chronic lung, heart, or kidney disease; diabetes; immunosuppressed; developmental disability; chronic tracheostomy; or tube feeding.

Alternatives: 
  • Optional: Betadine nasal spray applied 3 times a day. (Lazada).
  • Optional: Curcumin: 500 mg twice a day (Ref) 
  • Duration for supplements: Most supplements (e.g. vitamin D, zinc, quercetin) for early treatment are given for 5 - 10 days. To continue for preventive purposes, dosages will need to be reduced as per the prevention or prophylaxis protocol.
  • If you can’t get fluvoxamine (Luvox), using 30mg once a day of fluoxetine (Prozac) is equally effective (equivalent to 50mg twice a day of fluvoxamine).
  • Optional: Azithromycin 250 mg twice a day. (Ref) 
  • Optional: Bromhexine 8 mg three times a day (Ref) (Lazada Malaysia)

Updates

We are adding a section for links and references so that we can update the article as new information comes in.

Key Takeaway

Treat early! As soon as you have symptoms, start treatment as early as possible. If treatment is delayed i.e. after 5 days of symptoms, your chances of severe COVID are higher.


Disclaimer: Always see your doctor before taking any supplements or medications. This info-article is provided as a not-for-profit public educational service. In no event shall we or our affiliates be liable for any special, incidental or consequential damages arising out of or in connection with this information or website, including negligence.

The information in this article is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. We encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.

You will still need to follow the advice given by WHO and your local public health authority in terms of local guidelines such as face mask wearing, social distancing, hand sanitisation, vaccination, avoiding crowds and self-quarantine. There is unlikely to be any single magic bullet strategy. It's better to combine multiple strategies in order to reduce your risk and defend yourself against this virus.


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