Can You Buy Ivermectin in Malaysia?

Ivermectin is an FDA-approved anti-parasitic drug widely used for treating several neglected tropical diseases, including onchocerciasis, strongyloidiasis and helminthiases 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.

Where to buy ivermectin in Malaysia? 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).

There is evidence that vitamin C and quercetin co-administration exerts a synergistic antiviral action due to overlapping antiviral and immunomodulatory properties and the capacity of ascorbate to recycle quercetin, increasing its efficacy.

For prevention, the Front Line COVID-19 Critical Care Working Group (FLCCC) recommends (updated June 30, 2021):

• Vitamin D3: 1000–3000 IU/day. Note 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. (Lazada)
• Vitamin C: 500 - 1,000 mg BID (twice daily) (Lazada)
• Quercetin: 250 mg daily. 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. (Lazada)
• Melatonin: 6 mg before bedtime (causes drowsiness).
• Zinc: 30 - 40 mg/day (elemental zinc). Zinc lozenges are preferred. (Lazada)
• Ivermectin for 
• prevention in high-risk individuals (> 60 years with co-morbidities, morbid obesity, long term care facilities, etc): 0.2 mg/kg per dose (take with or after meals) — one dose today, repeat after 48 hours, then one dose weekly.
• Post COVID-19 exposure prevention: 0.2 mg/kg per dose (take with or after meals)  — one dose today, repeat after 48 hours.

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.

For early outpatient protocol (COVID-19 positive), the Front Line COVID-19 Critical Care Working Group, FLCCC recommends (updated June 30, 2021):

• Vitamin D3 — 4000 IU/day. (Lazada)
• Vitamin C: 500 - 1,000 mg BID (twice daily) (Lazada)
• Quercetin: 250 mg twice a day.  (Lazada)
• Melatonin: 10 mg before bedtime (causes drowsiness).
• Zinc: 100 mg/day. Zinc lozenges are preferred. (Lazada)
• Ivermectin: 0.2–0.4 mg/kg per dose (take with or after meals) — one dose daily, take for 5 days or until recovered.
• Fluvoxamine (Luvox): 50 mg twice daily for 10–14 days. Add to ivermectin if: 1) minimal response after 2 days of ivermectin; 2) in regions with more aggressive variants; 3) treatment started on or after day 5 of symptoms or in pulmonary phase; or 4) numerous co-morbidities/risk factors. Avoid if patient is already on an SSRI (selective serotonin reuptake inhibitor).
• Nasopharyngeal Sanitation: Steamed essential oil inhalation 3 times a day (i.e. vapo-rub) and/or chlorhexidine/benzydamine mouthwash gargles (Lazada) and Betadine nasal spray 2–3 times a day (Lazada).
• Aspirin: 325 m/day unless contraindicated. (Lazada)
• 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)

The medical evidence to support each drug and nutrient can be found under “Medical Evidence” on the FLCCC’s website.

Summary

Be aware that most of the 'treatment' dosages are above the recommended dietary allowance (RDA) and therefore such dosages should NOT be maintained on a long term basis. 

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 sanitization, 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.