Ivermectin dosage, cutting through the misinformation

[Res Ipsa]

Mike, you say you hate politics, but you keep addressing this issue through a political lens. I don't care whether you eat horse paste or not. I do care that people are out misrepresenting the evidence about the safety and efficacy of ivermectin.

Everybody plus their great great grand mother and the pet dog understands by now that there is a vaccine. Some people just aren't going to take the vaccine. Take Joe Rogan for instance, he was prescribed all sorts of stuff by his doctor including Ivermectin. Was his doctor wrong?

That’s between the doctor and his licensing board. Standard of care varies from state to state. And the informed consent requirements probably do as well. But “a doctor did it” isn’t evidence of safety or efficacy.

[Alf'Omega]

Who cares what Joe Rogan does? The guy is a self-proclaimed moron by his own words when he was criticized over the vaccine. He insists he isn't anti-vaccine though.

So Tucker Carlson is your pinnacle of truth, and now a podcaster who admits being a moron.

[Chap]

The Smith case has been mentioned in an earlier post. This article is highly informative:

Ohio judge reverses colleague’s decision on covid patient’s ivermectin treatment: ‘Judges are not doctors’

This bit relates to the status of the doctor who prescribed Ivermectin to Smith:

When Smith was placed in a medically induced coma on Aug. 20, his wife reached out to Fred Wagshul, who prescribed the drug without seeing Smith, court records state.

Wagshul is listed as a founding physician of Front Line Covid-19 Critical Care Alliance. The nonprofit organization, which promotes ivermectin as a preventive treatment for covid, is referenced in the lawsuit. Wagshul does not have medical privileges to work at West Chester Hospital, according to Oster’s order.

A spokeswoman for the nonprofit told The Post in a Tuesday email that Wagshul understood the judge’s ruling but wishes the hospital would have tried the unproven treatment as a last resource.

[..]

When asked whether the drug was improving Smith’s health, Wagshul “was only able to say that [Jeffrey] Smith ‘seems to be’ getting better after receiving ivermectin,” [judge] Oster wrote. And when Oster asked whether continued use of ivermectin would benefit Smith, Wagshul answered, “I honestly don’t know,” court records state.

Here's the whole text:

Last month, an Ohio judge ordered a hospital to treat covid-19 patient Jeffrey Smith with ivermectin after his wife sued, alleging that the facility refused to give her husband the drug, despite him having a doctor’s prescription.
Since mid-July, Smith has been in West Chester Hospital’s intensive care unit, battling a severe case of covid, according to court records. Ivermectin — a deworming drug that some people are using to prevent or treat covid, despite several public health agencies advising against it — was Smith’s last shot at survival, his wife and guardian, Julie Smith, argued.
But on Monday, after Smith’s wife and the doctor who prescribed him the ivermectin failed to provide “convincing evidence” at a court hearing to show that the drug could significantly improve his condition, a different judge reversed course. Butler County Judge Michael A. Oster Jr. ordered the hospital to cease administering Smith, 51, the unproven treatment, arguing that “judges are not doctors or nurses.”
“Based on the current evidence, ivermectin is not effective as a treatment for COVID-19. … Even Plaintiff’s own doctor could not say [that] continued use of ivermectin would benefit [Jeffrey] Smith,” Oster wrote in an order filed on Monday.
Oster added: “After considering all of the evidence presented in this case, there can be no doubt that the medical and scientific communities do not support the use of ivermectin as a treatment for COVID-19.”
The judge’s reversal is the latest example of government officials addressing the use of ivermectin — long used to kill parasites in animals and humans — as a treatment for the coronavirus. In recent months, the Food and Drug Administration and other public health agencies have urged people to refrain from taking the unproven treatment, warning it could be “dangerous” and potentially fatal.
“You are not a horse,” the Food and Drug Administration tweeted last month. “You are not a cow. Seriously, y’all. Stop it.”
The drug, which has garnered support in conservative circles, has been promoted by some doctors, Republican lawmakers and talk show hosts.
Doctors dismayed by patients who fear coronavirus vaccines but clamor for unproven ivermectin
Smith, a father of three, tested positive for the coronavirus on July 9 and was admitted to West Chester Hospital’s ICU less than a week later, according to the lawsuit his wife filed in Butler County Common Pleas Court. The hospital treated Smith with remdesivir, plasma and steroids, and he eventually reached a “period of relative stability,” court records state.
But on July 27, his condition deteriorated, according to the lawsuit, and he was sedated and put on a ventilator days later. When Smith was placed in a medically induced coma on Aug. 20, his wife reached out to Fred Wagshul, who prescribed the drug without seeing Smith, court records state.
Wagshul is listed as a founding physician of Front Line Covid-19 Critical Care Alliance. The nonprofit organization, which promotes ivermectin as a preventive treatment for covid, is referenced in the lawsuit. Wagshul does not have medical privileges to work at West Chester Hospital, according to Oster’s order.
A spokeswoman for the nonprofit told The Post in a Tuesday email that Wagshul understood the judge’s ruling but wishes the hospital would have tried the unproven treatment as a last resource.
“The most disturbing issue is that the hospital itself, after telling Julie Smith they had tried everything to recover her husband and could do nothing more for him, refused to try ivermectin," Wagshul said. "There was nothing to lose by trying it. During a killer pandemic, compassion too has become a casualty.”
Smith’s wife requested that the hospital administer the drug, but doctors told Julie Smith they could not treat her husband with ivermectin because it could interfere with other medications, the lawsuit states. There was nothing left to be done for him, the doctors said.
Julie Smith alleges that she offered to sign a release relieving the hospital and its doctors of any liability related to the drug treatment, a statement the hospital denied in its response to the court. Jonathan Davidson, an attorney representing Julie Smith, told The Post that his client was not available for an interview Monday night.
On Aug. 23, Butler County Judge J. Gregory Howard ordered the hospital to administer 30 milligrams of ivermectin to Smith daily for three weeks, as requested by his wife. The order, which was first reported by the Ohio Capital Journal and the Cincinnati Enquirer, did not include any explanation for the judge’s decision.
But Oster on Monday struck down that order, saying that neither Julie Smith nor Wagshul were able to demonstrate how the ivermectin treatment had changed Smith’s prognosis.
When asked whether the drug was improving Smith’s health, Wagshul “was only able to say that [Jeffrey] Smith ‘seems to be’ getting better after receiving ivermectin,” Oster wrote. And when Oster asked whether continued use of ivermectin would benefit Smith, Wagshul answered, “I honestly don’t know,” court records state.
Julie Smith, for her part, told the judge she believes the drug is working.
The judge wrote in his order that several public health organizations, including the FDA and the Centers for Disease Control and Prevention, do not recommend the drug be used to treat covid. At the moment, no studies or data analysis support said treatment for the virus, Oster wrote.
“While this court is sympathetic to the Plaintiff and understands the idea of wanting to do anything to help her loved one, public policy should not and does not support allowing a physician to try ‘any’ type of treatment on human beings,” the judge wrote.
Nevertheless, Oster said that Jeffrey Smith could safely be transferred to another hospital where Wagshul has medical privileges if he wishes to continue with the ivermectin treatment, an option that would not require the court’s intervention.
The attorney representing Julie Smith said his client was “disappointed” by the court’s decision, adding that the drug has improved her husband’s illness.
“I know this was a decision that Judge Oster did not take lightly,” Davidson told The Post in an email. “Fortunately, Mr. Smith was able to receive 14 days of treatment of Ivermectin, during which time his condition did improve. While he has likely received his last dose at UC West Chester hospital, we can only hope his condition continues to trend positively.”
A spokeswoman for UC Health, which includes West Chester Hospital, said the hospital was grateful for the judge’s decision.
“We do not believe that hospitals or clinicians should be ordered to administer medications and/or therapies, especially unproven medications and/or therapies, against medical advice,” spokeswoman Amanda Nageleisen told The Post in an email. “We are grateful for the judge’s careful consideration and for the judicial process in this matter.”
An attorney representing the hospital did not immediately respond to messages from The Post late Monday. Julie Smith’s attorney did not respond to a question about whether the couple had been vaccinated

[Res Ipsa]

Yes, Chap. That's the advocacy group I'm talking about. I don't think any study, even the small or poorly done ones, has shown any effect on severe cases. And there's no data on safety when administered to a severely ill patient.

The first judge was out of his mind.

[Chap]

Yes, Chap. That's the advocacy group I'm talking about. I don't think any study, even the small or poorly done ones, has shown any effect on severe cases. And there's no data on safety when administered to a severely ill patient.

The first judge was out of his mind unfortunately appears to have misdirected himself.

Fixed it for you.

[Res Ipsa]

Yes, Chap. That's the advocacy group I'm talking about. I don't think any study, even the small or poorly done ones, has shown any effect on severe cases. And there's no data on safety when administered to a severely ill patient.

The first judge was out of his mind unfortunately appears to have misdirected himself.

Fixed it for you.

Much appreciated!

[Doctor Steuss]

This information is from memory, and is at least a decade old, so please keep that in in mind:

There are generally acceptable levels of variance in medication manufacturing and packaging. Blend homogeneity sampling plans also tend to vary somewhat between manufacturers, so the sampled variance can actually be slightly higher or lower than the actual variance of the packaged doses. You can also expect some purity variance in the base compounds.

As an example, let’s say you’re prescribed Lipitor. Your prescription is for 20mg a day, and your pharmacy fills the prescription with 10mg caplets. The likelihood of any of those caplets containing exactly 10mg is pretty much nil. The variance between caplets is likely going to be very small, especially if it is name-brand manufactured domestically. You’ll maybe see 1-3% variation. The FDA though, If I recall correctly, is groovy with there being about a 20% difference in either direction. So, in one 2-pill dose, you could potentially get 16mg of active compound, and the next 24mg.

Depending on the compound, those small variations can make some significant difference -- especially when it comes to sampling batches with dosages in the microgram area. This is one of the reasons that hospitalizations aren’t uncommon for bodybuilders using grey market thyroid hormones.

Maybe it’s not anything to worry about, but I’d be concerned that between a greater tolerance for homogeneity variance, and bioavailability standards, you might roll the wrong dice when breaking up the dose for a 1200 lb critter into something appropriate for a 150 lb critter.

[Some Schmo]

"We need to quit horsing around and get serious with this Ivermectin stuff. Whoever suggested ingesting your Ivermectin with some bleach better pony up with evidence of its safety."
-- Mr. Ed and his companion Wilbur

I saw a guy about to take some Ivermectin and asked him, "Why the long face?"

"I have COVID."

I said, "Well quit being a ninny and take the vaccine."

"It's too late. I've already caught a colt." (I thought he articulated that too well to have a stuffed nose. His voice wasn't even horse.)

"Who told you to take Ivermectin?"

"The Mare of our town."

"I'm sorry you've been saddled with that advice." He was visibly disturbed, and I felt bad about it. I didn't mean to stirrup so many emotions.

He eventually got himself under control, so to encourage him, I called him a stud.

[Gunnar]

I saw a guy about to take some Ivermectin and asked him, "Why the long face?"

"I have COVID."

I said, "Well quit being a ninny and take the vaccine."

"It's too late. I've already caught a colt." (I thought he articulated that too well to have a stuffed nose. His voice wasn't even horse.)

"Who told you to take Ivermectin?"

"The Mare of our town."

"I'm sorry you've been saddled with that advice." He was visibly disturbed, and I felt bad about it. I didn't mean to stirrup so many emotions.

He eventually got himself under control, so to encourage him, I called him a stud.

Precious! I literally laughed out loud when I read that! Thanks for the comic relief!

[Gunnar]

Gunnar, the link opens to a page full of this:



- Doc

Weird. Both Gunnar’s link and my link work for me.

ETA: Figured it out. The link I posted required a google.com account. I took that part out of the URL, so it should work now.

Thanks for correcting your link so I could read it. I can see clearly now why the FLCCC claims merit being taken with at least a small grain of skepticism. I'm not sure, though, that they were intentionally trying to mislead. The nature of this pandemic, with so many who manage to survive infection without any medical intervention while a small but significant percentage suffer deadly consequences is very frustrating. It makes it very difficult to separate the real remedies from the "snake oil."