Consent for off-label use of pharmaceuticals.

Ivermectin is approved in New Zealand for the treatment of Onchocerciasis, Strongyloidaisis, Scabies and Cutaneous larva migrans.
With regard to the prevention or treatment of Covid-19, the Royal New Zealand College of General Practitioners has issued the following statement:
"Ivermectin has become the subject of much debate and conjecture in both the popular press and social media for the treatment of COVID-19. While there is low-quality data that supports further evaluation of Ivermectin in well-conducted clinical trials, there is as yet no evidence that supports the use of Ivermectin for treatment of COVID-19 outside the setting of one of these trials. Additionally, there is reason to doubt these trials will demonstrate benefit, as the level of Ivermectin required to inhibit SARS-CoV-2 in-vitro greatly exceeds the highest safe dose in humans. Off-label use of Ivermectin for treatment of COVID-19 is strongly not recommended."

Ivermectin is a critical medicine for treating some parasitic infections, including Strongyloides stercoralis, which can rarely cause life threatening ‘hyper infection syndrome’ in people who receive immunosuppressive medications. As a result, Ivermectin is regularly used to treat proven or suspected Strongyloidiasis in patients who are treated with immunosuppressive medications, which include many of the proven treatments for COVID-19 (e.g., dexamethasone and tocilizumab). Some people with COVID-19, who have lived in areas endemic for Strongyloides, receive treatment for this condition in addition to other COVID-19 specific therapies.

Ivermectin can, and does, cause harm when misused. Prescribing it could well mean that even if the patient had given consent, the doctor could still be held liable for making an ill-informed decision on a medication that at this point has not been shown to provide benefit and could cause harm. It would be difficult to justify this position with either the Medical Council or the Health and Disability Commissioner.

However, many doctors internationally have treated thousands of Covid-19 patients successfully using Ivermectin along with other drugs that are also being used off-label for the treatment of Early Covid-19. These include:

Ivermectin 0.4mg / kg for 5 days or until better with addition of
Doxycycline 100mg twice daily (on script); this should be taken at the same time as Zinc; take with food but not with dairy
Budesonide inhaler 400mcg (2 x 200mcg /puff) twice daily
Melatonin (on script) daily
Aspirin 300mg daily
Naltrexone (low dose)