Administration of a P450 inhibitor will cause the levels of other medications in a person's blood to rise, and will cause some prodrugs to be ineffective due to reduced metabolism.

I can't even walk into a doctors' office and get prescribed Singulair, an allergy medication, without giving them a reason to believe that I need it. And if I was a doctor, I'd err on the side of caution, as well, when it comes to prescribing things I don't think my hypothetical patients need. Not only is it a question of ethics, it's also a question of legal liability and keeping a license to practice.

But I also don't know the dosage schedule doctors who are prescribing Ivermectin are using. They're probably using one from a research paper that they believe justifies its use to treat or prevent COVID. Those dosage schedules are afaict similar to how it's used to treat on-label conditions - take one dose every three months, or whatever.

It's pure speculation that doctors are out there writing prescriptions for dangerous dosages of Ivermectin.

However one thing for sure is that in lieu of a prescription, people are more likely to self-medicate with a dangerous formulation and dosage, ex: horse paste.

Usually yearly or bi-yearly. Not bi-weekly. There is much less safety data on doses that frequent.

You can say the same thing about COVID boosters.

So why are people going for something without any data?

However, there is no data on the long-term effects of the COVID vaccines, mRNA or otherwise. That's an indisputable scientific fact. They just haven't existed long enough for that data to be available. Hopefully a decade from now we'll discover that they were safe.

We do have data on the long-term effects of Ivermectin.

Someone who is not concerned about COVID will take neither a vaccine nor Ivermectin. Someone who is concerned about COVID but who is also concerned about the long-term effects of the vaccine may opt to take Ivermectin. It's their choice. It could also end up being the wrong choice.

Because this seems like whataboutism, and of course it's impossible to prove a negative, and people are dying while waiting.

> We do have data on the long-term effects of Ivermectin

At bi-annual dosage rates, yes. Not daily or even weekly.

I don't know. But we still may be in the "short-term side effect" phase for the COVID vaccines. It hasn't even been a year.

> Because this seems like whataboutism, and of course it's impossible to prove a negative, and people are dying while waiting.

Not sure how it's whataboutism to point out that some people have lower risks of contracting serious COVID, and that their decision to take a very new vaccine may be different than someone who is more at risk for contracting serious COVID.

If they miscalculate and die, well, that's their decision.

> At bi-annual dosage rates, yes. Not daily or even weekly.

Are the COVID/Ivermectin studies doctors are referencing for prescription dosages recommending daily Ivermectin use?

If covid is a low risk, then the vaccine, which is essentially just the immune response to covid without any of the actual viral damage, should be much more benign, yes? I'm failing to see the risk here.

The treatment regimens in current Ivermectin studies are usually daily dosage, for which there are no long term studies for humans. Prophylactic usage of Ivermectin is all over the place, but seems to mostly be within 72h of exposure, so several doses per week, which also doesn't have long term studies. Staying on antibiotics for long periods is generally a bad idea due to disturbing the gut microbiota.

The point is that if this drug did help people make it through covid (like the vaccines do) then it would be worth the risk of these horrible things happening - if they were rare (they are). But unfortunately it looks like this is not true, so people are taking a risk of having a horrid side effect with no chance of the pill working.

On the other hand if you take the pill to avoid river blindness then the risk of the side effect seems well worth taking to me. But not for covid - 0 benefit for 0.001 risk is not good trade.

Not the pharmacist. Not the FDA.

GP: All of this is for the patient and their doctor to decide.

P: They're [often] using the horse formulation because their doctor said no.

X: How many got the horse formulation and how many got adverse effects from [horse formulation]?

C: Who said anything about adverse effects?

It this human brain on Twitter? We can't possibly read 4 short stanzas in a row and keep the context?

https://www.google.com/amp/s/news.yahoo.com/amphtml/vegas-st...

They have a legal and moral obligation to understand how those drugs are going to be used and whether the patient is at risk for taking them.

- They are morally opposed to the medication, ex: "abortion pills"

- They know that the patient is taking another drug that would result in a deadly interaction

- The patient is drug-seeking a scheduled drug, ex: they've brought multiple valid prescriptions for opiates, but from different doctors

The pharmacist doesn't know why you've been prescribed Ivermectin. They can ask, but you're under no obligation to tell them. Maybe you need it for river blindness. Unlikely, but it's none of their business.

I guess a pharmacist could claim moral opposition to filling an Ivermectin prescription if they believe that sans Ivermectin the patient would instead get a COVID vaccine. That makes sense to me. But it's a slippery slope I'm uncomfortable with.

> Not the pharmacist. Not the FDA.

In case you don't know,the FDA is the US regulatory body whose mission is to " [protect] the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices;"

In the US, doctors only prescribe drugs that have been verified by the FDA, and pharmacists only distribute drugs approved by the FDA.

If not the FDA, who do you think is responsible in the US to ensure a drug works and is safe?

The FDA is pretty much the US instition devoted to anti-quackery and anti-fraud. Why is this a problem?

The FDA has approved the use of Ivermectin in humans. We're not talking about like, heroin, or some toxic chemical that isn't even a drug.

1 in 5 prescriptions are off-label.

Meaning, to treat conditions that the FDA has not approved the drugs for. This idea that doctors are only allowed to prescribe drugs for FDA-approved use is just like, incorrect.

He was only planning to take small doses here or there as he's a teacher and around sick kids all the time, as if it were like Zinc to hopefully help reduce the severity of Covid-19 if he does get it, but despite going through the effort and succeeding in finding a doctor willing to prescribe it (and my friend even signed a document saying he understands it's an experimental treatment and will assume any risks), his local CVS is refusing to fill it.

My opinion is if you can get a proper doctor to prescribe it (by proper doctor I mean none of this "I got a medical exemption for wearing a mask from my Chiropractor" bullshit like is going on in Florida), a pharmacy shouldn't be allowed to decide not to fill it, as if they know better than your doctor.

It sounds like you have a pretty misguided idea of how pharmacies and pharmacists worked before Covid. You’re describing a situation where pharmacists act at the behest of doctors who know best, when in reality pharmacists have always had some level of independent authority over what drugs get dispensed to whom thanks to their expertise. It’s part of the pharmacists job to watch out for bad prescriptions, both in terms of abuse (e.g. opioids) improper dosages, and unintended side effects and interactions between drugs. In some states pharmacists have their own ability to prescribe medicine on their own.

I’m not sure exactly how much control a pharmacist should have over whether a valid prescription is filled, but the idea that they’re only expected to blindly fulfill the order of your doctor is not correct, and never was. In fact, they probably know more about the drugs you’re prescribed than your doctor does, as that’s their entire speciality. (Especially given the long and sordid history of doctors pushing drugs on the basis of pharmaceutical sales reps, doctors often actually know very little about what they prescribe).

Absolutely. I had to fire my doctor after he prescribed a sulfa drug to me, even though I'd made it clear that I have an allergy to sulfa drugs.

In fact, I would never have known (well, until I became sick/dead) that the drug prescribed was a sulfa drug if the pharmacist hadn't known the drug involved and checked it against known allergies. He contacted both me and my doctor and a different drug was prescribed.

In fact, it's entirely possible that I'm alive today thanks to the expertise and knowledge of the pharmacist.

I learned my lesson and now do my own research before just taking any medicine a doctor wants to prescribe now.

But I still don't think pharmacists should be able to just override the decision of a doctor. Make sure the person is fully informed of potential dangers, side effects and correct usage, sure, but not override the doctor. The doctor has had an opportunity to examine and talk to the patient at length, multiple times over multiple visits, and know their history and specific needs, the pharmacist doesn't know any of that background and are most likely just making assumptions.

I mean if it's literal rat poison or a dose guaranteed to kill the person is being prescribed, maybe they can hold off on fulfilling it and alert authorities, but otherwise?

Opioids are a major problem, as there are addicts that cycle doctors to get multiple prescriptions so some doctors might not realize it's being overprescribed, but that's a matter of addiction and abuse and I don't know how a pharmacist is expected to know when it's being abused or not, unless they're getting them all filled at the same pharmacy. Again, they're not spending enough time with these people to know what their situation is. The most interaction I have with my pharmacist is "Picking up a prescription." "Verify your address please?" "My address." "Okay this has these side effects and you should only have it after a meal." "Okay thanks." Yeah that's totally enough for them to make a medical decision on my behalf. /s

If anything, I think them deciding when to withhold medicine could make them MORE liable, not less, because they're inserting themself into the decision process. What if their withholding fulfillment of a prescription results in that person dying? If the doctor said yes and they said no, that seems to open up room for litigation to me.

You’re free to believe that, but understand that this is well in the “wishes and hopes” territory more than a factual understanding of how doctors, patients, and pharmacists actually interact. Personally I believe the idea that we’d spend a huge amount of time and effort as a society training a whole class of specialists and then declare that they must abide by the decisions made by a generalist to be quite odd. Your personal doctor isn’t able to override your oncologist, so why should they be able to override the experts on prescribed medicine?

> If anything, I think them deciding when to withhold medicine could make them MORE liable, not less, because they're inserting themself into the decision process.

I’m sorry, but that’s clearly motivated reasoning and completely unrelated to the actual law. Pharmacists are subject to medical malpractice laws just like every other type of doctor, there’s no magical “I didn’t insert myself into the process therefore I’m not liable” clause.

Let's put it this way, I haven't seen any evidence based on what I've seen that this isn't the normal interaction with a pharmacist after decades of seeing pharmacists myself, or sitting waiting for my parents to get medicine filled, or watching other users interact with pharmacists while I've been waiting in line, etc., across multiple pharmacies in multiple cities.

If there's a more personal and intimate pharmacist reaction that you see as common (or even uncommon), please share those details for me. I would love to have an example otherwise.

I made a good faith effort in researching this, and here are some examples of interaction you might be alluding to:

1. The doctor made an obvious mistake in dosage or a might not be aware of safer alternatives and the pharmacist contacts the doctor to verify that there wasn't a mistake on the prescription or mention those alternatives and see if they can persuade the doctor to change the prescription. Great, no issues with me. Everyone makes human mistakes. I do it in software also.

2. Something obvious they can see about the patient gives them some information that contradicts the prescription (i.e. an obviously pregnant women being given a drug that's dangerous to pregnant people). Again, they contact the doctor to inform and verify. Again, no issues from me.

3. Patients sometimes see other specialists and get prescriptions from them without informing their PCP (sometimes on accident), whereas a pharmacy probably sees all of these prescriptions, and can catch when two prescriptions could have dangerous interactions that a PCP or specialist might not realize they were causing because they weren't aware of the other prescription. Again they contact the physician and verify. Again, no issues from me.

4. The pharmacist has a religious reason not to want to fulfill a prescription. Some states that's allowed, some they aren't. In those where it's allowed, most pharmacies have a policy that they must allow another pharmacist at the facility to fulfill the prescription or help transfer the prescription to another doctor. Fine with me.

Note that for the first three, they generally contact the doctor and verify/try to persuade, not outright override and refuse. They help catch problems, not generally cause them. It looks like there are several states where pharmacists are actually required to provide medication[1], although that link mentions specifically personal beliefs, so I don't know if it applies for the other three issues as well.

If that's all you mean, then I don't think we disagree actually. But it doesn't look like it's as clear-cut legally as you were suggesting before, and I'm far from alone in thinking that pharmacists can't just decide never to fulfill a prescription without a damn good reason (i.e. it's definitely going to kill the patient).

[1]: https://www.nbcnews.com/news/us-news/can-pharmacist-legally-...

Legally in my state they must refuse to fill prescriptions they believe were not created by a proper doctor patient relationship, which includes a lot of these Ivermectin phone doctors. But that’s a slightly different issue.

But Ivermectin is not just a "dewormer" as the media has been running with to sensationalize things and try to throw shade at Joe Rogan for taking, and is known to have antiviral and anti-inflammatory properties, and is known to be safe in proper doses because it's been prescribed to humans for quite some time.

Dr. John Campbell is a highly respected doctor that, since the beginning of this pandemic, has been going over medical studies and data and making them understandable to the general public (I do watch a good handful of his videos, but I've been skipping the Ivermectin ones up until tonight).

The very first video[1] of him going over Ivermectin has a peer-reviewed meta-study that gives moderate-certainty level evidence that when clinicians have given Ivermectin to patients it's resulted in a 62% reduced risk of death compared to not taking it. And honestly that surprised me, up until I watched that tonight I was certain he was going to say it may have had a very mild positive effect and that's all.

[1]: https://www.youtube.com/watch?v=3j7am9kjMrk

I also know my friend highly respects this guy and watches his videos a lot as well. Probably why he was seeking the prescription in the first place, was after seeing the information from these studies, instead of just "well the FDA hasn't approved it therefore it's poison".

Again I'm not going to dig deeper than that right now, I've already spent most of my limited free time this evening doing this instead of other productive things. But yeah, sure looks like a pharmacist could potentially be doing harm by preventing these prescriptions from fulfilling.

I don't even care about this drug specifically (I've been actively avoiding reading up on it and just threw it in with Hydroxychloroquine as a non-drug up until now). It just bothered me to learn that pharmacists were refusing to fill a prescribed drug.

And after listening to my friend provide his reasoning for wanting to take it in small doses, I figured he had researched this a lot more than I had up to this point and was willing to give him the benefit of the doubt.

There are severe issues with the Ivermectin studies that have shown a positive effect. One of them is believed to be an outright piece of fraud. This was literally discussed in the article this thread is about.

If you're just going to ignore the article posted and "do your own research", then stop wasting our time here.

It doesn't matter, I don't care about Ivermectin or what you or anyone think about it, good or bad. I'm not planning to take it and never was.

My point was if something (ANYTHING) gets prescribed by a doctor, pharmacists should generally fill it barring those other reasons I mentioned above. I made my point, you made yours. Have a good day.

And we make fun of the Chinese using rhino horn for erectile disfunction...

They are legally required to make decisions about whether or not to fill it.

They are not just some supermarket cashier.

Why do Pharmacists even study and train for up to 6 years if you don't want their opinion on how this drug will affect you?

Also thank you for what I presume is you insuinuating by putting "friend of yours" in quotes that you think I'm talking about myself. I've been vaccinated since April and I have been a lot more careful about this virus than at least probably 90% of the people out there, at least in the US. I still wear masks outside the house and avoid going indoors very often (I didn't do it at all until I was vaccinated).

Hell, I wore masks on hiking trails outdoors while holding my breath when walking past others on the trail back in 2020, which was probably overkill in retrospect. I also only had food delivered, never even going through the drive thru, and didn't order anything that couldn't be heated in the microwave for 3 minutes to try to kill the virus since it was unclear whether it transmitted via surfaces back then (so no sushi, sandwiches, salads, ice cream, iced coffee, etc).

Personally I wouldn't try to hunt down some of these alternative drugs, which I'm pretty skeptical of, but there seems to have been some mixed data on this one and I can at least understand why someone might want to give it a shot in reasonable and proven to be safe doses, especially if they have no choice but to be surrounded by it all day long (I work from home, my risk at work is nonexistent).

You are actively encouraging people to get on a path that ends up in overdose and death.

“You should be permanently silenced for suggesting a medical drug”

Are you feeling any cognitive dissonance?

When taken in dosages that have been determined based on extensive studies and research.

This doesn't apply to COVID so it is completely responsible for them not to supply it.