Antiviral PK/PD Dynamics In Vitro vs Human Reality

Explore why promising in vitro cell-culture antivirals fail in clinical trial plasma dynamics due to unbound fraction thresholds.

Plasma Curve (0 - 72h) Cmax,free: 0.0035 µM
Cellular Compartment Viral Load: High
T = 00.0 hrs
Total Cmax
0.050 µM
Total Plasma
Unbound Cmax (Free)
0.0035 µM
Sub-therapeutic
EC50 Target
2.800 µM
In Vitro Standard
Inhibition Ratio
0.13%
Replication Active
Evidence Brief & Scientific Mechanics Ratio: 0.001x
Standard human dosing of Ivermectin (12mg) reaches an unbound plasma peak (Cmax, free) of ~0.0035 µM. This is 800-fold below the required SARS-CoV-2 in vitro antiviral threshold (EC50 = 2.8 µM). Despite 93.0% plasma protein binding and cellular lung accumulation, drug concentration in tissue remains far below antiviral potency thresholds.
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