DOSING OF IVERMECTIN
DETERMINING DOSE FOR ADULTS (using 15 mg capsule)
50 to 75 kgs = 1 capsule (15 mg.)
75 to 120 kgs = 2 capsules (30 mg)
120 kgs & up = 3 capsules (45 mg)
DETERMINING DOSE FOR CHILDREN (using 15 mg capsule)
Open a capsule, collect all powder contents, and spread on a saucer or paper.
Divide this into 5 equal portions.
Determine the total body weight of the child in kilograms.
Give one portion of the powder for every 10-kilogram body weight. (This measures at 300 mcg / kg body weight)
Round off to the higher number.
PROPHYLAXIS (for general prevention)
Take 1 dose every 3-4 days.
POST COVID EXPOSURE (for those exposed to a known or suspect Covid patient but without any symptoms)
Take 2 doses on Day 1, then 2 doses on Day 3.
EARLY TREATMENT PROTOCOL (for those experiencing any symptoms of Covid, confirmed or suspected)
A. In line with FLCCC Protocol
Take 2-3 doses (single intake) every day for 5 days or until recovery.
Three (3) doses are considered for cases with:
a. aggressive variants
b. treatment started after 5 days from onset of symptoms
c. multiple comorbidities or risk factors
B. Dr. Landrito’s Protocol
Phase 1. ‘High-enough dose’ for 3 days.
Determine individually the patient’s ‘high-enough dose’. Depending on severity of symptoms: start with 3 doses for mild symptoms, 4 doses for moderate symptoms, 5 doses for severe symptoms. Intake should be single intake and not divided intakes throughout the day. Assess general well-being after 24hrs. If significant improvement is achieved this is his ‘high-enough dose’. If no significant improvement is achieved, give a higher dose and assess again after 24 hours. Continue increasing every day until the ‘high-enough dose’ is reached. The patient should experience a significant improvement to say that he reached the ‘high-enough dose’. Then he takes this dose once daily for 2 more days. In case the patient experienced side effects such as drowsiness, dimming of peripheral vision, patterned vision, other visual changes, disorientation, or even hallucination, this means he has reached the ‘high-enough dose’ or has even exceeded it. He will then take the next lower dose once daily for the next 2 days.
Phase 2. Tapering doses.
Reduce by 1 dose each day until 2 doses is reached. Revert back to ‘high-enough dose’ or a lower dose than the ‘high-enough dose’ if his condition is deteriorating. Then remain on this dose for 3 days. If the patient is improving, tapering dose can again be initiated.
Phase 3. Maintenance dose.
Maintain on 2 doses until complete recovery.
LATE TREATMENT PROTOCOL (for those starting Ivermectin treatment after 1 week from onset of symptoms)
Determine ‘high-enough dose’ but start with 4 doses for mild symptoms, 5 doses for moderate symptoms, and 6 doses for severe symptoms, and 7 doses for very severe symptoms. The oxygen saturation becomes the determining factor for measuring improvement. The patient’s general well-being should also be noted.
Start with Methylprednisolone 16mg 1 tablet 3 times a day. Taper this dose 3 days after patient starts showing significant improvement.
ROUTE OF ADMINISTRATION AND TIMING
There are 3 routes of administration of Ivermectin 15mg capsules:
1) Oral Route. This is the usual route and the patients directly swallow the capsules. In certain situations, the capsules may be emptied and the powder contents dissolved in water or fruit juice and drank or given through an naso-gastric feeding tube (NGT).
2) Dissolved in Virgin Coconut Oil. The powder contents of the capsules are emptied onto a tablespoon, whereupon VCO is introduced and mixed. Using this mixture enhances its absorption and allows for the Ivermectin to have a direct contact with the larynx where it can stay there for a longer period of time. This has added benefits for those having itchy or sore throats and difficult coughing.
3) Sublingual Route. Emptying a capsule onto the space behind the teeth and under the tongue every 5 minutes allows for a better and immediate absorption. This also bypasses the ‘first pass’ effect by the liver when swallowed and absorbed through the gastrointestinal tract. This may also be the option when patients are intubated, sedated or unconscious.
Although Ivermectin can be given at any time, the best timing is after a meal. The absorption is even better if the meal is a fatty meal. Taking it after a meal also helps avoid possible stomach upset.
Paracetamol, Ibuprofen, Mefenamic Acid and other anitpyretics should be avoided unless fever reaches 40.0*C in order not to suppress immune response. Sauna, or blanket steaming (‘su-ob’ – where the whole body from the shoulder down is covered with a comforter or a thick blanket and a potful of newly boiled or steaming water with added aromatic herbs is placed underneath the chair on which the patient is seated) for 30 minutes before onset of fever can be done for patients experiencing flu-like symptoms. This helps in accelerating immune response while the body is prevented from initiating fever.
2. Vitamin C
Sodium Ascorbate is the form of Vitamin C that is tolerated in high doses. Give this daily in the amount of 3,000mg to 5,000mg 2 to 3 times a day. If osmotic diarrhea ensues, lessen the dose. Vitamin C is very important during any viral infection, and most patients end up getting depleted of this very important nutrient in a short period of time. Thus, Vitamin C supplementation using the highest tolerable dose is necessary. Liposomal Vitamin C is the solution for those who cannot tolerate oral intake. Where intravenous infusion of Vitamin C is possible, Sodium Ascorbate 500mg/ml diluted in 0.9% NaCl is given at 25,000mg every 12 hours for moderate cases, 50,000mg every 12 hours for severe cases, and 75,000mg every 12 hours for very severe cases of Covid-19.
3. Acetylcysteine or N-acetylcysteine
Imported NAC or locally available brands of Acetylcysteine such as Fluimucil or Exflem 600mg should be given 3 to 5 times a day. This is given not only to promote mucolysis but also to provide the precursor for Glutathione production. Ascorbic Acid together with Glutathione quells oxidative stress brought upon by the viral infection. It is therefore necessary to give high doses of Acetylcysteine.
4. Virgin Coconut Oil
VCO can cause disintegration of viral particles and adds to the increased energy requirements of Covid patients. Give 2 tablespoonsful at night and 1 tablespoonful in the morning an hour after meals.
Melatonin exerts a suppressive influence against coronavirus. It also balances hormones, regulate sleep and act as an anti-oxidant in Covid. Locally available brands such as Sleepwell and Sleepasil in 3mg capsules and can be given at 6mg to 9mg but only at night time.
6. Vitamin D3
Vitamin D3 2,000IU daily can be included in prophylaxis. This is necessary to ensure an efficient functioning of the immune system.
Zinc 20-50mg, Magnesium 400mg, and Selenium 200mcg are the basic minerals that can be included in prophylaxis to ensure an efficient functioning of the immune system. Zinc is important in inactivating viruses inside the target cells and can be given during infections.
Aspirin 325 mg tablet can be given after a meal once a day if hypercoagulability of blood is suspected. Ethylenedia-mine Tetraacetic Acid (EDTA) 3gm can be administered intravenously everyday if there is a necessity for it as determined by the physician.
9. Dimethyl Sulfoxide
DMSO 25ml diluted in 0.9% NaCl 300ml can be given intravenously depending on the discretion of the physician. This compound helps extend the viability of vital organs in the face of extreme oxidative stress.
10. Functional Nutrients
Allicin from Garlic and Curcumin from Turmeric are excellent immune boosters and anti-inflammatory agents that help augment the body’s fight against viral infections. A local product CAP2020 contains Allicin 240mg and Curcumin 240mg per capsule. Giving 2 capsules 2 times a day is a big help. Other garlic oil capsules can be used instead of CAP2020 if this is not available. CoEnzyme Q-10, Carnitine, Alpha Lipoic Acid in optimal amounts can be given to promote energy and vitality as patients are left devastated and weak after Covid syndromes.
Antibiotics are administered to check on concomitant opportunistic bacterial infections. Doxycycline 100mg capsule is an excellent broad-spectrum antibiotic with a known anti-viral property as well. Give 2 capsules initially as a loading dose, then give 1 capsule once a day to complete 1 week. Other antibiotics may be administered depending on the discretion of the physician.
Asthma or bronchoconstriction can occur in a background of Covid and the drug of choice is Budesonide. The locally available brand is Budecort and it comes as a metered dose inhaler or a solution for nebulization. Terbutaline 2.5mg tablets may also be given – 1 tablet 1 to 3 times a day if necessary. This may no longer be needed when a steroid is already being administered.
13. Cough Suppressant
Levodropropizine with locally available brand Levopront syrup can be given to suppress dry and unproductive cough at 10ml upto 3 times a day.
14. Hydrogen Peroxide Nebulization
Hydrogen Peroxide in Food Grade or USP at 3% or 10 volumes can be mixed with an equal to double amount of 0.9% NaCl or NSS (normal saline solution) and used for nebulization. This is only indicated in cases of incessant dry cough unabated by cough suppressants. Always use new solutions which are prepared just minutes before nebulization. Hydrogen Peroxide also helps in the breakdown of the biofilms shrouding chronic viral colonizations in the lining the nasal cavity, pharyngeal cavity, and the respiratory tract. Nebulization can also be done as immediate prophylaxis when exposed to infected of suspected Covid patients. This nebulization can be done every 6 hours when awake but done upto maximum of 10-15 minutes.
Colchicine is an anti-inflammatory drug that can be given in Covid to help alleviate cytokine storm. This comes in 500mcg tablets given as 2 tablets initially as loading dose followed by 1 tablet every 12 hours for 5 to 7 days.
Steroids is proven to be a very important and necessary part of therapeutics in advanced Covid that should be given during the immune dysregulation phase which usually start on the second week from onset of symptoms. It should not be given during the pulmonary phase. Methylprednisolone is the steroid of choice in Covid as indicated in moderate to severe Covid conditions. It comes in 16mg tablet given 3 times a day and tapered gradually once the patient have gained substantial improvement and on the way to recovery. Physicians may opt to give Methylprednisolone injections intramuscularly at 50mg to 100mg daily on more severe cases.
17. Rehydration Fluids
Fresh coconut or ‘buko’ water is the ideal rehydration fluid for Covid patients. Covid may present as vomiting and diarrhea, and the patients require rehydration with fluids and electrolytes. Encourage patients to completely consume the water from a whole coconut as well as its soft thin white meat not only as replenishment of fluid loss but also as an added nutrition. However, patients who become significantly dehydrated must be given prompt intravenous rehydration.
— As Prescribed by: Allan A. Landrito, M.D.Revision Date: 09/12/2021