COVID Care: Beyond IVM and HCQ

by | Mar 1, 2021 | COVID-19 | 41 comments

Many patients have remarkable results with Ivermectin and the FLCCC protocol of vitamins, but some patients arrive late and very sick and often need additional medications. Others have significant comorbidities and are much higher risk and warrant more aggressive treatment.

Thankfully there are a number of experimental off-label, adjunctive treatments available to front line physicians, some with very promising research backing them up, and others that are considered likely to work. None of them are considered dangerous and all have been used safely for decades in other conditions.

FLUVOXAMINE

The only comorbidity that lowers the risk of COVID-19 is depression. Scientists postulated that this was due to the protective effect of a common class of antidepressants called selective serotonin reuptake inhibitors (SSRIs).

Platelets hold 95% of the entire bodies serotonin stores and in COVID-19 the serotonin is released into the bloodstream where it becomes a large part of the problem – SSRIs deplete serotonin levels in platelets and prevent the damage that can occur to the vascular walls when serotonin levels skyrocket in the blood. They also activate the Sigma 1 receptor which inhibits inflammation and helps prevent the COVID-19 induced cytokine storm.

Retrospective cohort studies showed that patients on SSRIs like fluvoxamine had much lower rates of COVID-19. In one psychiatric hospital the staff was 3.5 times as likely as the patients to be diagnosed with COVID-19.

Based on this data a randomized controlled trial was conducted in the summer of 2020 by Lenze et al which showed a 100% protective effect of fluvoxamine – none of the patients who took it got worse vs 8% deterioration in those who were on placebo.

This result was repeated in a trial by Seftel et al showing once again:

Dr Seftel did not formally keep track of time to improvement, but reported in a personal communication that in most cases COVID-19 symptoms resolved completely within 3 days of starting fluvoxamine – in fact he said this was the most amazing effect he’d seen in the 25 years he’d been practicing medicine.

Fluvoxamine may also turn out to be useful for long COVID symptoms – especially when affecting the brain. This could prove very important as there is evidence in a mouse model to suggest that COVID-19 may sequester itself within neurons in the brain and this may be the source of many patients’ long COVID symptoms.

Dr. Drew, the famous physician and media personality, took fluvoxamine for long COVID and his tinnitus resolved within 30 minutes of taking it. Overall he was 80% better within hours of the first dose and 100% better within 12 days.

The 50 mg dose being used by many physicians is lower than that normally used for OCD and has no side effects for the vast majority of patients. Also there are usually no psychiatric effects with a short 2 week course.

Some considerations when taking fluvoxamine:

Avoid caffeine because it is not properly metabolized while on fluvoxamine and sticks around about 5 times longer than expected. Though this is not dangerous it can cause some very troublesome symptoms like insomnia and anxiety.

Selected more common side effects of fluvoxamine include constipation (≤6%), nausea (≤12%), vomiting (≤11%), confusion (≤11%), dizziness (2% to 15%), drowsiness (6% to 63%, may be transient), headache (2% to 11%), hypotonia (2% to 35%), hypotension (≤9%), urinary retention (≤8%), insomnia (≤7%), pain (≤4%), paresthesia (≤7%), seizure (≤10%),

Rare side effects (<1%) can include: abdominal pain and bleeding into the bowels, amnesia, blurred or double vision, elevated blood sugar, hallucinations, hypertension and others.

COLCHICINE

Colchicine is an old stand-by for treating acute attacks of gout and in one form or another the active ingredient has been known and used for more than 3000 years.

The COLCORONA trial in 4488 patients showed colchicine may be effective at preventing progression to severe COVID-19. In 4159 patients with proven COVID-19 it reduced the risk of death by 44%, mechanical ventilation by 50% and hospitalization by 25%.

Colchicine prevents inflammation in a specific way by blocking certain cytokines like IL-6 that are involved in the COVID-19 cytokine storm.

Dr. Darrell Dimello of India has treated more than 20,000 patients in the last year and noted that colchicine often prevented even high risk patients from developing clinical illness. In one cohort of about 30 dialysis patients who were given thrice weekly colchicine after dialysis, all turned antibody positive to COVID-19 and only one developed any clinical illness.

In Dr Dimello’s experience taking colchicine three times a day for the first month, then twice a day for the second month and daily for the 3rd month and possibly longer will prevent the development of long COVID. He also recommends an aspirin daily, or stronger blood thinner like plavix for the first 1-2 months.

Colchicine has some stomach side effects that can be mild to severe including nausea, vomiting, diarrhea and stomach pain in some patients, it can also cause liver, heart and kidney problems in patients who already have problems in those organs. In all patients taking it long term for many weeks to months labs (CBC, CMP) should be checked after a month and then every 3 months.

Colchicine used to cost a few cents a pill, but after it became an “on-label” treatment for gout about a decade ago the price skyrocketed and it is now about $4 a pill, even for the generic form. Many insurance companies do not cover this except for gout, so the expense as well as side effects can limit it’s use.

STEROID INHALERS

One interesting observation in the last year has been that asthmatics on average were not coming down with severe COVID-19 symptoms. It was hypothesized that this might be due to the protective effect of steroid inhalers which are widely prescribed in asthma moderate to severe asthma.

Now we have some trial data out of England confirming that the early use of the steroid inhaler budesonide prevents progression to severe lung disease in COVID-19.

The STOIC study was a phase two randomized trial done with 146 patients who all entered the study within 7 days of symptom onset and took either 800mcg of the inhaled steroid budesonide twice a day or were given no particular treatment.

The inhaled steroid group showed a 90% relative risk reduction for requiring hospitalization or urgent care and at 14 days only 10% of the steroid group still had persistent symptoms compared to 30% of the “usual care” group.

A steroid inhaler can be started either at the first sign of symptoms and taken twice a day, or patients can choose to wait and if they begin to have a cough or wheezing they can then start using the inhaler then.

The greatest benefit is likely to accrue when starting within the first 7 days before inflammation really gets going.

One theoretical risk of steroid inhalers is they could predispose to developing a bacterial lung infection, but over a short course of a couple weeks this is unlikely. They can also cause thrush in some people, which is more annoying than anything else and easily treated.

Another drawback is that, if paying out of pocket, they usually cost $200 – $300 even at goodrx.com. An alternative for people who happen to have a nebulizer machine handy, or can get one, is to get the same medication in ampules for the nebulizer, in which case you can often get it at a quarter of the cost of an inhaler.

LOW DOSE STEROIDS

Dr Mobeen Syed of DrBeen.com reports that after treating 400 patients with ivermectin and a short course of low dose steroids during their acute illness, none but one progressed to long COVID, and that patient started treatment relatively late in his disease course. Even that patient’s long-hauler symptoms resolved after repeating the course of low dose steroids.

This therapy is cheap and has a low incidence of side effects, but despite the very suggestive clinical experience the drawback is we don’t have any confirmatory studie yet.

The protocol is dexamethasone 0.5mg starting around day 7 of acute illness and taken three times a day for 2 days, then twice a day for 2 days then daily for 2 days.

Steroids strongly suppress the immune system, so we avoid starting in the first week when the immune system is usually fighting off the infection in a normal manner.

The second week is when the immune system often goes into overdrive producing the deadly cytokine storm that often wipes out lung function and puts patients on ventilators. So at that point in the infection the virus has usually completed it’s replication and we are just dealing with the after-effects of infection – the acute inflammation at risk of becoming chronic.

HIGH DOSE STEROIDS

If patient’s deteriorate clinically and a CRP blood test (marker of inflammation) shows significant elevation then high dose steroids are often very beneficial and for this reason they are part of the FLCCC inpatient protocol.

From relatively early in the pandemic their benefit has been obvious, especially in the ICU, and various studies have backed up clinical experience.

The NIH COVID-19 treatment guidelines include the use of steroids, particularly dexamethasone, in certain clinical situations.

BLOOD THINNERS

Acute COVID-19 infection often leads to microscoping clotting throughout the body and because of this many protocols being studied around the world include blood thinners ranging from aspirin and plavix to eliquis and even injection blood thinners AKA low molecular weight heparins (LMWH) like Lovenox.

Dr. Dimello reports that in his clinical experience if the oxygen saturation drops below 95% and there is significant inflammation present on a lung CT scan, rapid initiation of full dose lovenox treatment every 12 hours is often a life and lung saving intervention, and if started immediately the oxygen saturation often bounces back up within hours to days. I have seen this myself in a number of cases.

Again anecdotal evidence like this is certainly limited, but this is how off-label treatments usually get started and has been a mainstay of modern medical practice for generations.

VITAMIN D

Vitamin D, AKA the sunlight hormone, has long been known to boost immunity to viral infections, however much controversy has swirled around vitamin D and COVID-19.

Various studies showed remarkable effects when vitamin D was given early on to patients.

Other studies, seemingly designed to fail (reminds one of the HCQ controversy), used vitamin D far too late for it to be beneficial, especially considering it can take up to 2 weeks to become activated by the body when administered in its inactive form as has been the rule in all vitamin D studies thus far.

In my own practice everyone who comes with severe COVID-19 and is tested for vitamin D turns out to be low. And of those who come with mild disease, most have been on vitamin D for months.

Since it takes so long for vitamin D to be fully activated and available to your body, the time to top up your vitamin D levels is before you get sick and if you have not been taking at least 3000 IUs of vitamin D3 for a couple months you should either get tested and supplement accordingly or immediately take 100,000 IU of vitamin D3 and then start on at least 3000 – 5000 IU per day.

Such a high one time dose is not dangerous, even if you already have normal vitamin D levels and will help ensure that you reach vitamin D sufficiency within 2 weeks.

For patients who are already sick, do not know their vitamin D levels and have not been supplementing for long enough to be sure they are at a normal level an experimental prescription option is the synthetic activated vitamin D analog called calcitriol.

For hospitalized patients this can be given IV, but even when taken orally it is well absorbed and reaches peak blood levels within a few hours. There is one in vitro study showing significant activity against COVID-19, but no one has yet studied it in patients.

SUMMING UP

The ideal patient is low risk, has a normal vitamin D level and has been on the other recommended supplements for months. They might even be on an SSRI already. They show up on day 1 of symptoms and the pharmacy has ivermectin in stock and the pharmacist doesn’t balk at the weird dosing, so they start treatment right away.

This patient is often observed to improve and return to normal within 1 to 3 days of starting ivermectin and the FLCCC protocol supplement regimen.

Not all patients fit this mold.

Higher risk and late presentations may call for promising adjunctive treatments including fluvoxamine, colchicine, oral and inhaled steroids, stronger blood thinners and vitamin D.

And if in doubt assume it’s COVID – time is lung and time is brain and time is not on your side. Anywhere from 20-90% of patients develop some form of long COVID lasting weeks to months and I have seen it even in young children and healthy young adults. It can be debilitating and even knock off up to 8 IQ points.

My advice to all patients is to treat every COVID-like illness as COVID until proven otherwise.

Proof can be hard to come by, some blood groups (B) test false negative more often, One patient in the hospital tested negative multiple times over multiple days right up until they were intubated and a lung aspirate finally tested positive for COVID-19.

One silver lining to this pandemic is that we have come to appreciate that we have many cheap broad spectrum antivirals available. I would be surprised if similar treatments did not work for the flu and other viral illnesses.

When the proposed treatments are cheap old generic drugs and supplements that are generally safe and well tolerated there is little to lose assuming it’s COVID-19 and treating accordingly.

You May Also Like:

JOIN MY NEWSLETTER FOR THE LATEST ARTICLES.

Everyone needs stress-free, hassle-free healthcare and a good doctor. Get yours now.

Subscribe
Notify of
guest
41 Comments
Inline Feedbacks
View all comments
Kevin Lodge
Kevin Lodge
5 months ago

Hi Doctor Haider, I am a resident of Alberta Canada and am having a hard time getting a Doctor to prescribe me Ivermectin, I just had a Covid 19 test today and will know if I have it in a couple of daysbut would naturally like to pre-empt any serious sickness, do you have a list of Canadian Doctors who would be able to give me a prescription for Ivermectin
Thanks, Kevin

Dr Syed Haider
Admin
Dr Syed Haider
5 months ago
Reply to  Kevin Lodge

The biggest list we know of is at exstnc.com, unfortunately patients have told us that it is difficult to get ivermectin in Canada. Patients who approach US doctors online and indicate that they are present in a covered US state can get a prescription sent to a pharmacy in that state.

Kevin Lodge
Kevin Lodge
5 months ago

How many more must die!!

Dr Syed Haider
Admin
Dr Syed Haider
5 months ago
Reply to  Kevin Lodge

We share your indignation and distress, may God help us all.

What is the appropriate amount of vitamin D in the
What is the appropriate amount of vitamin D in the
5 months ago

Thanks! What is the appropriate amount of vitamin D in the blood

Dr Syed Haider
Admin
Dr Syed Haider
5 months ago

Generally speaking levels between 50 – 80 ng/ml are probably ideal. Within that range you can narrow it down further by checking a parathyroid hormone (PTH) level. If the d level is in the normal range, but the PTH level is above 30, it indicates the D level is likely still too low and should be raised. On the other hand if the D level appears borderline low and the PTH is below 30, the D level is probably sufficient.

Sunita
Sunita
4 months ago

Are all SSRIs effective? If someone is already on another SSRI?

Dr Syed Haider
Admin
Dr Syed Haider
1 month ago
Reply to  Sunita

There is evidence that all SSRIs have some effect, but doesn’t look like all are equally effective. We think the best are fluvoxamine (which has more data) and fluoxetine. skirsch.io has links to the studies.

If someone is already on another SSRI you could either leave them on it, taper and switch to fluvoxamine or try switching without tapering, which does work for some people, but not all.

Anita
Anita
4 months ago

I just got my ivermectin in the mail after much difficulty it is just plain evil that the big pharmacies blocked this to profit off their questionable vaccine that may cause harm. I still am not certain about the dosage but starting at 12mg a day I hope this is correct . It’s good this is finally being recognized as a real condition. I have had it a year now any other suggestions or questions welcome

Tara Lucky
Tara Lucky
3 months ago

Please tell me what the fees to get preventative Ivermectin prescription.

Steven Press
Steven Press
2 months ago

In the Carvallo study, carrageenan was used along with Ive, and many think it may have helped. Why are we not recommending this iota-carrageenan (not sure what that means) in protocol?

Dr Syed Haider
Admin
Dr Syed Haider
1 month ago
Reply to  Steven Press

That’s a good question. I have not studied this and took my protocols from the FLCCC. I did see it referenced here that Dr Carvallo later said the carageenan is unnecessary for the protocol. You can see Dr Carvallo’s discussion of carageenan here on youtube.

Robert Beasley
Robert Beasley
2 months ago

Vaccines are being made mandatory in my agency or one has to be tested twice weekly and continuously wear mask. Does the Johnson & Johnson vaccine carry a risk of blood clots? Most become ill for several days with Pfizer and Moderna, especially Moderna.

Last edited 2 months ago by Robert Beasley
Dr Syed Haider
Admin
Dr Syed Haider
1 month ago
Reply to  Robert Beasley

I’m not an expert on vaccines, but certainly any vaccine that uses the COVID-19 spike protein to trigger immunity could also trigger clotting. Whether it does this in a significant number of patients is the question. There was clotting reported due to the J&J vaccine but it was in a handful of patients out of millions who were given the vaccine.

Cristina
Cristina
2 months ago

Hi Doctor Haider, I recently took Ivermectin 16mg 2 days in a row (.2mg/kg) and have been on Lexapro 10mg daily for years. After the second dose I felt like I drank 20 cups of coffee. It’s been a week now and it feels as though I quit Lexapro cold turkey. When is this feeling of heightened anxiety going to end or did this cause permanent damage? Is this a side effect of Ivermectin or a drug-drug interaction?

Dr Syed Haider
Admin
Dr Syed Haider
1 month ago
Reply to  Cristina

This is unusual and I’ve never heard of a reaction like it. There are no known major interactions between ivermectin and lexapro. However they are both minor substrates of CYP3A4, so it might be possible that adding ivermectin increased your blood levels of lexapro and threw things off for you. I would discuss this with your prescribing physician.

Cristina L
Cristina L
1 month ago
Reply to  Dr Syed Haider

Thank you, I was thinking the same thing. It’s been a little over 2 weeks and I’m just starting to feel better. I spoke to my doctor about ivermectin because I’ve watched you speak about it with Dr. Been. Thank you for getting back to me I know you’re very busy. Take care.

Karen
Karen
2 months ago

Please I refused monoclonal and was refused Ivermectin – was told vaccine was proven to help lack of smell. I feel fine just loss all smell. I’m on day 6 or 7 – just done radiation treatment 21 days ago. I didn’t know your take on the monoclonal antibodies nor if I’m good at this point should I be concerned with long haul. I know you said IVM by day 6 and the wait was 2 to 3 days. Thank you!

Dr Syed Haider
Admin
Dr Syed Haider
1 month ago
Reply to  Karen

Long haul is hard to predict, which is why we recommend no exercise, alcohol or junk food for 30 days counting from the first day of symptomatic COVID-19 infection. There is some good data on monoclonal antibodies. You’ll just have to take it easy, wait a while and see what happens.

Karen
Karen
1 month ago
Reply to  Karen

So far so good, I’m day 11 after losing smell, 13 if count first slight headache.. I took IVM 4 days 6th – 9th or 8th -11th depending on actual onset. 18 mg preventative dose for weight. :/ it’s all I could get. Smell returned tad day 9 or 11th even better just two days later. Keeping hydrated & taking lots of zinc, C, B-12 & D-3. Will keep from any heart rasing activities, minimum 30 days. Keep the faith all !!

Jim Ayer
Jim Ayer
1 month ago

I’m 73 and have asthma. I’m in good shape. My D3 level is 120. I fly out in a week to work among a lot of people for 3 weeks. I have horse Ivermectin and would like to take it as a preventative. How much should I take. I’m 148ibs.

Dr Syed Haider
Admin
Dr Syed Haider
1 month ago
Reply to  Jim Ayer

Mr Ayer, I can’t give direct medical advice via blog comments. Register as a patient and we can discuss if you still need any answers to questions.

Eileen Pearson
Eileen Pearson
1 month ago

Dear Dr. Haider, I can’t tell you how much I appreciated your discussion with Dr. Mobeen – I was overwhelmed by your intelligence, dedication and desire to help people. I would be so grateful if you have any advice for loss of voice post covid. My mother-in-law living in Mozambique was extremely sick for over a month (after one vaccine) and now 2 weeks later is still weak, breathless and unable to speak normally. The healthcare where she lives is severely lacking and she was only given azithromycin. She managed to get some ivermectin on my recommendation and has started taking that now. Is there anything else you can think of that may help restore her voice and her strength?
Many thanks and very best wishes.

Dr Syed Haider
Admin
Dr Syed Haider
1 month ago
Reply to  Eileen Pearson

Fluvoxamine may help as well, as Dr Mobeen often recommends, low dose steroids may be of benefit, but since I’ve seen Ivermectin work on it’s own and it is safe, I usually recommend my patients just start out with that.

Marinela
Marinela
1 month ago

Hello doctor Haider, I live in the state of Vermont. How can I obtain a prescription for Ivermectin, and or HCQ for preventative measures? Please advise. Thank you.

Kim
Kim
1 month ago
Reply to  Marinela

Hello doctor Haider, I live in the state of Arizona, How can I obtain a prescription for Ivermectin, and or HCQ for preventative measures? And what would the total cost be? I have insurance, but I’m on a fixed income. I’m a Healthy Sr. who does not take any medications. Please advise advise. Thank-you.

Dr Syed Haider
Admin
Dr Syed Haider
1 month ago
Reply to  Kim

You can register on the site by clicking the red COVID-19 link at the top right. Cost for the medication is going up all the time due to supplier shortages, so it depends on the pharmacies that are available to ship to your state. Local pharmacies have now started refusing to dispense. Some patients have had to pay $600 or more for the medication from the pharmacy, in other cases there is a cheap mail order pharmacy available that sells it for 1/10th of that.

Dr Syed Haider
Admin
Dr Syed Haider
1 month ago
Reply to  Marinela

You can register on the site by clicking the red COVID-19 link at the top right.

Erica
Erica
1 month ago

Hi Dr Haider, I’m 55 years old, I’m on Hydrochlorothiazide, 12mg, In case I need covid 19 care, what can I use with ivermectin and what is the dosage for myself. Thank you for your interest and time.

Dr Syed Haider
Admin
Dr Syed Haider
1 month ago
Reply to  Erica

Ivermectin doesn’t have any absolute contraindications. If you need medical advice though you should register as a patient.

Tonya
Tonya
1 month ago

Thank you so much! I am so proud to be able to call you my doctor!

Joy
Joy
1 month ago

I’m so Grateful to have found your website. I’m an RN in the DFW area. I’ve been an information “nerd” for the last year and a half and am extremely disappointed in the Overreach by our government/medical facilities, the obvious disregard for therapeutics and lack of interest in Natural Immunity.
I explain “consent to treat” with every patient prior to their infusions, it’s their right to know and to make an informed decision. I’m struggling with the sudden disregard for right to Consent and Know in regards to the Vs.
I feel sure my days are numbered at my current position because I can Not in good conscience acquiesce and my heart hurts to know that I may no longer be able to care for patients but I feel that I must stand strong. Thank you for bringing Logic and Common Sense to the table.
Blessings!

Valerie Anne Rodriguez
Valerie Anne Rodriguez
26 days ago
Reply to  Joy

God bless you! Thank you for your true love for healing your patients! Praying that you will find a position that will support you in your quest to provide loving, quality and effective treatment for COVID-19!

James &Karen Hoyt
James &Karen Hoyt
29 days ago

We were both tested positive PCR over a week ago, and I since then have been without fever and cough; my wife went into crisis and has been in the hospital since Monday treated so far with enhanced oxygen, Actemra monoclonal, steroids etc, so if I can get her out of there we will head back to Arizona?!

James Bitakis
James Bitakis
28 days ago

Hi Dr. Haider, I just received 16mg dosage tabs of Ivermectin for my wife (20 tabs total). She is to take 16mg bid x 5 days and repeat IF she still has symptoms after 5 days. She is also taking Vit. D, Zinc,. However, I am giving the other 16mg x 5 days to my son (22yr) who also has Covid. He weighs about the same as my wife.
My 15 yr old ALSO has Covid and I am thinking about getting another script for Ivermectin for her. She has the WORST symptoms of all 3. Fever, sore throat, headache, bodyaches, can’t taste anything. Is it ok for 15yr 104 lb girls to take Ivermectin, and if so, what dose would it be?

Dr Syed Haider
Admin
Dr Syed Haider
3 days ago
Reply to  James Bitakis

Yes teens can take Ivermectin based on body weight, but I can’t give medical advice in the comments of a blog post. Hopefully you got the answer already through the patient portal.

John M
John M
28 days ago

Is there a resource you could point me to concerning tx and prophylaxis for pregnant women?

Valerie Anne Rodriguez
Valerie Anne Rodriguez
26 days ago

The doctors who refuse to prescribe ivermectin for the treatment of COVID-19 are responsible for those who over dosed on the veterinarian formula of ivermectin. Had they been following the ‘science’ based on the results of studies around the world, this would have never happened…
I also accuse these doctors of cowardice which has caused an untold significant number of Covid related deaths. Those doctors should resign from their profession in shame, as they ignored their oath to ‘first cause no harm’. Those doctors have blood on their hands…one day they will recognize that and have to live with the knowledge that they caused the deaths of many of their patients.
But the doctors who are the most despicable are the ones who are quietly prescribing or secretly providing ivermectin and other ‘off-label’ and effective medicine to treat COVID-19, but will not allow their patients to reveal who they are for fear of losing status or position. If they had any true concern for healing they would be at the forefront of FRONTLINE, shouting down the naysayers and leading verbal and legal assaults against large Pharma, and those treasonous against humanity, the CDC, FDA, WHO, AND NIH. The leaders of those organizations should be charged with genocide and murder. In a sane and just world they would be held accountable! Sadly, common sense, sanity and justice has been on the decline for quite some time.
We can turn the tide! Thank you, Dr. Haider and your colleagues, for having the courage to act on behalf of patients by using your knowledge, medical experience, expertise and common sense to provide effective treatment! Time is of the essence! I lost 2 very dear friends who I believe would have survived if they had known of the FLCCC protocols. The issue that upset me most is they and their families had never heard of it! What can we do to get this information out to the people in this country? I want to help! Tell me how!! Sincerely, Valerie Rodriguez

Dr Syed Haider
Admin
Dr Syed Haider
3 days ago

The best we can do is speak about it in our circle and take advantage of any platform we have available to us in the community.

Dr. Syed Haider