Supporting Documents


Early Covid Treatment

A Guide to Early Treatment of COVID-19

Early treatment is critical and the most important factor in managing this disease. COVID-19 is a clinical diagnosis; a confirmed antigen or PCR test is not required. Treatment should be initiated immediately after the onset of flu-like symptoms. The multiple therapies and drugs in this protocol have different mechanisms of action and work synergistically during various phases of the disease.

About this Protocol

The information in this document is our recommended approach to COVID-19 based on the best (and most recent) literature. It is provided as guidance to healthcare providers worldwide on the early treatment of COVID-19. Patients should always consult with their provider before starting any medical treatment.

New medications may be added and/or changes made to doses of existing medications as further evidence emerges. Please be sure you are using the latest version of this protocol.

A note about anesthesia and surgery:

Please notify your anesthesia team if you are using the following medications and/or nutraceuticals as they can increase the risk of Serotonin Syndrome — a life-threatening condition — when opioids are administered:

  • Methylene blue
  • Curcumin
  • Nigella Sativa
  • Selective Serotonin Reuptake Inhibitors (SSRIs)

For more information on nutritional therapeutics and how they can help with COVID-19, visit our guide to Nutritional Therapeutics.

For more information on vitamins and nutraceuticals during pregnancy, visit our guide to Vitamins and Nutraceuticals During Pregnancy.

First Line Therapies

(In order of priority; not all required.)

  • Ivermectin: 0.4 to 0.6 mg/kg – one dose daily for at least 5 days or until symptoms resolve.
    If symptoms persist longer than 5 days, consult a healthcare provider. See Table 1 for help with calculating correct dose. Due to a possible interaction between quercetin and ivermectin, these drugs should be staggered throughout the day (see Table 2). For COVID treatment, ivermectin is best taken with a meal or just following a meal, for greater absorption.

  • Hydroxychloroquine (HCQ): 200 mg twice a day for 5 to 10 days.
    Best taken with zinc. HCQ may be taken in place of, or together with, ivermectin. While ivermectin should be avoided in pregnancy, the FDA considers HCQ safe in pregnancy. Given the pathway used by the Omicron variant to gain cell entry, HCQ may be the preferred drug for this variant.

  • Mouthwash: 3 times a day.
    Gargle three times a day (do not swallow) with an antiseptic-antimicrobial mouthwash containing chlorhexidine, cetylpyridinium chloride (e.g., Scope™, Act™, Crest™), a combination of eucalyptus, menthol, and thymol (Listerine™), or 1% povidone-iodine.

  • Nasal spray with 1% povidone-iodine: 2-3 times a day.
    Do not use for more than 5 days in pregnancy. If 1% product is not available, dilute the more widely available 10% solution (see box) and apply 4-5 drops to each nostril every 4 hours.

    • Pour 1 ½ tablespoons (25 ml) of 10% povidone-iodine solution into a 250 ml nasal irrigation bottle.
    • Fill bottle to top with distilled, sterile, or previously boiled water.
    • To use: tilt head back, apply 4-5 drops to each nostril. Keep head tilted for a few minutes, then let drain.
  • Quercetin (or a mixed flavonoid supplement): 250-500 mg twice a day.
    Due to a possible interaction between quercetin and ivermectin, these drugs should not be taken simultaneously (i.e., should be staggered at different times of day.) As supplemental quercetin has poor solubility and low oral absorption, lecithin-based and nanoparticle formulations are preferred.

  • Nigella sativa: If using seeds, take 80 mg/kg once a day (or 400 to 500 mg of encapsulated oil twice a day).

  • Honey: 1 g/kg one to two times a day.

  • Melatonin: 5-10 mg before bedtime (causes drowsiness).
    Slow- or extended-release formulations preferred.

  • Curcumin (turmeric): 500 mg twice a day.
    Curcumin has low solubility in water and is poorly absorbed by the body; consequently, it is traditionally taken with full fat milk and black pepper, which enhance its absorption.

  • Zinc: 75-100 mg daily.
    Take with HCQ. Zinc supplements come in various forms (e.g., zinc sulfate, zinc citrate and zinc gluconate).

  • Aspirin: 325 mg daily (unless contraindicated).

  • Kefir and/or Bifidobacterium Probiotics.
    NOTE: Depending on the brand, these products can be very high in sugar, which promotes inflammation. Look for brands without added sugar or fruit jellies and choose products with more than one strain of lactobacillus and bifidobacteria. Try to choose probiotics that are also gluten-free, casein-free and soy-free.

  • Vitamin C: 500-1000 mg twice a day.

  • Home pulse oximeter
    Monitoring of oxygen saturation is recommended in symptomatic patients, due to asymptomatic hypoxia. Take multiple readings over the course of the day and regard any downward trend as ominous. Baseline or ambulatory desaturation under 94% should prompt consultation with primary or telehealth provider, or evaluation in an emergency room. (See box for further guidance.)

    • Only accept values associated with a strong pulse signal
    • Observe readings for 30–60 seconds to identify the most common value
    • Warm up extremities prior to taking a measurement
    • Use the middle or ring finger
    • Remove nail polish from the finger on which measurements are made
Second Line Therapies

(In order of priority/importance.)

Add to first line therapies above if: 1) more than 5 days of symptoms; 2) poor response to first line agents; 3) significant comorbidities).

  • Nitazoxanide (NTZ): 500 mg twice a day for 5 days.

  • Vitamin D3: For patients with acute COVID-19 infection, calcifediol as dosed in table below is suggested.

  • B complex vitamins.

  • Fluvoxamine: 25-50 mg twice a day.
    Can substitute fluoxetine (Prozac; 20-40 mg daily) if fluvoxamine not available. NOTE: Some individuals who are prescribed fluvoxamine experience acute anxiety, which needs to be carefully monitored for and treated by the prescribing clinician to prevent rare escalation to suicidal or violent behaviour.

  • N-acetyl cysteine (NAC): 600-1200 mg orally twice a day.

  • Omega-3 fatty acids: 4 g daily.
    Vascepa (Ethyl eicosapentaenoic acid); Lovaza (EPA/DHA); or alternative DHA/EPA. Vascepa and Lovaza tablets must be swallowed and cannot be crushed, dissolved, or chewed.

Treatment of BA.4/BA.5/BQ.1.1 and XBB1 Variants

The following protocol should be used where BA.4/BA.5/BQ.1.1 and XBB1 are the predominant circulating strains.

  • Hydroxychloroquine (HCQ): 200 mg twice a day or 400 mg daily for 5 days

  • Ivermectin: 0.4-0.6 mg/kg once daily for 5 days taken with a fatty meal
    Alternative to ivermectin: Nitazoxanide (500 mg three times a day for 5 days taken with a fatty meal).

  • Zinc: 75-100 mg daily for 5 days

  • Antiseptci/antimicrobial Mouthwash: 3 times a day.

  • Nasal spray with 1% povidone-iodine, Carrageenan, Nitric Oxide, or nasal irrigations with saline or neutral electrolyzed water: 2-3 times daily

  • Quercetin: 250-500 mg twice daily

  • Melatonin: 5-10 mg at night, slow-release formulation preferred

  • Nigella sativa: If using seeds, take 80 mg/kg once a day (or 400 to 500 mg of encapsulated oil twice a day taken with honey (1 g/kg one to two times a day).

  • Aspirin: 325 mg daily unless contraindicated

  • Home pulse oximetry

High-risk patients (aged over 60, comorbidities, poorly ambulatory), delayed treatment, high D-dimer, recently vaccinated, or severe symptoms, should add:

  • Apixaban: 5 mg daily for 15 days

  • Spironolactone: 200 mg once daily for 7 days
    avoid in patients with impaired renal function

If symptoms have not markedly improved by day 3 of treatment, the following medications should be started.
NOTE: physicians should provide prescriptions for these medications at first visit.

  • Prednisolone: 60 mg daily for 5 days

  • Oral antibiotic:
    Doxycycline (100 mg twice daily for 5 days)
    Doxycycline may act synergistically with ivermectin and may be the antibiotic of first choice

    OR Azithromycin/Z-pack (500 mg day 1, then 250 mg daily for 4 days)

    OR Amoxicillin/Clavulanate (Augmentin) (500 mg/125 mg tablet twice daily for 7 days)

About Ivermectin

Ivermectin is a well known, FDA-approved drug that has been used successfully around the world for more than four decades. One of the safest drugs known, it is on the WHO’s list of essential medicines, has been given over 3.7 billion times, and won the Nobel Prize for its global and historic impacts in eradicating endemic parasitic infections in many parts of the world.

To review the totality of supporting evidence for ivermectin in COVID-19, visit our Ivermectin information page.

Ivermectin is a remarkably safe drug with minimal adverse reactions (almost all minor), however its safety in pregnancy has not been definitively established. Talk to your doctor about use in pregnancy, particularly in the first trimester.

Potential drug-drug interactions should be reviewed before prescribing ivermectin.

Ivermectin has been demonstrated to be highly effective against the Omicron variant at a dose of 0.3 to 0.4 mg/kg, when taken early.

Higher doses (0.6 mg/kg) may be required: in regions with more aggressive variants; if treatment starts on or after 5 days of symptoms; in patients in advanced stage of the disease or who have extensive risk factors (i.e., older age, obesity, diabetes, etc.)

Table 1. How to calculate ivermectin dose

Note that ivermectin is available in different strengths (e.g., 3, 6 or 12 mg) and administration forms (tablets, capsules, drops, etc.). Note that tablets can be halved for more accurate dosing, while capsules cannot.

How much do I weigh? What dose does the protocol say?
In pounds In kilos 0.2 mg/kg: 0.3 mg/kg: 0.4 mg/kg: 0.6 mg/kg:
70-90 32-41 6-8 mg 10-12 mg 13-16 mg 19-25 mg
91-110 41-50 8-10 mg 12-15 mg 17-20 mg 25-30 mg
111-130 50-59 10-12 mg 15-18 mg 20-24 mg 30-35 mg
131-150 60-68 12-14 mg 18-20 mg 24-27 mg 36-41 mg
151-170 69-77 14-15 mg 21-23 mg 27-31 mg 41-46 mg
171-190 78-86 16-17 mg 23-26 mg 31-35 mg 47-52 mg
191-210 87-95 17-19 mg 26-29 mg 35-38 mg 52-57 mg
211-230 96-105 19-21 mg 29-31 mg 38-42 mg 58-63 mg
231-250 105-114 21-23 mg 32-34 mg 42-45 mg 63-68 mg
251-270 114-123 23-25 mg 34-37 mg 46-49 mg 68-74 mg
271-290 123-132 25-26 mg 37-40 mg 49-53 mg 74-79 mg
291-310 132-141 26-28 mg 40-42 mg 53-56 mg 79-85 mg

Table 2. Proposed medication schedule for first line treatments

Breakfast Lunch Dinner Bedtime
Hydroxychloroquine  ✓  ✓
Mouthwash/nasal spray  ✓  ✓  ✓
Quercetin  ✓  ✓
Nigella sativa  ✓
Melatonin  ✓
Curcumin  ✓
Zinc  ✓
Aspirin  ✓
Probiotics  ✓
Vitamin C  ✓  ✓
Pulse oximetry  ✓  ✓  ✓

Table 3. A Single-Dose Regimen of Calcifediol to Rapidly Raise Serum 25(OH)D above 50 ng/mL

Body Weight (lbs) Body Weight (kgs) Calcifediol (mg) Equivalent in IU If Calcifediol is not available,
a bolus of Vitamin D3
15-21 7-10 0.1 16,000 20,000
22-30 10-14 0.15 24,000 35,000
31-40 15-18 0.2 32,000 50,000
41-50 19-23 0.3 48,000 60,000
61-70 28-32 0.5 80,000 100,000
71-86 33-39 0.6 96,000 150,000
86-100 40-45 0.7 112,000 200,000
101-150 46-68 0.8 128,000 250,000
151-200 69-90 1.0 160,000 300,000
201-300 91-136 1.15 240,000 400,000
>300 >137 2.0 320,000 500,000

This protocol is solely for educational purposes regarding potentially beneficial therapies for COVID-19. Never disregard professional medical advice because of something you have read on our website and releases. This protocol is not intended to be a substitute for professional medical advice, diagnosis, or treatment with regard to any patient. Treatment for an individual patient should rely on the judgement of a physician or other qualified health provider. Always seek their advice with any questions you may have regarding your health or medical condition. Please note our full disclaimer at:

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