DOSING OF IVERMECTIN

DETERMINING DOSE FOR ADULTS (using 15 mg capsule)

50 to 80 kg = 1 capsule (15mg.)

80 to 120 kg = 2 capsules (30mg.)

120 kg & up = 3 capsules (45mg.)

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.

GENERAL PROPHYLAXIS (for general prevention)

Take 1-2 doses every 3-4 days.

COVID EXPOSURE PROPHYLAXIS (for those exposed to a known or suspect Covid patient but
asymptomatic)

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 may mean he has reached the ‘high-enough
dose’ or has even exceeded it. He will then take this dose once daily for
the next 2 days or take a higher dose single intake next day.

Phase 2. Tapering doses.

Reduce by 1 dose each day until 2 doses are 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 (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.

CONVALENCENCE REGIMEN (to prevent relapse after full recovery)

Take one dose every 3 days for one month.

POST-COVID PROPHYLAXIS (to prevent reactivation and long hauler states)

Take one dose every week.

PRE- AND POST-VACCINE PROPHYLAXIS v(to avoid vaccine adverse reactions but not late
complications)

Take 2 doses every day for 5 days before and 2 doses every day for 5 days after
vaccination.
OTHER APPLICATIONS
For Dengue and other viral infections, follow same early treatment protocol as
with Covid-19.

For cancers and autoimmune disorders, there are no standardized dosing for
Ivermectin but taking one to two doses everyday is recommended. Ivermectin is
known to be effective in Breast, Ovarian, Cervical, Esophageal (Squamous Cell
type), Renal, Glioma, Nasopharyn-geal, Gastric, Liver, Leukemia, Colon, and
Bladder cancers.

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-gatric 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 time to give is an
hour 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.
 OTHER THERAPEUTICS
1. Antipyretics

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 tablespoons at night and 1 tablespoonful
in the morning an hour after meals.
5. Melatonin

Melatonin exerts a suppressive influence against coronavirus. It also balances

hormones, regulates sleep and acts 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.

7. Minerals

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.

8. Anticoagulants

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.
11. Antibiotics

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.

12. Bronchodilators

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. Nebulization should be discontinued when
the patient is already producing frothy or white phlegm.

15. Colchicine

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.

16. Steroids

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.

18. Herbal Preparations

a. Damong Maria (Hilba in Visayan, Sampaga in Pangasinan) decoction is a

source of Artemisin which is good for Covid and is a good herb for cough.
b. Chlorophyll helps in improving oxygenation.
c. Theobroma from Cacao helps in providing energy.
d. Oregano extract is good for easing cough.
e. Lagundi extract is also known to clear phlegm and bronchodilation in
asthma.
f. Gingko biloba extract is an excellent blood thinner and acts on the central
nervous system.
g. Black Cumin seeds (3-5 gm daily) as substitute to Ivermectin and as adjunct
in treatment.

— As Prescribed by: Allan A. Landrito, M.D.

Revision Date: 11/8/2021