Quercetin, Zinc, Vitamin D, Vitamin C and Melatonin: FLCCC Protocol for COVID-19

In October 2020, the FLCCC Alliance developed a preventive and early outpatient combination treatment protocol for COVID-19 called I-MASK+. It’s centered around ivermectin, a well-known, FDA-approved anti-parasite drug that has been used successfully for more than four decades to treat onchocerciasis “river blindness” and other parasitic diseases. It is one of the safest drugs known. It is on the WHO’s list of essential medicines, has been given 3.7 billion times around the globe, and has won the Nobel prize for its global and historic impacts in eradicating endemic parasitic infections in many parts of the world. 

FLCCC medical discovery of a rapidly growing published medical evidence base, demonstrating ivermectin’s unique and highly potent ability to inhibit SARS-CoV-2 replication and to suppress inflammation, prompted our team to use ivermectin for prevention and treatment in all stages of COVID-19. 

In October 2020, the FLCCC Alliance identified, based on a review of the recent and rapidly emerging clinical trials evidence, that ivermectin, an anti-parasitic medicine, has highly potent real-world, anti-viral, and anti-inflammatory properties against SARS-CoV-2 and COVID-19. This conclusion is based not only from multiple in-vitro and animal models, but from numerous clinical trials from centers and countries around the world showing repeated, consistent, large magnitude improvements in clinical outcomes when ivermectin is used not only as a prophylactic agent but also in mild, moderate, and even severe disease states. Further, data from large “natural experiments” that appear to have occurred when various regional health ministries and governmental authorities within South American countries initiated “ivermectin distribution” campaigns which then led to temporally associated decreases in case counts and case fatality rates.

Based on these findings, the FLCCC team has developed the I-MASK+ protocol for prophylaxis and at home treatment of early stage disease. 

FLCCC (Front Line COVID-19 Critical Care) Protocols

PREVENTION Protocol (for Delta variant)

The I-MASK+ protocol has been updated several times and is now divided into I-PREVENT and I-CARE protocols. Below are their latest version (version 1.3: June 29, 2022).

PREVENTION PROTOCOL (I-PREVENT)

CHRONIC PREVENTION (In order of priority; not all required)

• Ivermectin: 0.2 mg/kg – start treatment with one dose, take second dose 48 hours later, then 1 dose every 7 days (weekly). Those at high risk of contracting COVID-19 can consider dosing twice a week. 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. For COVID treatment, ivermectin is best taken with a meal or just following a meal, for greater absorption. 
• Zinc: 30-40 mg daily. Zinc supplements come in various forms (e.g., zinc sulfate, zinc citrate and zinc gluconate). 
• Melatonin: Begin with 1 mg and increase as tolerated to 6 mg before bedtime (causes drowsiness). Slow- or extended-release formulations preferred. 
• Mouthwash: three 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™) or povidone-iodine (e.g. Betadine® Antiseptic Sore Throat Gargle™).
• Steam inhalation: once a day. Inhaled steam supplemented with antimicrobial essential oils (e.g., Vicks VapoRub™ inhalations) has been demonstrated to have virucidal activity. Antimicrobial essential oils include lavender, thyme, peppermint, cinnamon, eucalyptus and sage. 
• Vitamin D: dosing varies (see tables below). Vitamin D supplementation is likely a highly effective and cheap intervention to lessen the impact of this disease, particularly in vulnerable populations, (i.e., the elderly, obese, people of color, and those living in northern latitudes). The greatest COVID protection benefit from Vitamin D supplementation will occur in individuals deficient in Vitamin D. Those individuals should take Vitamin D prophylactically on a longer-term basis. When a person with Vitamin D deficiency develops COVID-19, risks increase for developing complications, and Vitamin D supplementation subsequent to infection will have less of a response. Dosing recommendations for Vitamin D supplementation vary widely. The optimal target is over 50 ng/ml; at this level the risk of dying from COVID-19 is extremely reduced. It may take many months or years to achieve optimal levels in patients who are extremely Vitamin D deficient. It is therefore important that the optimal regimen for Vitamin D supplementation for the prophylaxis of COVID-19 is provided promptly, based on baseline Vitamin D levels (see Table 2). If baseline levels are unknown, the needed dose can be calculated from body weight or BMI (see Table 3).
• 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. 
• Nigella sativa (black cumin): 80 mg/kg daily and Honey 1 g/kg daily. Note: thymoquinone (the active ingredient of Nigella sativa) decreases the absorption of cyclosporine and phenytoin. Patients taking these drugs should therefore avoid taking Nigella sativa. 
• Vitamin C: 500-1000 mg twice a day. 
• Quercetin (or a mixed flavonoid supplement): 250-500 mg daily. 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. 
• Probiotics. Low levels of Bifidobacterium may predispose a person to COVID-19 and increase disease severity. Likewise, COVID-19 depletes the microbiome of Bifidobacterium, which may then increase the severity and duration of symptoms. Kefir (a fermented milk drink) is high in Bifidobacterium and other probiotics that have demonstrated health benefits. Suggested probiotic supplements include Megasporebiotic (Microbiome labs), TrueBifidoPro (US Enzymes) and yourgutplus+.

Table 1. How to calculate ivermectin dose for chronic prevention

Table 1. How to calculate ivermectin dose for chronic prevention

Table 2. How to replenish Vitamin D levels based on baseline levels

Table 2. How to replenish Vitamin D levels based on baseline levels

Table 3. How to calculate Vitamin D dose when baseline not available

Table 3. How to calculate Vitamin D dose when baseline not available

POST-EXPOSURE PREVENTION

If symptoms develop, treat promptly with I-CARE protocol. If symptoms do not develop, resume chronic prevention after one week.

• Ivermectin: 0.4 mg/kg immediately, then repeat second dose in 48 hours. See Table 1 for help calculating dose. 
• Hydroxychloroquine (HCQ): 200 mg twice a day for 5 days. 
• Zinc: 75-100 mg daily. 
• Melatonin: 6 mg daily, at bedtime. 
• Mouthwash: three times a day. 
• Nasal spray with 1% povidone-iodine: two to three times a day. Sprays such as Immune Mist™, CoFix™ or IoNovo™ administered 2-3 times per day are recommended in post-exposure prophylaxis and in the early phase of COVID-19 infection. Due to low level systemic absorption, povidone-iodine nasal spray should not be used for longer than 5-7 days in pregnant women. IoNovo™ contains iodine in an amount equivalent to the daily dietary requirement and hence is safe to ingest. 
• Curcumin (turmeric): 500 mg twice a day for 1 week. Nigella sativa: 80 mg/kg daily for 1 week. 
• Vitamin C: 1000 mg twice daily for 1 week. 
• Quercetin: 500 mg twice daily for 1 week. 
• Probiotics. 
• B complex vitamins.

EARLY TREATMENT PROTOCOL (I-CARE)

For early outpatient protocol (COVID-19 positive), the Front Line COVID-19 Critical Care Working Group recommends:

FIRST LINE THERAPIES (In order of priority; not all required)

• Ivermectin: 0.3 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. 
• Zinc: 75-100 mg daily. Take with HCQ. Zinc supplements come in various forms (e.g., zinc sulfate, zinc citrate and zinc gluconate). 
• Mouthwash: three 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™) or povidone-iodine (e.g. Betadine® Antiseptic Sore Throat Gargle™).
• 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. 
• Aspirin: 325 mg daily (unless contraindicated). 
• 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. 
• Kefir and/or Bifidobacterium Probiotics. 
• Vitamin C: 500-1000 mg twice a day. 
• Quercetin (or a mixed flavonoid supplement): 250 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 – see Table 2). As supplemental quercetin has poor solubility and low oral absorption, lecithin-based and nanoparticle formulations are preferred.
• 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.

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.

• Nigella sativa (black cumin): 80 mg/kg daily and Honey 1g/kg daily. 
• Vitamin D3: 10,000 IU daily (two 5,000 IU capsules) for two weeks. 
• B complex vitamins. Nitazoxanide (NTZ): 600 mg twice a day for 5 days. 
• Fluvoxamine: 25-50 mg twice a day. Can substitute fluoxetine (Prozac; 20-40mg daily) if fluvoxamine not available. 
• 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.

Table 1. How to calculate ivermectin dose

Alternatives: 

• Optional: Xlear Nasal Spray with Xylitol: use twice a day (Ref) (Amazon)
• Optional: Azithromycin 250 mg twice a day. (Ref) (Find a Doctor). 
• Optional: Bromhexine 8 mg three times a day (Ref) (Lazada Malaysia*)

* Not available on Amazon

Related: 

• List of Doctors that will prescribe Ivermectin

• List of Pharmacies that will fill Ivermectin

For post-COVID or long COVID syndrome, check out Long Haulers Treatment Protocol. 

For an up-to-date overview of all published studies on ivermectin in the treatment and prevention of COVID-19 we recommend visiting c19ivermectin.com; in addition, a meta-analysis of all studies can be found at ivmmeta.com (constantly updated). For adoption and regulatory status of ivermectin globally, check out "Countries using Ivermectin".

About FLCCC Alliance

The Front Line COVID-19 Critical Care (FLCCC) Alliance was initially formed as a working group under “emergency” conditions of the early COVID-19 pandemic in response to multiple early reports of COVID patients with an inexplicably high need for prolonged mechanical ventilation and an excessive mortality associated with the prevailing “supportive care only” recommendations disseminated by the majority of national and international health care organizations.

As a group of highly published leaders in critical care with expertise in therapies directed at severe infections, in particular “HAT” therapy first developed by Dr. Paul Marik for the treatment of bacterial sepsis, and along with published high patient survival rates from our centers, we were contacted by equally concerned and motivated colleagues from other specialties.

Key Takeaway

Although ivermectin is a relatively safe drug, it's still a synthetic chemical that can have side effects and require a medical doctor's prescription. Vitamin D, C, Zinc and Quercetin are nutrients that your body require for optimal health. Nutrients are safer alternatives especially if your risk is low e.g. age below 50 with no other chronic illness. Discuss with your doctor on the benefit vs risk for each treatment.

Related: 

• Best Zinc Supplements

• CAN QUERCETIN, ZINC, VITAMIN C AND VITAMIN D HELP AGAINST CORONAVIRUS?

• Best Vitamin D3 Supplement

• Quercetin and Hydroxychloroquine

• Benefits of Quercetin Bromelain Supplements

Just so you know, we may earn commission from shopping links. We rely on your support to fund our expenditure across our network. 

Disclaimer: Always see your doctor before taking these supplements. Be aware that most of the dosages are above the recommended dietary allowance (RDA) and therefore such dosages should not be maintained on a long term basis. Our aim here isn't to replace your doctors' advice. It is intended as a sharing of knowledge and information. Do take note that supplements are not 100% protective or curative against COVID-19. 

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