FLCCC I-PREVENT COVID, FLU and RSV Protection Protocol (2023)

As rates of infection with influenza and RSV rose in fall/winter 2022, FLCCC adapted the I-PREVENT protocol to include prevention against these viruses. The interventions recommended are likely to reduce the risk and severity of infection with COVID-19, influenza, and RSV infections as well as the common cold. It should be noted that the medications included in the I-PREVENT protocol are inexpensive, safe, and widely available. This protocol includes a section for pre-exposure (long-term) as well as a post-exposure (acute, short-term).

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 return to our website at often to be sure you are using the latest version of this protocol.

The I-PREVENT protocol consists of inexpensive, safe, and widely available medications. Use these therapeutics in conjunction with an overall strategy that includes common sense public health actions like washing your hands, avoiding crowded gatherings, getting adequate ventilation, and other measures.

The following protocol can be used for both pre-exposure and post-exposure prevention. Follow post-exposure prevention if a household member is COVID-positive or if you have had prolonged exposure to COVID but have not developed symptoms. 

At the onset of any flu-like symptoms, please refer to the I-CARE Early COVID Treatment Protocol or I-CARE: RSV and Flu Treatment Protocols.

Note that there are two I-Prevent Protocols; the I-Prevent Covid protocol to prevent Covid and the I-Prevent Post vaccine protocol to prevent vaccine injury.

How to prevent infection before you’ve been exposed (Pre-exposure)

• Antiseptic antimicrobial mouthwash: gargle twice daily (do not swallow). Choose mouthwashes containing chlorhexidine, povidone-iodine, cetylpyridinium chloride (e.g., ScopeTM, ActTM, CrestTM), or the combination of eucalyptus, menthol, and thymol.
• Vitamin D: dosing varies; optimal target is greater than 50 ng/ml (Table 1) presents a safe and practical treatment schedule for raising serum concentrations in non-urgent situations. The dosing schedule illustrated in Table 2 should be used when recent serum concentration levels are unavailable.
• Vitamin C: 500 mg twice daily
• Zinc: 20-50 mg/day
• Commercial zinc supplements are commonly formulated as zinc oxide or salts with acetate, gluconate, and sulfate.
• Melatonin: 1-6 mg nightly (slow/extended)
• Begin with 1 mg and increase as tolerated to 6 mg at night. Causes drowsiness. Some patients are intolerant to melatonin, having very disturbing and vivid dreams; in these patients, it may be best to start with a 0.3 mg slow-release tablet and increase slowly, as tolerated.
• Elderberry syrup, supplements or gummies: follow manufacturer’s dosing recommendations
• Take during periods of high transmission of COVID-19, influenza, and RSV. A triple combination containing elderberry, Vitamin C, and zinc may be a convenient approach. Patients with autoimmune disease should take for 2 weeks or less and monitor their symptoms closely.
• Resveratrol or a Combination Flavonoid supplement: 400-500 mg daily
• The safety of resveratrol, quercetin, and pterostilbene has not been determined in pregnancy and they should therefore be avoided. Due to the possible drug interaction between quercetin and ivermectin, these drugs should not be taken simultaneously (i.e., should be staggered morning and night).
• Ivermectin: In the current situation of abundant natural immunity along with the recent circulation of less severe and more highly transmissible variants, chronic weekly or Twice weekly ivermectin prophylaxis is no longer applicable to most people. The following prophylaxis approaches with ivermectin can be considered and applied based on patient preference, comorbid status, immune status, and in discussion with their provider:
• Twice weekly ivermectin at 0.2mg/kg; can be considered in those with significant comorbidity and lack of natural immunity or immunosuppressive states or those with long COVID or post-vaccine syndrome who are not already on ivermectin as treatment
• Daily ivermectin just prior to and during periods of high possible exposure such as travel, weddings, conferences, etc.
• Immediate initiation of daily ivermectin at treatment doses (0.4mg/kg) upon first symptoms of a viral syndrome

Table 1. Guidance on Upfront Loading Dose Regimens to Replenish Vitamin D Stores in the Body

When serum vitamin D levels are available, the doses provided in this table can be used for the longer-term maintenance of serum 25(OH)D concentration above 50 ng/mL (125 nmol/L). The table provides the initial bolus dose, weekly dose, frequency, and the duration of administration of oral vitamin D in non-emergency situations, in a non-obese, 70 kg adult. *

^* A suitable daily or weekly maintenance dose to be started after completing the loading-dose schedule. The dose should be adjusted for those who are overweight (higher) or underweight (lower).
^** To convert ng/mL to nmol/L, multiply the amount in ng by 2.5; One µg = 40 IU.
^$ Mentioned replacement doses can be taken as single, cumulative doses, two to three times a week spread out over a few weeks.
^$$ From the day one of week two onwards.
^# Estimated total Vitamin D dose needed to replenish the body stores (i.e., the deficit) is provided in the last column.

(Table adapted with permission from S.J. Wimalawansa)

Table 2. Vitamin D Dosing in the Absence of a Baseline Vitamin D Level

Longer-term maintenance schedules of oral vitamin D based on body weight to maintain the levels above 50 ng/mL (125 nmol/L) when the serum 25(OH)D concentrations are unknown.

^* Example of a daily or once-a-week dose range for adults with specific body types (based on BMI for white Caucasians and body weight for other ethnic groups). Appropriate dose reductions are necessary for children.
^# For those with chronic comorbid conditions, such as hypertension, diabetes, asthma, COPD, CKD, depression, and osteoporosis, and to reduce all-cause mortality, higher doses of vitamin D are needed. For them, one can use the doses that are recommended for persons with obesity (BMI, 30–39: the third row).
^$ Those with multiple sclerosis, cancer, migraine headaches, and psoriasis, and those routinely taking medications such as anti-epileptic and anti-retroviral agents that significantly increase the catabolism of vitamin D should consider taking age-appropriate doses recommended for those with morbid obesity (BMI ≥ 40; the higher end of the daily doses in the fourth row).

(Table adapted with permission from S.J. Wimalawansa)

How to prevent infection if you have potentially been exposed (Post-exposure)

• Naso-Oropharyngeal hygiene (Nasal Spray and Mouthwash): 2-3 times daily
• The combination of nasal antiseptic sprays and oropharyngeal mouthwashes is strongly suggested. Choose a nasal spray with 1% povidone-iodine (for example Immune Mist™, CofixRX™ or Ionovo™) and a mouthwash containing chlorhexidine, povidone-iodine, cetylpyridinium chloride (e.g., Scope™, Crest™ or Act™), or the combination of eucalyptus, menthol, and thymol (Listerine™).
• Elderberry: four times daily as per manufacturer’s directions for 1 week (gummy, supplement, or syrup)
• Vitamin C: 500-1000 mg four times daily for 1 week
• Elemental Zinc: 50-90 mg daily for 1 week
• Melatonin: 2-5 mg at night (slow/extended release)
• Resveratrol/Combination Flavonoid supplement: 500 mg twice daily
• A flavonoid combination containing resveratrol, quercetin and pterostilbene is recommended.

Optional with documented exposure to COVID-19 (positive test):

• Ivermectin: 0.4 mg/kg immediately, then repeat second dose in 24 hours;

AND

• Hydroxychloroquine (HCQ): 200 mg twice a day for 5 days.

OR

• Nitazoxanide: 500-600 mg twice daily for 5 days

Table 3. 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.

FLCCC protocols

The Front Line COVID-19 Critical Care Alliance has also developed other protocols aimed at early treatment, prevention (post-vaccine), long-haul COVID treatment, post-vaccine recovery and hospital treatment. 

DISCLAIMER

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 FLCCC full disclaimer at: www.flccc.net/disclaimer

Related: 

• List of Doctors that will provide early treatment for COVID-19

• List of Pharmacies that will fill Ivermectin