PreprintPDF Available

SUB-ACUTE AND CHRONIC COVID: THERAPEUTIC PLAN FOR PATIENTS WITH PERSISTENT SYMPTOMS OF COVID.

Authors:
Preprints and early-stage research may not have been peer reviewed yet.

Abstract and Figures

THERAPEUTIC PLAN FOR COVID-19. In the first document on the use of IVM in COVID that we made available on May 2, 2020 (11), based on the publications and clinical experience to that date, a Therapeutic Plan for COVID-19 was established in which they are indicated 3 main Therapeutic Lines of Action. As for Sub-Acute and Chronic COVID (or Persistent COVID or Long COVID), as it is a continuation of the same COVID disease, in general this Therapeutic Plan is maintained with the 3 Therapeutic Lines of Action indicated for Acute COVID (see Table 1). But it must be taken into account that in Sub-Acute and Chronic COVID there is a greater problem in what corresponds to the destruction of clots. It happens that there is an inhibition or arrest of the body's Fibrinolysis System, that is, the physiological system does not work to destroy clots, so the clots do not break down and persist, causing hypoperfusion in tissues and cells. Routine clotting tests more frequently are normal. Specific tests are required to identify if there is an arrest of the fibrinolysis system, such as viscoelastic tests (TEG, ROTEM, Quantra, Sonoclot, iCoagLab and others). TREATMENT SCHEMES FOR PERSISTENT SYMPTOMS OF COVID. After evaluating a patient with Persistent Symptoms of COVID, in a majority group of patients the clinical-epidemiological diagnosis of Sub-Acute or Chronic COVID Syndrome will be established, as the next step it is indicated to request diagnostic aid tests to confirm that there is a Persistent Intracellular Infection by the SARS CoV-2 virus, but as already explained, to date within the conventional tests available, there are no tests to identify the presence of viral load in intracellular locations. Taking into account that IVM is a low-cost drug, without significant side effects and wich as decades of experience in its use in humans, What we have indicated since May 2020 is a Treatment Scheme that includes IVM, for Sub-Acute and Chronic COVID. We present this First Treatment Scheme as a "Therapeutic Test" to be used in patients with Persistent Symptoms of COVID. In the medical field, Therapeutic Tests have been used for several decades as a diagnostic aid in various diseases. In the case of Sub-Acute and Chronic COVID, the objective is to support the Diagnosis of a Persistent Infection by SARS CoV-2 We must mention that a large part of the decision to give the name of "Therapeutic Test" to this intervention is due to the fact that by mid-2020 the vast majority of the scientific community did not accept that the SARS CoV-2 virus persisted longer than 10 days. The high percentage of patients that we have observed that respond favorably to this "Therapeutic Test" supports its usefulness as to assist the diagnosis and supports the existence of viral persistence in most of the patients with Persistent COVID Symptoms. "THERAPEUTIC TEST" AND FIRST TREATMENT SCHEME FOR PATIENTS WITH PERSISTENT SYMPTOMS OF COVID. In September 2020, the First Treatment Scheme to be used in patients with Persistent Symptoms of COVID (21) was made available, and in which the 3 Lines of Action of the Therapeutic Plan for Sub-Acute and Chronic COVID are covered: 1) Reduce Viral Load: with IVERMECTIN. 2) Reduce Platelet Hyperactivity and Break down Persistent Clots and Biofilms: with ASA. 3) Treat Nutrient Depletion, Oxidative Stress and Immune Dysfunctions: included FAMOTIDINE, SODIUM BICARBONATE and a DIET low in Arginine and Histamine and high in Lysine and Vitamin D. The First Line of Action of the Therapeutic Plan for COVID-19 is the main one, and it is aimed at reducing the Viral Load, this action should be emphasized, since it is directed to the cause that triggers the problems that encompass the other 2 lines of action. Regarding the doses to be given of each drug in the "Therapeutic Test", we have already published this in detail in a previous document (19). Table 2 shows the consolidated indications for this First Treatment Scheme or "Therapeutic Test" for patients with Persistent Symptoms of COVID. RESULTS OF THE APPLICATION OF THE "THERAPEUTIC TEST" IN 390 PATIENTS WITH PERSISTENT SYMPTOMS OF COVID. In our experience of 390 patients with Persistent Symptoms of COVID who received a clinical epidemiological diagnosis of Sub-Acute or Chronic COVID Syndrome, and the "Therapeutic Test" was applied, at the end of the 6 to 16 days that the Test last, it was obtained as a result that: - 83% of the patients presented an improvement in symptoms of between 40 to 100%, which means that the “Therapeutic Test” was Positive (see Table 3); - In 11% of the cases the improvement in symptoms was between 5% and 39%; - In 6% there was either no improvement (0%) or almost no improvement (1 to 4%), interpreting in the latter group that the test was Negative. The objectives of applying the "Therapeutic Test" are, on the one hand, to serve as a diagnostic aid test, and on the other hand to serve as a treatment. Regarding its usefulness as a diagnostic aid test: The results that we have obtained and that are shown in Table 3, support that the main cause of the diagnosis of Persistent Symptoms of COVID or of Post Acute and Chronic COVID Syndrome or Long COVID, is a Persistent Infection by SARS CoV-2. It is also important to bear in mind that a Negative result of this Test would indicate that it is not a persistent SARS CoV-2 infection, so in these cases other possible causes should be investigated. Regarding its usefulness as a treatment: At the end of taking the 6 days of drugs of the “Therapeutic Test”, the patients who resulted in an improvement of 40% to 99% of All the symptoms, they were instructed to continue taking all the medications, this while they observe that the medications generate an improvement in their symptoms. The patients were specified to continue every day until one of the following 2 situations occurs: - Up to 4 days after achieving a complete (100%) improvement in symptoms, or - Until you notice that you no longer show improvement with treatment, and up to the a maximum of 10 additional days of treatment (16 days in total). INCREASED DOSE OF DRUGS AGAINST VIRAL LOAD DUE TO SARS COV-2 MUTATIONS. It should be taken into account that the SARS CoV-2 virus is constantly mutating within the body of people who have a persistent infection. Since 2021, infections due to Variants of SARS CoV-2 predominate, and in medical practice we have observed that, for the treatment of Acute COVID due to Variants, higher doses, more days of treatment and a greater number of medications given at the same time are required. Similar to Acute COVID, in Sub-Acute and Chronic COVID, it has been necessary to increase the daily doses and days of treatment of drugs against Viral Load, such as IVM, Nitaxozanide and Zinc. What is understood to happen is that the Viral Load mutates rapidly and develops more and more resistance to the drugs to which it is exposed. TREATMENT SCHEME TO FOLLOW AFTER APPLYING THE “THERAPEUTIC TEST” FOR PERSISTENT SYMPTOMS OF COVID. After having finished applying the "Therapeutic Test" or First Treatment Scheme, using IVM, ASA, Famotidine, Sodium Bicarbonate and the described diet, according to our experience, 25% or more of the patients will still present Persistent Symptoms of COVID. Adormecimiento, entumecimiento, In these cases, it should be evaluated if they are symptoms associated with the presence of tissue hypoperfusion, these symptoms are mainly: 1) Fatigue or weakness that increases with activity and effort, 2) Mental fog, 3) Dyspnea or shortness of breath , 4) Tachycardia, 5) Stiffness and joint pain in the fingers of one or both hands when waking up from bed, 6) Numbness, numbness, tingling or cold in the hands and feet, 7) Chilblains, erythema perneum or COVID Fingers, on all in the feet, 8) Acrocyanosis or bluish discoloration of the hands and feet, which mainly affects the fingers and 9) Symptoms associated with orthostatic intolerance (when standing up). If the patient has 2 or more of the mentioned symptoms, a D-dimer analysis should be performed. If found elevated, this result gives the diagnosis of the presence Persistent Clots. In the event that his D-dimer is normal (less than 0.5 ug/ml), or slightly increased (up to 0.6 ug/ml), the recommendation is that the patient perform another Therapeutic Test, which is what we have established as an aid to the diagnosis of Persistent Clots. This Test consists of taking 1 Antiplatelet, 1 Fibrinolytic and an H2 Blocker for 6 days, and on the 7th day the patient must undergo a new D-Dimer analysis. The test is POSITIVE if there is an improvement in symptoms associated with hypoperfusion of 3 or more points out of 10 (or > 30%), and/or the D-Dimer increases more than 30% compared to the previous analysis. A Positive Test indicates that there are Persistent Clots, which in turn are formed by a persistent infection. Then the patient would be given the diagnosis of: Persistent Infection by SARS CoV-2 with the presence of Persistent Clots. In these cases, due to the fact that, with the First Scheme or "Therapeutic Test" the recovery of the patient was not achieved, we indicate a Scheme that contains at least 3 medications or supplements for each of the 3 Lines of action of the Therapeutic Plan (in addition of the Diet already described). That is, it is included in the Scheme at least: 1) 3 drugs against Viral Load, 2) 3 drugs against platelet hyperactivity and persistent clots and biofilms. 3) 3 drugs against nutrient depletion, oxidative stress and immune dysfunctions. Giving 3 or more medications or suplements against Viral Load corresponds to a Treatment Scheme prepared for cases in which the patient's recovery was not achieved by applying Schemes that included 1 or 2 medications against Viral Load. In these cases, it should be suspected that the low or partial response to treatment is due to a lower sensitivity, or greater resistance acquired by the Viral Load, and that the Viral Load may also be hidden or protected by clots and fibrin deposits or amyloid, and/or that there is Viral Load in sites with immune privilege within the body, where immunity and medications do not adequately reach. So, Schemes that include 3 or more drugs against Viral Load, correspond to Treatment Schemes for patients with: Drug-Resistant and Undercover Viral Load. Designation of the Scheme to follow. To give a name to the Treatment Scheme to follow, we will use 3 numbers. Each number indicates the amount of medications or supplements for each of the 3 Lines of Action of the Therapeutic Plan. The minimum Treatment Scheme would be the one that includes 3 drugs from each Line of Action. In this case, the Scheme is called 3-3-3 and it is the recommended Scheme for cases in which persistent symptoms are mild and the patient can carry out activities of daily living almost normally. In the event that the symptoms associated with hypoperfusion are moderate or severe, in such a way that the patient is limited, and cannot carry out his activities of daily life normally, it is recommended to apply a Scheme with a greater number of medications or supplements. According to the number of drugs in each Action Line, the Scheme will be given a name. Thus we have, Schemes 3-6-6, 3-6-9, 6-6-9 and 6-9-9. Duration of the Scheme. The duration established for the first part of this Scheme is 8 days, 8 days, being able extend up to a total of 36 continuous days. which can be extended to a total of 36 continuous days. The patient must take all the drugs included in the Scheme for 8 days. The day after finishing taking the 8 days of medications, the patients who result, with an improvement of 40% to 99% of all symptoms, are instructed to continue taking every day, the medications indicated in the 8th day, this while observing that the treatment generates an improvement in their symptoms, and they should continue with the treatment until one of the following 2 situations occurs: o Up to 6 days after achieving total (100%) improvement in symptoms, or o Until you notice that you no longer show improvement with treatment, and up to a maximum of 28 additional days of treatment, which is equivalent to a cumulative 36 days. In patients who, on the ninth day after starting the Scheme, achieve 100% improvement in all their symptoms, the recommendation is that, from that day on, they take IVM at a dose of 0.2 mg per kilo of weight per day, and until completing 4 additional days, that is, take the same ninth day and 3 more days at a dose of 0.2 mg per kilo, which would add up to a total of 12 days from the start of the Scheme. In addition to IVM, the patient must continue taking the other medications in the Schedule for an additional 2 days, which would add 10 days of taking these medications. RECOMMENDED DRUGS TO INCLUDE IN THE SCHEME TO FOLLOW AND ITS ALTERNATIVES. Table 4 shows the drugs that, based on scientific references and our experience, we consider to be the first options to include a 3-3-3 Treatment Scheme. In the following paragraphs, the doses of each drug or supplement included in the 3-3-3 Treatment Scheme described in Table 4, and the main alternatives are described. Other possible alternatives are also mentioned, but without further detail. 1ST LINE OF ACTION OF THE THERAPEUTIC PLAN: REDUCE THE VIRAL LOAD: In Sub-Acute and Chronic COVID, the first day of the Treatment Scheme begins with the drugs of the 2nd Line of Action, the drugs against viral load are not yet taken. It is from day 2 to day 8 of the Scheme (7 days in total), that medications aimed at reducing viral load are taken.
Content may be subject to copyright.
1
Sub-Acute and Chronic COVID:
THERAPEUTIC PLAN FOR PATIENTS WITH PERSISTENT SYMPTOMS
OF COVID.
In a similar way as in Acute COVID, treatments against Viral Load and Persistent
Clots are the main Lines of Action of the Therapeutic Plan.
Aguirre-Chang, Gustavo and Trujillo Aurora. ResearchGate. April 30, 2021.
PERSISTENT INFECTION BY SARS COV-2.
The existence of Persistent Infection by SARS CoV-2 is being evidenced in several
scientific publications (1-10), of this we have had no doubts since April 2020 when we
began to treat for COVID-19 and we carried out our first report of cases on a effective
treatment in Acute COVID (11), in said document, in the reported cases it is mentioned
and an estimate of the tendency to develop a Persistent Infection is made, which depends
both on factors of the virus, as well as the host organism.
The first study to report cases of patients with Persistent Symptoms of COVID or Long
COVID (12) was carried out based on patients we treated between the months of May and
June of the year 2020.
Unlike Acute COVID, the viral load in Persistent SARS CoV-2 Infection is not concentrated
mainly in the upper respiratory tract, but a disseminated infection occurs at the level of the
blood vessels, which causes the affectation of the organs and systems, which have a
higher requirement of oxygen and nutrients, which are the muscles, brain, heart and lungs,
and it can also affect the blood circulation of the hands and feet and especially of the more
distal structures that are the fingers (2,4,13,14,15).
Due to the fact that it is a viral load located at the intracellular level, it is very unlikely that
the diagnosis can be made with currently available molecular tests using samples of
secretions from the nasopharynx and oropharynx (16,17).
DIAGNOSIS OF PERSISTENT INFECTION BY SARS COV-2.
In our medical practice, the diagnosis of a Persistent SARS CoV-2 Infection is based first
on clinical and epidemiological criteria.
What is identified after the first medical evaluation is the presence of Persistent Symptoms
of COVID, and these must be differentiated from other causes of the symptoms, mainly
the coexistence of other pathologies (infectious and non-infectious), alteration of the
intestinal microbiota and other microbiota (pulmonary, upper respiratory, renal, vascular,
etc.), nutrient depletion, immune dysfunctions and sequelae.
After having made the clinical-epidemiological diagnosis, the conventional medical
procedure tells us that we must resort to diagnostic aid tests.
At this point, we must point out that there are several types of conventional tests that can
be useful for the diagnosis of other infectious diseases that have already been known for
years, but for a new infectious disease and still partially understood as COVID: Sub-Acute
and Chronic, to date, adequate diagnostic aid tests have not yet been developed for its
diagnosis, it would be understood that, first, the scientific community must advance in the
knowledge of its etiopathogenesis and according to this progress new procedures will be
generated to be able to carry out its diagnosis
Conventional Molecular Tests of secretions of nasal and oropharyngeal mucosa.
To date, to detect the etiological agent that is the SARS CoV-2 virus, there are molecular
tests (PCR) based on secretions of nasal and oropharynx simples taken with swabs.
But these tests are not very useful for the diagnosis of intracellular infections, therefore, it
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
2
is expected that they will be negative if requested in a patient with Sub-Acute and Chronic
COVID (16).
What is indicated in patients with Persistent Symptoms of COVID, is that they undergo
molecular tests using samples that contain cells and not secretions. A cytological (cell)
sample can be obtained using a cytobrush at the level of the olfactory mucosa located in
the upper part of the nasal cavity. A sample of blood cells can also be obtained by
centrifuging the blood and using the layer of leukocytes and platelets that forms after
centrifugation.
THERAPEUTIC PLAN FOR COVID-19.
In the first document on the use of an effective drug against the Viral Load in COVID that
we made available on May 2, 2020 (11), based on the publications and clinical experience
to that date, a Therapeutic Plan for COVID-19 was established in which there are indicated
3 Therapeutic Lines of Action.
As for Sub-Acute and Chronic COVID (or Persistent COVID or Long COVID), as it is a
continuation of the same COVID disease, in general this Therapeutic Plan is maintained
with the 3 Lines of Action indicated for Acute COVID (see Table 1).
Table 1
But it must be taken into account that in Sub-Acute and Chronic COVID there is a greater
problem in what corresponds to the destruction of clots. It happens that there is an
inhibition or arrest of the body's Fibrinolysis System, that is, the physiological system does
not work to destroy clots [14], so the clots do not break down and persist, causing
hypoperfusion in tissues and cells.
Routine clotting tests more frequently are normal. Specific tests are required to identify if
there is an arrest of the fibrinolysis system, such as viscoelastic tests (TEG, ROTEM,
Quantra, Sonoclot, iCoagLab and others).
TREATMENT SCHEMES FOR PERSISTENT SYMPTOMS OF COVID.
After evaluating a patient with Persistent Symptoms of COVID, in a majority group of
patients the clinical-epidemiological diagnosis of Sub-Acute or Chronic COVID Syndrome
will be established, as the next step it is indicated to request diagnostic aid tests to confirm
that there is a Persistent Intracellular Infection by the SARS CoV-2 virus, but as already
explained, to date within the conventional tests available, there are no tests to identify the
presence of viral load in intracellular locations.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
3
Taking into account that IVM is a low-cost drug, without significant side effects and which
has decades of experience in its use in humans, What we have indicated since May 2020
is a Treatment Scheme that includes IVM, for Sub-Acute and Chronic COVID.
We present this First Treatment Scheme as a "Therapeutic Test" to be used in patients
with Persistent Symptoms of COVID.
In the medical field, Therapeutic Tests have been used for several decades as a diagnostic
aid in various diseases.
In the case of Sub-Acute and Chronic COVID, the objective is to support the Diagnosis of
a Persistent Infection by SARS CoV-2
We must mention that a large part of the decision to give the name of "Therapeutic Test"
to this intervention is due to the fact that by mid-2020 the vast majority of the scientific
community did not accept that the SARS CoV-2 virus persisted longer than 10 days.
The high percentage of patients that we have observed that respond favorably to this
"Therapeutic Test" supports its usefulness to assist the diagnosis and supports the
existence of viral persistence in most of the patients with Persistent COVID Symptoms.
"THERAPEUTIC TEST" AND FIRST TREATMENT SCHEME FOR PATIENTS WITH
PERSISTENT SYMPTOMS OF COVID.
In September 2020, the First Treatment Scheme to be used in patients with Persistent
Symptoms of COVID (21) was made available, and in which the 3 Lines of Action of the
Therapeutic Plan for Sub-Acute and Chronic COVID are covered:
1) Reduce Viral Load: with IVERMECTIN.
2) Reduce Platelet Hyperactivity and Break down Persistent Clots and Biofilms: with ASA.
3) Treat Nutrient Depletion, Oxidative Stress and Immune Dysfunctions: included
FAMOTIDINE, SODIUM BICARBONATE and a DIET low in Arginine and Histamine
and high in Lysine and Vitamin D.
The First Line of Action of the Therapeutic Plan for COVID-19 is the main one, and it is
aimed at reducing the Viral Load, this action should be emphasized, since it is directed to
the cause that triggers the problems that encompass the other 2 lines of action.
Regarding the doses to be given of each drug in the "Therapeutic Test", we have already
published this in detail in a previous document (19).
Table 2 shows the consolidated indications for this First Treatment Scheme or
"Therapeutic Test" for patients with Persistent Symptoms of COVID.
RESULTS OF THE APPLICATION OF THE "THERAPEUTIC TEST" IN 390 PATIENTS
WITH PERSISTENT SYMPTOMS OF COVID.
In our experience of 390 patients with Persistent Symptoms of COVID who received a
clinical epidemiological diagnosis of Sub-Acute or Chronic COVID Syndrome, and the
"Therapeutic Test" was applied, at the end of the 6 to 16 days that the Test last, it was
obtained as a result that:
- 83% of the patients presented an improvement in symptoms of between 40 to 100%,
which means that the “Therapeutic Test” was Positive (see Table 3);
- In 11% of the cases the improvement in symptoms was between 5% and 39%;
- In 6% there was either no improvement (0%) or almost no improvement (1 to 4%),
interpreting in the latter group that the test was Negative.
The objectives of applying the "Therapeutic Test" are, on the one hand, to serve as a
diagnostic aid test, and on the other hand to serve as a treatment.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
4
Table 2
Table 3
RESULTS OF THE APPLICATION OF THE "THERAPEUTIC TEST"
TO ASSIST THE DIAGNOSE OF PERSISTENT VIRAL INFECTION
IN 390 PATIENTS WITH PERSISTENT SYMPTOMS OF COVID
% IMPROVEMENT
OF THE SYMPTOM
% OF
PATIENTS
RESULTING FROM THE
"THERAPEUTIC TEST"
40% a 100%
83%
POSITIVE
5 a 39 %
11%
INTERMEDIATE
0 a 4%
6%
NEGATIVE
Regarding its usefulness as a diagnostic aid test:
The results that we have obtained and that are shown in Table 3, support that the main
cause of the diagnosis of Persistent Symptoms of COVID or of Post Acute and Chronic
COVID Syndrome or Long COVID, is a Persistent Infection by SARS CoV-2.
It is also important to bear in mind that a Negative result of this Test would indicate that it
is not a persistent SARS CoV-2 infection, so in these cases other possible causes should
be investigated.
Regarding its usefulness as a treatment:
At the end of taking the 6 days of drugs of the “Therapeutic Test”, the patients who resulted
in an improvement of 40% to 99% of All the symptoms, they were instructed to continue
taking all the medications, this while they observe that the medications generate an
improvement in their symptoms.
The patients were specified to continue every day until one of the following 2 situations
occurs:
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
5
- Up to 6 days after achieving a complete (100%) improvement in symptoms, or
- Until you notice that you no longer show improvement with treatment, and up to the
a maximum of 10 additional days of treatment (16 days in total).
INCREASED DOSE OF DRUGS AGAINST VIRAL LOAD DUE TO SARS COV-2
MUTATIONS.
It should be taken into account that the SARS CoV-2 virus is constantly mutating within
the body of people who have a persistent infection.
Since 2021, infections due to Variants of SARS CoV-2 predominate, and in medical
practice we have observed that, for the treatment of Acute COVID due to Variants, higher
doses, more days of treatment and a greater number of medications given at the same
time are required.
Similar to Acute COVID, in Sub-Acute and Chronic COVID, it has been necessary to
increase the daily doses and days of treatment of drugs against Viral Load, such as IVM,
Nitaxozanide and Zinc.
What is understood to happen is that the Viral Load mutates rapidly and develops more
and more resistance to the drugs to which it is exposed.
TREATMENT SCHEME TO FOLLOW AFTER APPLYING THE “THERAPEUTIC TEST”
FOR PERSISTENT SYMPTOMS OF COVID.
After having finished applying the "Therapeutic Test" or First Treatment Scheme, using
IVM, ASA, Famotidine, Sodium Bicarbonate and the described diet, according to our
experience, 25% or more of the patients will still present Persistent Symptoms of COVID.
In these cases, it should be evaluated if they are symptoms associated with the presence
of tissue hypoperfusion, these symptoms are mainly: 1) Fatigue or weakness that
increases with activity and effort, 2) Mental fog, 3) Dyspnea or shortness of breath , 4)
Tachycardia, 5) Stiffness and joint pain in the fingers of one or both hands when waking
up from bed, 6) Numbness, tingling, paleness or cold in the hands and feet, 7) Chilblains,
erythema perneum or COVID Fingers, on all in the feet, 8) Acrocyanosis or bluish
discoloration of the hands and feet, which mainly affects the fingers and 9) Symptoms
associated with orthostatic intolerance (when standing up). If the patient has 2 or more of
the mentioned symptoms, a D-dimer analysis should be performed. If found elevated, this
result gives the diagnosis of the presence Persistent Clots.
In the event that his D-dimer is normal (less than 0.5 ug/ml), the recommendation is that
the patient perform another Therapeutic Test, which is what we have established as an
aid to the diagnosis of Persistent Clots.
This Test consists of taking 1 Antiplatelet, 1 Fibrinolytic and an H2 Blocker for 6 days, and
on the 7th day the patient must undergo a new D-Dimer analysis.
The test is POSITIVE if there is an improvement in symptoms associated with
hypoperfusion of 3 or more points out of 10 (or > 30%), and/or the D-Dimer increases more
than 30% compared to the previous analysis.
A Positive Test indicates that there are Persistent Clots, which in turn are formed by a
persistent infection. Then the patient would be given the diagnosis of: Persistent Infection
by SARS CoV-2 with the presence of Persistent Clots.
In these cases, due to the fact that, with the First Scheme or "Therapeutic Test" the
recovery of the patient was not achieved, we indicate a Scheme that contains at least 3
medications or supplements for each of the 3 Lines of action of the Therapeutic Plan (in
addition of the Diet already described). That is, it is included in the Scheme at least:
1) 3 drugs to Reducr Viral Load,
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
6
2) 3 drugs to Reduce Platelet Hyperactivity and Persistent Clots and Biofilms.
3) 3 drugs to Treat Nutrient Depletion, Oxidative Stress and Immune Dysfunctions.
Giving 3 or more medications or suplements against Viral Load corresponds to a
Treatment Scheme prepared for cases in which the patient's recovery was not achieved
by applying Schemes that included 1 or 2 medications against Viral Load.
In these cases, it should be suspected that the low or partial response to treatment is due
to a lower sensitivity, or greater resistance acquired by the Viral Load, and that the Viral
Load may also be hidden or protected by clots and fibrin deposits or amyloid, and/or that
there is Viral Load in sites with immune privilege within the body, where immunity and
medications do not adequately reach.
So, Schemes that include 3 or more drugs against Viral Load, correspond to Treatment
Schemes for patients with: Drug-Resistant and Undercover Viral Load.
Designation of the Scheme to follow.
To give a name to the Treatment Scheme to follow, we will use 3 numbers. Each number
indicates the amount of medications or supplements for each of the 3 Lines of Action of
the Therapeutic Plan.
The minimum Treatment Scheme would be the one that includes 3 drugs from each Line
of Action. In this case, the Scheme is called 3-3-3 and it is the recommended Scheme for
cases in which persistent symptoms are mild and the patient can carry out activities of
daily living almost normally.
In the event that the symptoms associated with hypoperfusion are moderate or severe, in
such a way that the patient is limited, and cannot carry out his activities of daily life
normally, it is recommended to apply a Scheme with a greater number of medications or
supplements.
According to the number of drugs in each Action Line, the Scheme will be given a name.
Thus we have, Schemes 3-6-6, 3-6-9, 6-6-9 and 6-9-9.
Duration of the Scheme.
The duration established for the first part of this Scheme is 8 days, 8 days, being able
extend up to a total of 36 continuous days.
which can be extended to a total of 36 continuous days.
The patient must take all the drugs included in the Scheme for 8 days.
The day after finishing taking the 8 days of medications, the patients who result, with an
improvement of 40% to 99% of all symptoms, are instructed to continue taking every day,
the medications indicated in the 8th day, this while observing that the treatment generates
an improvement in their symptoms, and they should continue with the treatment until one
of the following 2 situations occurs:
o Up to the same number of days that you required to achieve total (100%) improvement
in symptoms. For example, if it took 15 days to recover, it will require 15 more days of
treatment, with the aim of not presenting a reactivation or rebound of the symptoms.
o Until you notice that you no longer show improvement with treatment, and up to a
maximum of 28 additional days of treatment, which is equivalent to a cumulative 36
days.
In patients who, on the ninth day after starting the Scheme, achieve 100% improvement in
all their symptoms, the recommendation is that, from that day on, they take IVM at a dose
of 0.2 mg per kilo of weight per day, and until completing 4 additional days, that is, take
the same ninth day and 3 more days at a dose of 0.2 mg per kilo, which would add up to
a total of 12 days from the start of the Scheme.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
7
In addition to IVM, the patient must continue taking the other medications in the Schedule
for an additional 2 days, which would add 10 days of taking these medications.
RECOMMENDED DRUGS TO INCLUDE IN THE SCHEME TO FOLLOW AND ITS
ALTERNATIVES.
Table 4 shows the drugs that, based on scientific references and our experience, we
consider to be the first options to include a 3-3-3 or 3 x 3 Treatment Scheme.
In the following paragraphs, the doses of each drug or supplement included in the 3-3-3
Treatment Scheme described in Table 4, and the main alternatives are described. Other
possible alternatives are also mentioned, but without further detail.
Table 4
3-3-3 TREATMENT SCHEME FOR PATIENTS WITH CHRONIC COVID
OR LONG COVID WITH VIRAL LOAD DRUG-RESISTANT AND UNDERCOVER
(WHO DID NOT REACH RECOVER WITH THE FIRST TREATMENT SCHEME)
1st Line of Action: REDUCE THE VIRAL LOAD:
1.1 IVM (or Monolaurin, Pyronaridine+Artesunate, Pelargonium, MOX).
1.2 NITAZOXANIDE (or Root of LITHOSPERMUM ERYTHRORHIZON or GROMWELL:
Tollovid or powdered, Ozono therapy, HOCTT, IVIG, last mAbs, Chinese Skullcap
or Baicalin, Niclosamide, Hydrogen Peroxide, Lactoferrin, Woad or Isatis, Green
tea or EGCG, Dan-shen, Hyperthermia with Far Infrared Sauna).
1.3 ZINC (or Black Seed Oil: Nigella sativa, Vitamin C, Rutin, Plitidepsin, Nirmatrelvir+
Ritonavir, Spironolactone, Turmeric, Olive Leaf Extract, Licorice or Glycyrrhiza).
2nd Line de Action: REDUCE PLATELET HYPERACTIVITY AND BREAK DOWN
PERSISTENT CLOTS AND BIOFILMS:
2.1. ANTIPLATELET: ASA, or LASA: Lysine Acetylsalicylate, or LASAG: + Glicine
(or Clopidogrel, Ginger, Dipyridamole, Garlic, Policosanol, Taxifolin, Naringin).
2.2. FIBRYNOLYTIC: SERRAPEPTASE and/or LYSINE (or LUMBROKINASE,
NATTOKINASE, Bromelain, Seaprose S, Thrombolytics IV, NAC, Pentoxifylline).
2.3. ANTICOAGULANT or Alternative: APIXABAN (or LMWH, Rivaroxaban, E-EPA
or EPA, OMEGA 3, Liposomal Glutathione, Piracetam, Colchicine, ALA).
3ra Line de Action: TREAT NUTRIENT DEPLETION, OXIDATIVE STRESS AND
IMMUNE DYSFUNCTIONS:
3.1. B COMPLEX VITAMINS: Vit. B12 (sublingual or in intramuscular ampoule), B1 or
Derivatives, B6, B3 or Derivatives, and B9 (Folic Acid or Folinic Acid).
3.2. FAMOTIDINE (or Baking Soda or Sodium and/or Potassium Bicarbonate).
3.3. ANTIHISTAMINES: 1 Classic 1st Generation H1 Blocker is indicated before
bedtime (Diphenhydramine or Hydroxyzine or Promethazine), 1 Derivate
(Dimenhydrinate or Cinnarizine) and, 1 2nd or 3rd Generation H1 Blocker at
breakfast and lunch (Fexofenadine, Desloratadine, Acrivastine or Rupatadine). It
can also include: Quercetin, Luteolin and/or Sodium Cromoglycate.
Additional indications:
1. The risk of hemorrhage must be previously evaluated.
2. Diet low in Histamine and Arginine, and high in Lysine, Vitamin D, Magnesium.
Avoid Coffee, sodas, caffeinated or lactated drinks
3. If the patient presents on the first or second day a Herx-type inflammatory reaction
that cannot be tolerated, the medications of the 1st and the 2nd Line of Action
should be suspended, and these will be resumed one by one and according to the
tolerance that the patient presents.
Source: Aguirre-Chang Gustavo and Trujillo Aurora. Sub-Acute and Chronic COVID:
Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate. April, 2021.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
8
1ST LINE OF ACTION OF THE THERAPEUTIC PLAN: REDUCE THE VIRAL LOAD:
In Sub-Acute and Chronic COVID, the first day of the Treatment Scheme begins with the
drugs of the 2nd Line of Action, the drugs against viral load are not yet taken. It is from day
2 to day 8 of the Scheme (7 days in total), that medications aimed at reducing viral load
are taken, which are described below:
1.1. IVERMECTIN: IVM (Ivecop, Iverfast, Iverheal, Ivermax, Ivermectol, Ivervid, Ixel,
Stromectol): TB 3, 6 or 12 mg, Dropper bottle of 6 mg per ml (0.6%).
It is a macrocyclic lactone of the Avermectin group. In our experience, it is the drug of
choice against viral load in SARS CoV-2 infections, so it is important that it is always
included in the Treatment Schedule.
Doses of 0.4 to 0.6 mg per kilo of weight per day are recommended for patients with
mild persistent symptoms.
For those with moderate symptoms, a dose of 0.6 to 1.2 mg per kilo of weight per day
is recommended. The symptoms that are considered Moderate have been described
in detail in our publication on the "Therapeutic Test" (19).
In case the symptoms are severe, daily doses greater than 1.2 mg per kilo may be
indicated.
Although, we observed that the single daily doses, that is, taking the entire dose of the
day in a single dose after lunch, has a better effect than dividing the dose in 2 doses
during the day, for doses greater than 1.0 mg per kilo of weight per day it is
recommended to divide the dose of the day in 2 doses, one after breakfast and the
other after lunch, this to reduce the presentation of side effects.
In case of temporary side effects (such as blurred, yellowish or darkened visión, and
dizziness), the indication is for the patient to stop receiving 1 or 2 intakes of IVM, and
after at least 6 hours after the side effects have passed, the treatment would be
restarted by reducing the doses to half the amount of what you were taking, and you
should not take the IVM after 6 pm since it has been observed that the aforementioned
visual side effects and dizziness occur more frequently between 3 am and 9 am.
And in these cases, to compensate for this reduction in the dose of IVM, it is necessary
to make sure to take other medications to reduce the viral load, and if it is believed it
is advisable to increase the doses of these.
It is also indicated that IVM should not be taken at the same time as probiotics, sodium
bicarbonate or any alkaline substance.
The main metabolic pathway of IVM is cytochrome P450 3A4 (or CYP 3A4), so if taken
together with drugs that inhibit this cytochrome (such as Berberine, Cimetidine,
Ciprofloxacin, Clarithromycin, Cyclosporine, Diphenhydramine, Disulfiram,
Erythromycin, Fluconazole , Fluoxetine, Fluvoxamine, Itraconazole, Ketoconazole,
Metronidazole, Omeprazole, Paroxetine, Grapefruit, Quinidine, Ritonavir), there will
be a decrease in the clearance of IVM, increasing its concentration in plasma, its half-
life and presentation of side effects.
It has been identified that it is useful in persistent Epstein Barr Virus (EBV) infections,
also in Chronic Lyme Disease and against other viruses.
As in several countries it is difficult to obtain it, what can be done is to place the order
via some web pages, such as:
https://healthworldcp.com/products/stromectol.html
https://www.dosepharmacy.com/iverheal-12mg-tablet-ivermectin
https://www.medicineofcovid.com/
https://canshipmeds.com/
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
9
https://www.chinesemedicine-th.com/pt/worms/266-stromectol-ivecop-ivermectin-12-
mg-50-tablets.html#/size-50_tablets
www.indiamart.com
https://ivermectinseller.com/
You can get even without the need for a prescription, here is a link to a pharmacy
located in Miami, and that you can send to other US states:
https://acepharmacy.business.site/
ALTERNATIVES AS A 1ST MEDICATION OF THE 1ST LINE OF ACTION:
When IVM is not available in the place where the patient is located, or if the patient
does not have tolerance to take it, the following alternatives can be used:
o MONOLAURIN (glycerol monolaurate or glycerol monolaurate): TB or Capsules of
300, 500, 600, 950, 1000 mg.
Regarding the dose, it is suggested to start with 2000 mg (1000 mg at breakfast
and dinner) per day for 4 days, and then increase to 3000 mg per day (1000 mg at
breakfast, lunch and dinner).
If you weigh less than 55 kilos, it is recommended to start with 1500 mg (500 mg
every 8 hours) for 4 days, and then go up to 2500 mg a day.
If the patient weighs more than 95 kilos, the dose is increased to between 3000 to
4000 mg. It is recommended to take it with food.
It is a monoester formed from glycerol and lauric acid. The richest dietary source of
Monolaurin is coconut oil.
o PYRONARIDINE + ARTESUNATE (Pyramax): TB or Sachets of 60, 120 or 180
mg of Pyronaridine tetraphosphate, and 20, 40 or 60 mg of Artesunate,
respectively.
The ratio with Artesunate is 3 to 1.
The recommended doses are:
For adults weighing more than 65 kilos the dose is 720 mg per day for 3 days. If
they are TB of 180 mg, it would be 4 TB per day.
For adults and children weighing 45 to 65 kilos, the dose is 540 mg per day for 3
days. If they are TB of 180 mg, it would be 3 TB per day.
For children weighing 24 to 44 kilos the dose is 360 mg a day for 3 days.
For children weighing 20 to 23 kilos it is 180 mg a day for 3 days.
o PELARGONIUM SIDOIDES o EPs 7630 (Kaloba, Umcka loabo, Jaquam,
Umquan). TB of 20mg. Dropper bottle of 20 and 50. Syrup of 50 and 100 ml.
The dose indicated for adults and children over 12 years of age is 60 mg per day,
administered in 3 doses (breakfast, lunch and dinner). Each dose would be 20 mg,
which is equivalent to 30 drops, or 7.5 ml of syrup, or one 20 mg tablet.
The suggested dose for children from 6 to 12 years of age is 40 mg per day,
administered in 3 doses, each dose would be 20 drops or 5 ml. If 20 mg tablets are
indicated, it would be in 2 doses.
For children from 3 to 5 years old, the dose is 20 mg per day, administered in 3
doses, in this case each dose would be 10 drops every 8 hours.
In adults who weigh more than 95 kilos, the dose can be increased to between 80
to 90 mg per day.
It is recommended not to exceed 2 weeks taking it daily.
t has immunomodulatory and antiviral effects.
It is well tolerated, only 1.5% have adverse effects and these are not relevant, they
are mainly gastrointestinal discomfort.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
10
EPs 7630 (Kaloba, V Clear): Dropper bottle of 20 and 50 ml. 50 and 100 ml syrup.
It is a standardized ethanolic extract from the root of Pelargonium sidoides. It was
marketed for the first time in England, in 1897, it is indicated mainly for the treatment
of respiratory infections.
The recommended doses of EPs 7630 are the same as those mentioned for
Pelargnium sinoides.
o MOXIDECTIN (MOX). It is a macrocyclic lactone of the Milbemycin group. The dose
that appears in the schemes against: parasites and other persistent
microorganisms is 0.5 mg per kilo of weight per day.
o OTHER MACROCYCLIC LACTONES: in alphabetical order:
- Abamectin.
- Doramectin.
- Emamectin.
- Eprinomectin.
- Selamectin (37).
Todas las mencionadas pertenecen al grupo de las Avermectinas
o HYDROXYCHLOROQUINE (HCQ), TB of 400 or 200 mg.
It is recommended to take 400 mg per day, preferably divided into 2 doses every
12 hours, that is, 1 tablet of 200 mg, or half a tablet of 400 mg, every 12 hours.
In people who weigh less than 56 kilos, the dose is reduced to 200 mg per day.
In this Treatment Scheme, it is taken from day 2 to day 8.
It should be taken on an empty stomach, it is recommended that it be at least 1
hour before or after food.
Because it presents a defined risk of prolonging the QT interval, it is recommended
to exercise caution or avoid taking it together with other drugs that also have a risk
of prolonging the QT interval.
o MILK THISTLE or SILYMARIN (Silybum marianum). Capsules of 150, 200, 240,
300, 500, 1000 mg.
The usual dose ranges from 750 to 1300 mg per day, divided into 2 to 3 doses per
day. It has traditionally been used to treat liver and gallbladder disorders. It is
mentioned that it is a liver protector and antioxidant.
It is mentioned that it has antiviral properties and against SARS-CoV-2.
It is noted that it can cause an increase in blood pressure, so caution should be
exercised.
o HOLY BASIL OR TULSI (Ocimum tenuiflorum or Ocimum sanctum), in capsules
of 500 mg, or in filter sachet for infusion.
The doses used in various studies vary between 300 to 3000 mg a day. It is
indicated to take it before meals.
It is mentioned that it has antiviral properties against H1N1 and SARS-CoV-2
(26,27,28,29,30,50). It is also reported to significantly reduce glucose and blood
pressure (by about 25%) and improve lipid profile (30).
o FEBENDAZOLE:
The suggested dose is 10 mg per kilo of weight for 5 days, for example, for
someone who weighs 70 kilos the dose would be 700 mg per day. Indicated take
after lunch or food high in fat. According to the Sharkman's Protocol, Febendazole
should not be taken with IVM on the same days. It is an antiparasitic derived from
Benzoimidazole.
o OTHER ANTIPARASITIC BENZOIMIDAZOLE: such as:
o Albendazole.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
11
o Cambendazole.
o Flubendazole.
o Mebendazole.
o Oxfendazole.
o Thiabendazole.
o OTHER ANTIPARASITIC: such as (in alphabetical order):
- Levamisole. It is an anthelmintic and immunomodulator.
- Niridazole.
- Oxantel and Pyrantel Pamoate.
- Praziquantel.
- Pyrantel Pamoate.
o ARTESUNATE: TB of 50, 100, 200 mg.
The recommended dose is 200 mg per day, or 3 to 4 mg per kilo of weight.
It is a semi-synthetic derivative of Artemisia annua. There is good evidence of the
activity of Artemisia and its derivatives against various DNA viruses such as
Cytomegalovirus, human herpes virus 6, herpes simplex virus 1 and 2, Epstein-
Barr virus (EBV) and hepatitis B virus (HBV) (59).
It can produce as side effects, headaches, tinnitus, nausea, vomiting, abdominal
pain, itching, fever, bradycardia.
For COVID-19, it can be used alone or together with an antimalarial drug, such as
Pyronaridine, Mefloquine, Lumefantrine or Amodiaquine.
o ARTEMISIA ANNUA or SWEET WORMWOOD (33,35). TB or Capsules of 100,
200, 400, 425, 450 or 500 mg.
It is indicated between 500 to 800 mg 2 times a day. It is indicated to take it away
from food, at least 2 hours before or after.
The active ingredient contained in the plant is called Artemisin, which is also
marketed as such in 200, 300, 450 mg capsules.
o ATOVACUONE (Mepron).
It is marketed in bottles of oral suspension containing 750 mg per 5 ml (1 teaspoon).
o ARTEMETER + LUMEFANTRINE. TB with 20 mg of Artemether and 120 mg of
Lumefantrine, which is also known as Benflumetol.
o OTHER ANTIPALUDICS: there are other antimalarials of which their effects on
COVID-19 are still under investigation:
o Atovaquone plus Proguanil Hydrochloride (Malarone).
o Halofantrine.
o Mefloquine.
o Pirimetamina (Daraprim). 25mg BT. It is the drug of choice for Toxoplasmosis.
o Primaquine.
o Quinacrine.
o Tafenoquine. For the prevention of Malaria relapses, it is indicated in a single
dose of 300 mg.
o Tetrandrine (Hanfangchin A).
1.2. NITAZOXANIDE (Adonid, Annita, Alinia, Colufase, Daxon, Dexidex, Kidonax, Mitafar,
Nitasafe, Nitax, Nitaxide, Nitazox, Nizonide, NT-300, Pacovanton, Paramix, Pardil),
TB of 259 or 500 mg. 100mg/5ml Syrup.
The recommended regular dose is 1 TB of 500 mg at breakfast and dinner. It is taken
with food.
If the patient weighs more than 75 kilos, from the 3rd day the dose is increased to 3
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
12
TB of 500 mg per day, it would be 1 TB at breakfast, lunch and dinner. If the patient
weighs more than 95 kilos, from the first day they start taking it, they are given a dose
of 3 TB per day, then they take 1 TB of 500 mg at breakfast, lunch and dinner.
In most patients it causes a change in color of the urine to yellow or Orange.
There is good experience in its use in Chronic Lyme Disease, in which case 500 mg
is initially indicated at breakfast and dinner for 25 to 45 days, which can be extended
to 3 months.
It is mentioned that it is also useful for Babesia, Helicobacter pylori, Campylobacter sp
and Clostridium difficile; and against viruses other than SARS CoV-2, including
hepatitis B and C viruses, rotavirus, and influenza A virus.
On the other hand, there are studies that show that Nitaxozanide can produce an
inhibition of the formation of biofilms, which serve as protection and refuge for the
persistence of microorganism.
As in several countries it is difficult to obtain it, what can be done is to place the order
via some web pages, such as:
https://www.dosepharmacy.com/nizonide-500mg-tablet
www.indiamart.com
https://canshipmeds.com/
http://www.chinesemedicine-th.com/en/anti-diarrhea/222-alinia-nizonide-500mg-
nitazoxanide-60-tablets.html#/size-60_tablets
https://ivermectinseller.com/
ALTERNATIVES AS A 2ND MEDICATION OF THE 1ST LINE OF ACTION:
For places where Nitazoxanide is not available, alternatives as a second viral load
drug are:
o ROOT OF LITHOSPERMUM ERYTHRORHIZON or GROMWELL or SHIKONIN:
POWDERED or TOLLOVID or ZI CAO. Capsules, Bottle of extract or Bag with
extract powder.
Also called Purpura or Red Gromwell.
A product in jars called Zi Cao is sold on the Amazon store website, but it is made
from the dried leaves, not the roots. What is indicated is to consume the roots. The
root is also sold on Amazon and other websites in powder form, some of these
powder presentations are more intended for the preparation of skin creams.
In Traditional Chinese Medicine and in other Asian countries it has been used for a
long time, the recommended dose is between 3 to 9 grams per day.
For our part, we are indicating doses of between 45 to 90 mg per kilo of body weight
per day. The dose varies according to several factors to consider, such as the
estimation of the Total Body Viral Load, the severity of the symptoms, the tendency
to persistence, the history of Rebound or Reactivation, the estimation of Drug-
Resistance, the presence of multiple infections and symptoms of hypoperfusion or
very persistent clots, among others.
The minimum dose we recommend for patients with Chronic COVID or Long COVID
is 3.6 grams per day (1.2 grams 3 times per day) for 7 to 12 days. This dose is for
patients who weigh between 42 to 65 kilos and who do not have moderate to severe
symptoms associated with hypoperfusion.
In patients weighing 66 to 95 kilos, a dose of 4.5 grams per day (1.5 grams 3 times
a day) is recommended.
If they weigh more than 95 kilos the suggested dose is 5.4 grams a day for the first
7 to 12 days (1.8 g 3 times a day) and then continue with 4.5 grams a day.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
13
In addition to the patient's weight, another parameter to determine the dose is the
severity of the symptoms associated with hypoperfusion, which correlates with the
total body Viral Load and the tendency to persistence.
In patients who present moderate to severe symptoms associated with
hypoperfusion, the aforementioned doses can be increased by 15 to 35% and a
fibrinolytic such as Serrapeptase or Lumbrokinase must be included in the Scheme
or Protocol, in addition to the Antiplatelet.
It should also be taken into account both for the dose and for the duration of
treatment, the history of Rebound or Reactivation, the estimation of Drug-
Resistance and the presence of other infections and if these are multiple.
If after 7 days the patient has presented an improvement in symptoms of between
40% and 99%, but still presents symptoms associated with Hypoperfusion or Viral
Persistence, we recommend continuing with the same dose until the patient
perceives that he no longer improves with the treatment. treatment or up to a
maximum of 21 continuous days at the mentioned doses. It can be continued up to
36 days, but at lower doses by 50%.
In cases that present an improvement in symptoms of between 5 to 39%, it would
mean that the patient is a carrier of a Viral or Microbial Load that is difficult to
reduce, so it is recommended to give other medications or supplements effective
against Viral Load, such as IVM, Nitazoxanide, Niclosamide, IVIG, Baicalin, Rutin,
Nigella sativa, Lactoferrin, Monolaurin, Vitamin C or others, and also, in case of
suspected infections by other microorganisms, it is recommended to include a
procedure against the Microbial Load such as Hyperthermia and/or Ozone Therapy.
Resorting to a Scheme with 3 or more effective drugs against Viral Load is also
recommended in cases that have presented a Rebound of symptoms, which would
be due to a Reactivation of the infection and a tendency to persistence.
When taken at high doses, some patients may experience semi-liquid stools and
nausea, which resolves with dose reduction.
Its active principles are SHIKONIN, shikonofurans and derivatives.
It has antiviral, anti-inflammatory, antipyretic, antiplatelet effect and decreases
blood stasis. Several studies have been published on the antitumor effect of
Shikonin, identifying several mechanisms of action, such as the induction of
apoptosis and autophagy in cancer, the inhibition of NOS, topoisomerase and
STAT3 activity (73). Within its antiviral action mechanisms, it is noted that it is an
inhibitor of SARS CoV-2 Protease 3CL (3-Chymotrypsin-Like). Nirmatrelvir +
Ritonavir (Paxlovid) is also a 3CL protease inhibitor.
TOLLOVID, Capsules, 300 mg.
It is the commercial name of a supplement that contains Lithospermum
erythrorhizon Root and Lecithin.
o OZONO THERAPY (78,79).
Like hyperthermia, this therapy is effective not only against viruses but also against
other microorganisms, so it is indicated when the patient has multiple infections,
that is, by various types of microorganisms. This condition can be suspected in
patients with Persistent Symptoms in whom an improvement equal to or greater
than 40% is not achieved after applying the Therapeutic Test, or in cases in which
Treatment 3-3-3 or greater. Ozone is an effective gas to eliminate viruses, bacteria
and other microorganisms.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
14
OXYGEN-OZONE AUTOHEMOTHERAPY (O2-O3-AHT). 2 weekly sessions of 30
minutes each are indicated. Improvements are usually evident from the second to
sixth session.
EBOO or EBO2 (Extracorporeal Blood Oxygenation and Ozonation): is a
procedure that involves taking blood from the body, passing it through a dialysis
filter, the blood is then ozonized and infused back into the body through another
catheter in the other arm.
HOCTT or HOCATT (Hyperthermic Ozone and Carbonic Acid Transdermal
Therapy). It is a machine in the shape of a personal sauna. Steam is first infused
for heating, then carbon dioxide gas (carbonic acid) is infused. The heat and carbon
dioxide serve to increase circulation at the skin level so that when the ozone gas is
infused it is absorbed through the skin into the general circulation. Each session
lasts between 25 to 30 minutes.
It must be taken into account that in patients with tachycardia, hyperthermia will
often produce an increase in heart rate, so in these cases it is recommended to
resort to procedures without hyperthermia.
OZONE SAUNA PACKAGES
They are packages of 2 products, which includes ozone on the one hand, and the
far-infrared sauna or traditional steam sauna on the other.
o INTRAVENOUS HUMAN IMMUNOGLOBULIN: IVIG (Privigen, Flebogamma,
Plangamma, Kiovig). Vial or Ampoule of 50, 100, 200 or 400 mg/ml.
The suggested dose is 1.5 g per kilo of weight per day in infusion, with a maximum
dose of 140 g. Regularly 3 doses are indicated, but up to 6 doses can be given, on
different days.
There is also the option of Subcutaneous Immunoglobulin (SCGIV).
o MONOCLONAL ANTIBODIES (mAbs).
Until the year 2021, 3 mAbs were authorized by the FDA:
- Sotrovimab.
- Casirivimab and Imdevimab.
- Bamlanivimab and Etesevimab
According to the FDA, these mAbs are not indicated in patients with COVID who
are hospitalized due to the severity of their disease and in those who present a
decrease in oxygen saturation. We understand that in these cases the Viral Load
is very high, therefore, in these cases, a single dose of mAbs would be insufficient
to reduce the high Viral Load.
In Chronic COVID or Long COVID, a rapid favorable response has been observed
in 50 to 60% of cases, but there are 20 to 40% of cases in which symptoms worsen
a few days after the dose has been applied.
In Chronic COVID, its use is being tested in more than 1 dose, as well as with doses
between 3 to 8 times the usual dose, this with the aim of reducing the Viral Load as
much as possible.
The drawback that has been observed is that Drug-resistance to mAbs develops
rapidly, so after a few months the first 3 mAbs authorized by the FDA are no longer
useful in SARS CoV-2 infections.
Next, we will describe the doses of each of these 3 mAbs.
SOTROVIMAB. 8 ml ampoules with 500 mg of Sotrovimab (62.5 mg/ml).
The recommended dose is 500 mg as an intravenous infusion over 30 minutes.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
15
CASIRIVIMAB and IMDEVIMAB (Regen-CO or Regeneron, Ronapreve). 2 Vials
or Ampoules of 2.5 ml, 1 Vial with 300 mg of Casirivimab and the other with 300 mg
of Imdevimab. They contain 120 mg per ml.
The usual dose is 600 mg of each, which is equivalent to 2 ampoules of 2.5 ml of
Casirivimab and Imdevimab both given in a single dose. It is indicated as a slow
intravenous infusion over 25 to 50 minutes.
The FDA has also authorized its application subcutaneously, in this case the total
dose is administered divided into 2 to 4 injections applied separately in different
areas of the body.
BAMLANIVIMAB and ETESEVIMAB. 2 Vials or Ampoules of 20 ml, 1 vial with 700
mg of Bamlanivimab and the other with 700 mg of Etesevimab. They contain 35 mg
per ml.
The usual dose is 1 ampoule of 700 mg of Bamlanivimab plus 2 ampules of 700 mg
(1400 mg) of Etesevimanb, given as a single dose.
o CHINESE SKULLCAP or BAIKAL SKULLCAP or HUANG QIN (Scutellaria
baicalensis) (34), TB or capsules of 300, 400, 425, 500 and 800 mg. It can also be
obtained as a tincture.
The recommended regular dose is between 1200 to 1800 mg a day.
BAICALIN, It is considered to be the essential active component of Chinese
skullcap, it is a flavonoid and that it is also marketed as such in 250, 350 and 500
mg capsules. It has antiviral, anticoagulant, antithrombotic and anti biofilms effect.
It also contains Wogonin which has been identified as having an antiviral and
anticoagulant effect as well.
It is mentioned that it is useful in Babesia, Lyme disease and Mycoplasma, so it
would be indicated in cases where co-infection with any of these diseases is
suspected. Effects have also been identified against Enterovirus, dengue virus,
respiratory syncytic virus, Newcastle disease virus, HIV and HBV (50).
o NICLOSAMIDE (Niclosan, Niclocide Hexin) (37,54), TB of 500 mg.
The recommended dose for adults is 1,500 mg per day in a single dose, preferably
taken at least half an hour before breakfast.
If you weigh from 75 to 95 kilos, the dose is increased to 2000 mg to be taken in 1
dose before breakfast. In those who weigh more than 95 kilos, it is suggested to
increase the dose to 2500 mg per day, in this case I would take 2000 mg before
breakfast and 500 mg at 10 pm.
In children weighing between 30 and 40 kilos, the recommended dose is 1000 mg
per day in a single dose to be taken at least half an hour before breakfast. In those
who weigh between 15 and 30 kilos, the suggested dose is 500 mg a day in a single
dose.
One study showed a significant synergistic effect when used in conjunction with
IVM (54). Studies suggest that it could have a therapeutic benefit in slowing the
progression of Parkinson's Disease through the activation of the mitochondrial
protein kinase called PINK1 (54).
An important drawback is that it is not available in several countries, but it can be
obtained via the Internet through some websites that sell medicines, such as:
https://www.dosepharmacy.com/niclosan-500mg-tablet
o HYDROGEN PEROXIDE, is an antiseptic agent that is sold in bottles at a
concentration of 10 volumes (V10), which is equivalent to 3% (or food grade). It is
also marketed in higher concentrations (V40 or 12%), which is used to bleach hair.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
16
USE ON HANDS AND FEET: if there are lesions on the hands and feet such as
chilblains or similar, or if there is a bluish or purple coloration, pain, numbness or
tingling in these, it is recommended that in a small tub or container, but where the
patient's foot enters, place an amount of Hydrogen Peroxide up to a height of 3 to
6 cm, in such a way that it covers the entire hand. And put your hands first and then
your feet, one at a time, for 15 minutes each, once a day for 8 days.
USE FOR GARGLES AND NASAL DROPS: for use it as a gargle or as nasal drops,
the use of Hydrogen Peroxide in a 1% dilution is recommended. To obtain the
concentration of 1%, the 3% presentation must be diluted with twice the amount of
water. Then, to obtain 30 mL of the dilution, use 10 mL of hydrogen peroxide of 10
Vol. And add 20 mL of simple water or cold boiled water.
If you have upper respiratory symptoms, such as cough, sore throat and/or
bronchial spasm, we recommend gargling 3 times a day for 8 days.
For gargling, because it does not have a pleasant taste, it can be combined with a
commercial mouthwash, instead of with water.
Mouthwashes containing already diluted Hydrogen Peroxide are also sold in some
pharmacies, and can be used as a gargle.
USE FOR NASAL WASHES: in patients with olfactory disorders, such as Anosmia
and Hyposmia, we recommend performing nasal washes using a 20 ml syringe or
Netty pot, and mouthwashes, both performed twice a day for 7 to 9 days. For this
use, it must be diluted to 1%, as explained for gargles, it can even be diluted more,
since the nasal mucosa is more sensitive than the oral mucosa.
o LACTOFERRIN. Capsules of 40, 100, 200, 250, 300 or 500 mg. Syrup.
It is a protein found in the milk of most mammals. It acts against many pathogenic
microorganisms and has been shown to inhibit SARS-CoV-2 infection by blocking
the ability of the virus to enter target cells, as well as supporting the cells' antiviral
defense mechanisms (63).
It is noted tha t it also has effects against other viruses, that it is anti-inflammatory
and tends to reduce the formation of biofilms.
The recommended dose is 500 mg per day.
In those who weigh more than 75 kilos, 750 mg per day is recommended.
In COVID, it has been indicated together with Diphenhydramine, which is a first-
generation anthistamine, with good results.
o WOAD, DYER'S WOAD, ISATIS, CHINESE WOAD, Glastum or Ban Lan Gen
(Isatis indigotica) (37). Capsules of 500, 750, 1060 and 1120 mg. Syrup with 330
mg/1 ml.
The recommended dose is 6,000 mg a day, taken in 2,000 mg doses 3 times a day.
In those who weigh between 75 and 95 kilos, the dose is increased to 8000 mg per
day, in this case it would be 3000 mg in the morning, 2000 mg in the afternoon and
3000 mg at night. And in those who weigh more than 95 kilos a day, the suggested
dose is between 9,000 to 10,000 mg a day.
It is noted that it has antibacterial properties and is included in treatment schemes
against Mycoplasma and Bartonella. It has also been identified that it has an
antiviral effect by inhibiting the 3CL protease of the coronavirus (65).
o GREEN TEA (Camellia sinensis) (34).
Contains Epigallocatechin-3-gallate (EGCG), also known as Epigallocatechin
Gallate. It has also been identified as containing L-theatin, Theaflavin, Apigenin and
a smaller amount of vitamin K and antiplatelet polyphenols.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
17
It is reported to have an antioxidant and antiviral effect against HSV-1 and 2 viruses,
and against SARS CoV-2 (50).
EPIGALLOCATECHIN-GALLATE (EGCG), is the most abundant catechin in
Green tea. Activity against SARS-CoV-2 Protease 3CL has been identified, as has
the flavonoid Theaflavin.
MATCHA. It is a finely ground powder of green tea leaves. The green tea plant
used for matcha is grown in the shade, and is said to produce more Theatin this
way.
L-THEATINE. It is an amino acid, it helps a better sleep since it opposes the effects
of caffeine by stimulating the GABA4 receptors that caffeine blocks and is
responsible for its ability to induce insomnia.
o DAN-SHEN, CHINESE SALVIA or RED SAGE (Salvia miltiorrhiza) (37). TB or
capsules of 400, 500, 600, 750 or 1200 mg. It is also sold in powder form.
The regular dose is 1,000 to 1,800 mg per day.
It is mainly indicated for the treatment of cardiovascular and cerebrovascular
diseases. Promote circulation to eliminate blood stasis. It has inhibitory activity
against the 3CL and PL proteases of SARS-CoV-1 [65].
Among its interactions, it is noted that it increases the effect of digoxin,
anticoagulants and drugs that slow blood clotting, increasing the risk of bleeding.
o HYPERTHERMIA, HYPERTHERMIA THERAPIES or THERMOTHERAPY:
It consists of raising the temperature of the whole body or of a region. As the SARS
CoV-2 virus and other microorganisms are sensitive to heat, Hyperthermia is useful
as a procedure against Viral and Microbial Load.
In patients with Persistent Symptoms of COVID, it is recommended in those who
present other infections in addition to the persistent infection by SARS CoV-2, and
especially if they are multiple, that is, they present several infections by different
viruses and microorganisms. This condition can be suspected in patients in whom
an improvement equal to or greater than 40% is not achieved after applying the
Therapeutic Test, or in cases in which a great improvement is not achieved with
almost complete or complete recovery after applying the Scheme or Treatment
Protocol 3-3-3 or greater.
In patients with tachycardia, other procedures are recommended because
hyperthermia often increases heart rate. In patients who have symptoms
associated with histaminosis, MCAS or allergies, an exacerbation of symptoms
may occur, so the convenience of indicating hyperthermia procedures should also
be evaluated.
FAR INFRARED SAUNA. It is a sauna that uses Far Infrared Radiation, also called
FIR by its initials.
FIR is a type of electromagnetic radiation in the infrared spectrum that has
wavelengths longer than visible light. It carries radiant energy and has the ability to
penetrate deep through the skin and produce heat inside the body, without heating
the air around it.
It is a form of Hyperthermia Therapy with effects against the viral and microbial
load, but also has other beneficial effects.
On the one hand, the heat dilates the blood vessels, improving blood circulation.
On the other hand, several studies are being carried out on its use in different
diseases, it has been identified that it increases the expression of endothelial nitric
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
18
oxide synthase, as well as the production of nitric oxide. It has also been identified
that it improves the intestinal microbiota.
A session of between 20 to 30 minutes a day for 3 to 5 days a week is
recommended, until accumulating between 10 to 12 sessions, and at this time the
case is reassessed.
FAR INFRARED SAUNA BLANKET. The equipment consists of a sleeping bag-
type blanket that generates FIR. Its cost is not high and it allows to carry out the
Hyperthermia sessions with FIR in the patient's home. There is also a presentation
in the form of a Dome.
HYPERTHERMIA TO WRAP UP MORE: it is a simple procedure, but usually it is
not possible to raise the body temperature much. It consists of dressing up very
warm, with the aim of increasing body temperature until sweating occurs. To
contain the heat, it is indicated to place sheets of paper covering the front and back
of the chest, the paper is in contact with the skin, under a polo shirt or shirt, on top
of this 2 sweaters are placed and then a jacket. You should drink 2 or 3 cups of hot
liquids, it can be infusions or soups. It is indicated to start it from 8 to 10 pm
considering that at night the body temperature rises more. The patient must
produce sweating to consider that the body temperature has been raised. The
sweaters and jacket will remain while the patient sleeps, being able to remain with
these during all the hours of sleep. In the event that excessive sweating occurs
after 2 or 3 hours, warm clothing will be removed little by little, drying the sweat with
towels and avoiding exposure to cold and drafts.
TRADITIONAL SAUNA OR BATHS WITH HOT WATER: it may be indicated to
resort to the traditional sauna or baths with hot water, preferably in a tub, in the
latter case the patient must be supervised, since the heat can cause a decrease in
blood pressure and temporary loss of consciousness or fading.
USE OF MEDICAL EQUIPMENT TO GENERATE HYPERTHERMIA: specialized
procedures have been developed in which medical equipment is used, this is mainly
indicated for the treatment of cancer, but it can also be used in any other disease
where the use of hyperthermia is beneficial.
o REMOVAL OF BIOFILM OR DENTAL PLAQUE. The SARS CoV-2 virus has been
identified inside the dental plaque along with other microorganisms, since this is a
Biofilm it can persist there for a long time as a persistent infectious focus. Apart
from the removal of dental biofilm, it is recommended that patients regularly use a
mouthwash, preferably containing CPC (Cetylpyridinium Chloride).
o HELP AFERESIS, HELP stands for Heparin Induced Extracorporeal LDL
Precipitation. It is an effective procedure for the mechanical removal of bioclots
containing inflammatory cytokines and viral load.
o PARTIAL EXANGUINE TRANSFUSION (ETP). It is the accepted treatment of
Polycythemia, which is the presence of an excess amount of red blood cells, which
makes the blood more viscous (thick) and does not flow efficiently, and both are
conditions that contribute to the formation thrombi or blood clots. ETP involves
slowly withdrawing part of the patient's blood volume (known as bleeding), replacing
the withdrawn blood with certain fluids to dilute the concentration of red blood cells
and the viscosity of the blood.
It is a non-complex procedure that can be performed in practically any city in the
world and since it does not require the use of medical equipment, its cost is low. In
patients who are going to undergo HELP Apheresis or other similar procedures that
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
19
use blood filters, our recommendation is that 1 to 3 ETP sessions be performed
before starting Apheresis, this to reduce blood viscosity and reduce blockages by
clots in some of the medical equipment and catheters.
o OTHER PROCEDURES AND INTERVENTIONS: there are various procedures
and interventions that can be incorporated as part of the treatment, in alphabetical
order we have:
o ACUPUNCTURE and LASERAPUNCTURE.
o BIOFLEX COLD LASER THERAPY, which is a Low-Intensity Laser Therapy
(LILT), uses a light-based technology called Photobiomodulation.
o COMPRESSION STOCKINGS or COMPRESSION SOCKS. They improve
muscle contraction and increase blood flow.
o COVID CONVALESCENT PLASMA.
o EECP (Enhanced External Counterpulsation): it is an outpatient therapy (applied
in a doctor's office), non-invasive, authorized by the FDA, indicated for the
treatment of angina, congestive heart failure and post-acute myocardial
infarction. Increases circulation and improves endothelial function.
o EXANGUINE TRANSFUSION. It is a procedure that is performed mainly on
neonates. It is indicated in children with hyperbilirubinemia and hemolytic
disease of the newborn. It has also been used in neonatal sepsis, metabolic
disorders with severe acidosis, severe pertussis or coceluche.
o FASTING: it is pointed out that the autophagy process can be activated through
fasting. This process promotes the elimination of waste and damaged cells to
create new and healthy cells.
o FLOWTRIEVER SYSTEM, for clot removal. It consists of performing a
percutaneous mechanical thrombectomy.
o HEMOFILTRATION: it is a therapy similar to hemodialysis or renal dialysis, but
hemofiltration is more efficient in removing toxins of higher molecular weight, the
semi-permeable membrane used in hemofiltration is much more porous than that
used in hemodialysis.
o HYPERBARIC THERAPY (HBOT: Hyperbaric Oxygen Therapy). There is HBOT
equal to or less than 1.5 AT and greater than 1.5 AT. AT stands for Atmospheres
Absolute, it is the measure of gauge pressure.
o INTERMITTENT PNEUMATIC COMPRESSION. This is done with the use of
medical equipment designed for this purpose.
o INUSPHERESIS, is the procedure that the INUS company has developed based
on Apheresis.
o PHOTOTHERAPY.
o PLASMAPHERESIS (PLEX).
o RED LIGHT THERAPY.
o SOT, is Supportive Oligonucleotide Technique, or SOT for its initials. It was also
known as Antisense Oligodeoxynucleotide Therapy (AOT).
o STEM CELLS.
o THERAPEUTIC PHLEBOTOMY OR BLOOD-LETTING (BLEEDING
PROCEDURE) or PROCEDURE SIMILAR TO BLOOD DONATION: It consists
of drawing blood, which may be indicated in specific cases such as
Hemochromatosis, Polycythemia Vera, Porphyria cutanea tarda, etc., to reduce
the number of red blood cells.
o VACCINES AGAINST SARS COV-2: It has been observed that between 15
22% of patients improve their persistent symptoms after vaccination (24,25), but
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
20
it is also reported that between 15 and 21% of cases worsen or develop the
acute disease, and there are even cases with severe complications. Even more
research is required in this regard. The vaccines induce the body to generate
neutralizing antibodies against SARS CoV-2, the favorable response to the
vaccines in some cases supports the existence of a Persistent SARS CoV-2
Infection, while the unfavorable responses indicate that the vaccines can
produce a negative reaction that we consider to be associated with an activation
or reactivation of a persistent infection that was latent, or by the enhancement of
an infection that already produced persistent symptoms.
o ANDROGRAPHIS, CHIRETTA, GREEN CHIRETTA or KALMEGH, KalmCold,
Creat or King of bitters (Andrographis paniculata), TB of 300, 400, 500 or 800 mg.
Its main active component is Andrographolide.
The regular dose is between 1000 to 2000 mg a day.
It has a very bitter taste. May cause allergic reaction.
Effects against SARS CoV-2, Chikungunya, Influenza A and Flaviviruses have
been identified (50).
o QUERCETIN, TB or capsules of 250, 500 and 1000 mg:
The regular dose is 500 mg every 12 hours (1000 mg per day) for the 8 days of this
Scheme. If the patient weighs more than 95 kilos, the dose can be increased to 500
mg every 8 hours (1500 mg per day).
If you weigh less than 56 kilos, the dose is reduced to 500 mg per day.
o CAT'S CLAW (Uncaria tomentosa). [57]. Capsules of 200, 250, 350, 485, 500, 700,
800, 1000 mg.
The recommended dose is between 250 to 500 mg, 2 to 3 times a day, which is
equivalent to between 500 and 1,500 mg per day.
It is also marketed under the name of Samento, which is the name given to it by a
laboratory in the United States.
Anti-inflammatory, immunomodulatory, antimicrobial and biofilm formation
inhibition properties have been identified.
Its side effects include gastritis and stomach aches.
o POLYGONUM CUSPIDATUM or JAPANESE KNOTWEED, HU ZHANG,
FALLOPIA JAPÓNICA OR CENTINODIA OF JAPAN (37). Capsules of 50, 75, 225,
250, 375, 500, 650 or 1000 mg.
It contains a high amount of RESVERATROL, which is why it is often marketed like
this. It is mentioned that it is useful in Lyme disease, Bartonellosis and varicella
zoster virus. This herb contains Emodin, which inhibits the formation of biofilms, so
it would be indicated in cases where co-infection with any of these diseases is
suspected.
In addition, it is noted that it reduces blood stasis.
o ASHWAGANDHA or Winter cherry (Withania somnífera).
It has been identified to have an effect against Herpes Simplex 1 and SARS CoV-
2 (50). Th and it has also been identified as inhibiting the 3CL protease of the
coronavirus. One study showed that giving it for 6 weeks improved the overall
quality of sleep, significantly improving the perception of Non-Restorative Sleep.
The regular dose is between 600 to 1000 mg/day.
o BOSWELLIA, Indian Frankincense, Frankincense Oil or Indian Oli-banum
(Boswellia serrata, sacra and carterii). TB or Capsules of 250, 300, 450, 500, 520,
600, 700, 800, 1000, 1200 mg.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
21
Boswellia extract contains 65% Boswellic Acid, thus 300 mg contains 200 mg of
Boswellic Acid.
The recommended dose is 300 mg of Boswellia every 12 hours. In people who
weigh more than 75 kilos the dose can be increased to 300 mg every 8 hours a
day.
o BERBERINE: TB of 400, 500, 600, 1000, 1200, 1500 mg.
The recommended dose is 500 mg 30 minutes before breakfast, lunch and dinner
(1500 mg per day). It is an Alkaloid present in various plants such as Berberis
vulgaris, Berberis aristata, Coptis chinensis, Phellodendron amurense, Hydrastis
canadensis, Xanthorhiza simplicissima, Rhizoma coptidis, goldenseal, European
barberry. Antiviral effects against Herpesviruses have been identified (49). In
addition, it has the effects of reducing total cholesterol, LDL, triglycerides, glucose
(useful in diabetics), and inflammation.
There are presentations along with Ceylon Cinnamon (Cinnamomum verum) which
has antioxidant properties.
It should be taken into account that Berberine inhibits cytochrome P450 3A4 (or
CYP 3A4), so it will cause interactions with other medications, increasing its
concentration.
o ECHINACEA (Echinacea purpurea and/or Echinacea angustifolia) (36). TB of 250,
300, 400, 450, 500, 800, 1000, 1200, 1300, 1400 mg. Also in dropper bottle.
The recommended dose is between 1500 to 2400 mg per day.
If the patient weighs more than 95 kilos, the dose can be increased to 3600 mg/day.
It has been shown to have antiviral activity against human and avian influenza
viruses, H1N1 type IV, herpes simplex, and rhinovirus.
o NIFUROXAZIDE, TB of 400 or 200 mg, or Syrup of 200 mg/5 ml:
Its inclusion is recommended when there are gastrointestinal and/or
cardiorespiratory symptoms (23). The doses used are 400 mg every 8 hours, it
would be at 7 am, 3 pm and 11 pm (1,200 mg daily) for 7 days. If the patient weighs
more than 75 kilos, it is increased to 4 doses a day, that is, every 5.5 hours in the
time that you remain awake, it would be at 7am, 12.30, 6pm, 11.30pm (1,600 mg
per day). If you weigh more than 95 kilos it is increased to 600 mg every 8 hours, it
would be at 7 am, 3 pm and 11 pm (1,800 mg a day). In people who weigh less
than 50 kilos the dose is reduced to 400 mg every 12 hours (800 mg a day).
o RESVERATROL. TB of 100, 125, 250, 500 or 1000 mg:
The regular dose is 1000 mg per day. It is a natural polyphenol present in numerous
plants and fruits, especially it is found in red grapes and in the red wine made with
them. As the Polygonum Cuspidatum plant contains a high amount of Resveratrol,
it is often marketed as this.
It has been identified that it has antiviral effects against different viruses.
o PINE NEEDLES TEA. They are the green leaves (in the form of needles) of the
white pine (pinus strobe). It is noted that it contains Vitamin A, C and Suramin.
To prepare it, 1 bunch of pine needles is indicated in 1 and a half cups a day with
approximately 2 to 3 tablespoons of needles per cup of almost boiling water.
o SURAMINA (Germanin), 1 gram ampoules.
It is described that the regular dose is 1 gram once a week administered
intravenously and for 6 weeks.
It is common to produce moden proteinuria It is mentioned that 90% of patients will
present a rash or urticaria on the skin that disappears within a few days. There is a
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
22
greater than 50% chance of adrenal damage, but only a very small proportion will
require lifetime corticosteroid replacement.
It is reported that this compound was originally isolated from an extract of pine
needle oil.
o CRYPTOLEPIS SANGUINOLENTA: Extract or tincture bottles (concéntrate of
shredded herbs that are usually left to marinate in alcohol), it is usually sold in a 4
ounce bottle that is equivalent to 118 mL.
For the present Scheme, it is taken together with IVM from day 2 to day 8 (7 days).
It is recommended to start with a low dose of 3 drops in the morning and at night
for 2 days, then go up 3 drops per dose every 2 days, so on days 4 and 5 of this
Scheme I would take 6 drops in the morning and at night, on days 6 and 7 take 9
drops morning and night, and on day 8 take 12 drops morning and night. If you are
going to continue taking it, you can continue increasing the dose according to
tolerance until you reach between 15 to 20 drops per dose. Its main active
components of this plant are considered to be CRYPTOLEPIN and
CRYPTOLEPICARBOLINE (32).
It is recommended to include it in cases where the patient has a history of having
had Babesia or Lyme disease, or it is suspected that there is co-infection by any of
these diseases.
o FUCOIDAN. It is a high molecular weight polysaccharide found in brown algae,
such as Mozuku (Cladosiphon okamuranus), Konbu (Saccharina or Laminaria
japonica) and Wakame (Undaria pinnatifida). It is noted that it has an antival effect
and that it suppresses the angiogenesis process by inhibiting the formation of new
capillaries.
o DANDELION (Taraxacum officinale).
It has been identified that it potentiates the effect of anticoagulants.
o OTHER MEDICINAL PLANTS (27 a 38): the following can be used (in alphabetical
order):
o CHICORY o Common Chicory (Cichorium intybus).
o EUCALYPTUS (Eucalyptus globulus).
o FISH MINT or Dokudami, Yu Xing Cao or Chameleon plant (HOUTTUYNIA
cordata) (34,35,37). It is recommended to include it in cases where the patient
has a history of having had Bartonellosis or it is suspected that there is co-
infection by it.
o GRIFFITHSIN, is a Lectin isolated from red algae.
o GUDACHI or Gilay (Tinospora cordifolia) (35). It has been identified as have an
effect against Herpes Simplex 1 and SARS CoV-2 (50).
o KUDZU (Pueraria lobata).
o MORINGA or Drumstick (Moringa oleifera) (32). It has been identified to have an
effect against Herpes Simplex 1, SARS CoV-2 (50) and Epstein-Barr virus (EBV)
(59).
o PYRROSIA, or Shi Wei, or Tongue fern (Pyrrosia lingua) (33,34,35).
o RED SPIDER LILY, or Red magic Lily (Lycoris radiata). Its active principle is
LICORINE, which showed a strong inhibitory effect against SARS-CoV (33,
34,35,38).
o SILVESTROL, is a natural product found in Aglaia silvestris and Aglaia foveolata
trees.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
23
o THYME (Thymus vulgaris). It is noted that it has antiviral, antibacterial, antifungal
and anti biofilm properties.
o TORREYA NUCIFERA or TORREYA JAPONESA (65).
o STEPHANIA ROOT or Han Fang Ji (Stephania tetrandra).
o YACON (Smallanthus sonchifolius) (38), contains the flavonoid Rutina.
1.3. 3RD MEDICATION OF THE 1ST LINE OF ACTION:
In cases where the persistence of symptoms is more than 3 months or if the symptoms
are Moderate, in addition to IVM and Nitazoxanide (or its alternative), it is
recommended to add a third drug with effects against viral load. It must be chosen
according to the case, and some medications can also be useful against co-infections
that may exist. The alternatives are as follows:
o ZINC PICOLINATE, Capsules of 22, 25, 30, 50 or 100 mg.
To achieve an effect against viral load we indicate doses of 200 mg daily. Lower
doses are not as effective in reducing viral load. If the patient weighs less than 56
kilos, a lower dose of 150 mg per day may be indicated.
Zinc Picolinate is a form of chelated Zinc. Being chelated presents a better
absorption by the body. Other forms of chelated Zinc can also be used, such as
Citrate and Gluconate, these have a better absorption level than non-chelated
forms, but less than Picolinate.
In general, it is recommended to take it approximately 1 hour after meals. When
taking it, you should avoid consuming dairy products 2 hours before or after taking
it, since calcium reduces its absorption. When taken on an empty stomach in some
people it can cause stomach irritation and nausea, if this occurs it is indicated to
take it with food.
The daily dose should be distributed in 2 or 3 doses during the day, in order to
reduce side effects, the most frequent being nausea, vomiting and the perception
of a bitter or metallic taste.
If they are 100 mg capsules, it is indicated to take it at 9 am and 9 pm, approximately
1 hour after meals.
If they are capsules of 50 mg or less, it is indicated to distribute it in 3 doses a day,
it would be at 9 am, 3 pm and 9 pm.
For this Scheme, it is indicated to take it on the same days as the IVM, from day 2
to day 8 (7 days).
The antiviral efficacy of zinc can be enhanced by using a zinc ionophore, that is, a
molecule that allows it to enter cells and act at this level, inhibiting virus replication.
The best known and most accessible Zinc ionophores are IVM, Nigella sativa,
Quercetin, Olive Leaf Oil, EGCG, Neem, HCQ, Chloroquine.
It is not recommended to take Zinc in high doses for more than 30 continuous days
since it decreases the uptake of copper and iron, which can lead to anemia.
o BLACK SEED OIL or BLACK CUMIN SEED OIL or Habbatus sauda (NIGELLA
SATIVA) (34),
Its main active ingredient is Thymoquinone. It has been identified that it has
immunomodulatory and anti-inflammatory effects.
The recommended dose for both adults and children is between 60 to 80 mg per
kilo of body weight.
For patients weighing 56 to 75 kilos, a dose of 4000 mg per day, divided into 3
doses, is suggested.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
24
For those weighing 76 to 95 kilograms, the recommended dose is 4000 mg per day.
If the patient weighs more than 95 kilos, the dose is increased to between 6000 and
7500 mg per day. If you weigh 42 to 55 kilos it is recommended to reduce the dose
to 3000 mg per day.
It is indicated to distribute the dose of the day in 3 doses, and it is taken during the
8 days that this Scheme lasts, being able to prolong its taking up to 20 days.
o VITAMIN C or ASCORBIC ACID. TB of 500 and 1000 mg which is equivalent to 1
gram. Ampoules in grams.
The recommended dose is between 12 to 16 grams per day, it would be 3 to 4 g in
4 doses within the day. In those who weigh between 75 to 95 kilos, it is
recommended between 16 to 20 g per day divided into 4 to 5 doses during the day.
And in those who weigh more than 95 kilos, it is suggested between 20 to 24 g a
day in 5 to 6 doses.
It could also be given intravenously.
It is noted that it has antiviral effects, that it reduces Histamine levels and that it
repolarizes Monocytes.
o RUTIN o Rutoside (usually obtained from the plant Sophora japonica, Sophora or
Japanese Acacia). TB of 450, 500 or 550 mg.
It is a flavonoid, also known as quercetin-3-rutonoside.
The regular dose is 500 mg a day. In those who weigh more than 75 kilos, the dose
can be increased to 1000 mg per day.
It is recommended to take it together with vitamin C or citrus fruits, to improve its
effects. It is considered an antioxidant and phlebotonic, it inhibits angiogenesis and
improves the resistance of capillaries, reduces their fragility. It is mentioned that it
inhibits platelet aggregation and helps break down clots.
Pharmacological properties against SARS-CoV-2 have been identified (38,74). It
inhibits the main protease (Mpro) and the papain-like protease (PLpro) preventing
viral replication.
o PLITIDEPSIN (Aplidin): Vial of 2 mg of Plitidepsin and ampoule of 4 ml of solvent.
It is an antiviral produced in Spain. It has the characteristic of acting on the cell of
the host organism, and not on the virus, this differentiates it from most antivirals,
and gives the advantage that it would maintain its effectiveness despite the fact that
the virus mutates. It is an inhibitor of the Cellular Eukaryotic Elongation Factor,
known by the initials eEF1a, from eukaryotic Elongation Factor 1a.
The dose administered in patients with prolonged viral replication of SARS-CoV-2
is 2.5 mg daily for 3 days, intravenously diluted to a total volume of 250 mL in 0.9%
saline or 5% dextrose solution.
o NIRMATRELVIR + RITONAVIR or NIR-RIT (PAXLOVID): TB 150 mg/100 mg.
For Acute COVID it is not authorized to be used for more than 5 consecutive days.
3 tablets are indicated at the same time: 2 of 150 mg Nirmatrelvir and 1 of 100 mg
of Ritonavir, twice a day for 5 days (total: 30 tablets).
For Chronic COVID, it is not recommended to take it for only 5 days, since if the
patient still has symptoms after 5 days, it is very likely that there will be a
reactivation of the infection or a rebound of symptoms.
There is still not enough experience on its use, its side effects and pharmacological
interactions.
In Chronic COVID, it is being indicated to take it for a minimum of 5 to 10 days. But
it is difficult for the patient to get the medication to be able to take it for more than
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
25
5 days. Therefore, to reduce the probability of a Reactivation of the infection due to
discontinuation of treatment, we are indicating that at the end of taking NIR-RIT the
patient continues with 1 or 2 effective medications against Viral Load, such as
Ivermectin, Lithospermum erythrorhizon Root (Gromwell or Tollovid), Nitazoxanide,
Niclosamide, Antivirals or others.
Ritonavir is a potent inhibitor of the CYP3A4 isoenzyme, so it should not be taken
by patients who are taking or have taken in the last 14 days an inducer of the
CYP3A4 enzyme, such as Clopidogrel, Apixaban, Rivaroxaban, Dabigatran,
Warfarin, Amiodarone, Diazepam, Midazolam, Anticonvulsants, Antineoplastics,
Lovastatin, Simvastatin, Rifampicin, Domperidone, St. John's Wort.
o SPIRONOLACTONE. TB of 25, 50 or 100 mg.
It is traditionally indicated as a diuretic and to reduce blood pressure, but it also has
an antiandrogenic effect and antiviral effects have been identified.
The recommended dose for this Scheme is 50 mg every 12 hours for 7 days, which
would be from day 2 to day 8 of the Scheme.
In those who weigh from 76 to 95 kilos from the 3rd day, the dose can be increased
to 125 mg per day divided into 2 doses per day.
In those who weigh more than 95 kilos, a dose of between 150 and 175 mg per day
may be indicated.
In those who weigh between 42 and 55 kilos, it is recommended to start with a dose
of 25 mg every 12 hours during the first 3 days, and from the 4th day it increases
to 50 mg every 12 hours. If you are going to continue the treatment for more days,
it is recommended to reduce the dose to between 50 to 75 mg per day.
It has been identified to have favorable effects on SARS CoV-2 (60), EBV (61,62),
and HIV (77) viral infections. In dermatology it is indicated for the treatment of Acne,
Hirsutism and other skin conditions, with schemes that last several months. It
should be taken into account that it is a potassium-sparing diuretic.
o TURMERIC or CURCUMIN, with PIPERIN (Curcuma longa). TB or Capsules of
500, 525, 600, 700, 1000, 1200 or 1500 mg (32).
It belongs to the same family as Ginger or Kión. In Peru, Mexico and Bolivia it is
called Palillo. It is also known as Saffron from India.
It is recommended to start the first day with 1500 mg, if there is good tolerance and
there is no gastric discomfort, on the second day the dose is increased to 2500 mg,
and from the third day to between 3500 and 4000 mg per day according to
tolerance.
If the patient weighs more than 95 kilos, It is suggested to increase the dose on the
third day up to between 4500 and 5000 mg according to tolerance.
In those who weigh less than 56 kilos, it is suggested to increase the dose from the
third day up to between 3000 and 3500 mg per day.
It is described that its absorption is low, and to increase it it should be consumed
with preferably fatty foods. It is also marketed in capsules accompanied by black
pepper containing PIPERIN, which has been shown to increase the absorption and
availability of Turmeric.
It has been identified that it has an effect against Dengue virus, Herpes Simplex 1,
parainfluenza, hepatitis B and SARS CoV-2 (50). It also has antibiofilm activity.
In case of presenting symptoms associated with an increase in acidity in the
stomach, the dose of Turmeric should be reduced and a gastric protector such as
Famotidine or Nizatidine should be taken.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
26
It is reported to have antithrombotic activity by inhibiting the activities of thrombin
and activated factor X (FXa), and also inhibits platelet aggregation.
It has been identified to induce vasorelaxation.
o OLIVE LEAF EXTRACT (comes from the olive tree: Olea europaea): TB of 250,
450, 500, 650, 750 or 825 mg.
The regular dose is between 500 to 750 mg a day.
In those weighing 75 to 95 kilos, the suggested dose is between 400 to 500 mg
every 12 hours (800 to 1000 mg per day).
For those weighing more than 95 kilos, the suggested dose is 500 to 750 mg every
12 hours (1000 to 1500 mg daily).
In those who weigh less than 56 kilos, a dose of between 400 and 500 is
recommended.
It has been reported to have antiviral action against Epstein-Barr virus (EBV), liver
viruses, rotavirus, bovine rhinovirus, canine parvovirus, and feline leukemia virus.
It has been identified that it inhibits platelet aggregation and activation. It also has
antibacterial, antioxidant, anti-inflammatory, antiatherogenic, diuretic, and glucose-
lowering properties.
Contains OLEUROPEIN which has the effect of lowering blood pressure and
dilating the coronary arteries. Another active ingredient is Hydroxytyrosol.
o LICORICE or GLYCYRRHIZA or Yashtimadu (Glycyrrhiza glabra) (32,34,35,37,
50). Capsules or Chewable Tablets of 450, 500 or 900 mg.
Licorice extract contains a fifth of Glycyrrhine, thus 300 mg contains 60 mg of
Glycyrrhizin. The recommended dose is 300 mg of Licorice every 12 hours. In
people who weigh more than 75 kilos the dose can be increased to 300 mg every
8 hours a day.
It can cause arterial hypertension (do not take if the patient has a diagnosis of
hypertension). A deglycyrrhizinated licorice root extract is also marketed, known by
the initials DGL, it is mentioned that in this way the side effects of glycyrrhinic acid
or glycyrrhine are avoided (such as hypertension, edema or headaches). It is
recommended to include it in COVID cases with hypotension.
o FAVIPIRAVIR, (Fabiflu, Favipac). TB de 200, 400 y 800 mg.
For Acute COVID, 4 tablets of 200 mg 2 times a day for 5 days are indicated (total:
40 tablets). For Chronic COVID we have recommended taking it for at least 10 to
15 days, and together with other medications or supplements with an effect against
viral load. After finishing taking Favipiravir, the patient should continue taking 1 or
2 effective drugs against Viral Load until days after they no longer have symptoms.
o NEEM or NIM or MARGOSA (Azadirachta indica), TB or capsules of 300, 400, 450,
500 or 900 mg. The regular dose is between 800 to 1200 mg a day. For those who
weigh more than 95 kilos, the suggested dose is 1500 mg per day. There is also a
presentation in oil, but its taste is unpleasant, so the presentation in capsules is
recommended. You can also use the leaves to prepare it as an infusion, it has a
bitter taste. It is reported to have antiviral properties against H1N1 and SARS CoV-
2 (29,31,32,50). Its use is recommended especially in cases that present intestinal
symptoms. If you are going to continue taking it, it is noted that it should not be
taken for many continuous days. We recommend taking it for 20 days a month, with
a 10-day break from taking it.
o FENOFIBRATE: 160 or 200 mg TB:
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
27
The recommended dose is 160 mg once a day. In those who weigh more than 80
kilos, 200 mg a day can be taken.
Another similar cholesterol/triglyceride lowering agent is BEZAFIBRATE.
o BAKUCHI, BABCHI, BAKUCHIOL or BU GU ZHI (Psoralea corylifolia).
It has an inhibitory effect on the 3CL protease of SARS CoV-2 (65). It would also
have activity against fungi such as Candida.
o DOXYCYCLINE, TB of 100 mg: at a dose of 100 mg every 12 hours, it would be 1
TB at 8 am and 8 pm for 7 days. In those who weigh more than 90 kilos, the dose
is 100 mg 3 times a day, since the average recommended dose is 3 mg per kilo of
weight per day. Useful if co-infections are suspected. The recommendation for its
inclusion is more justified in cases where the patient has a history of having suffered
from a chronic intracellular infectious disease in which the use of antibiotics is
indicated, such as Lyme disease or Mycoplasma infection. Another tetracycline that
can be used is Minocycline, which is given in doses similar to Doxycycline. For
Lyme disease, Amoxicillin with Clavulanic Acid can also be used.
o AZITHROMYCIN, TB of 500 mg.
At a dose of 500 mg per day for 5 to 6 days.
It has an effect against Mycoplasma infections. It is also mentioned that it is useful
in viral infections, however, it has been identified that its use can induce the
reactivation of a pre-existing latent infection by the Herpesvirus associated with
Kaposi's sarcoma (72).
Because it presents a defined risk of prolonging the QT interval, it is recommended
to exercise caution or avoid taking it together with other drugs that also have a risk
of prolonging the QT interval.
o MOLNUPIRAVIR, (Lagevrio, Molcovi, Molravir, Tamicovir). TB of 200 or 400 mg.
For Acute COVID, 4 tablets of 200 mg are indicated twice a day for 5 days (total:
40 tablets).
In the case of Chronic COVID or Long COVID, it is being tested to indicate it for 15
to 20 days and together with other medications or supplements with an effect
against the viral load. And the general indication is that anti-viral drugs should be
taken until several days after the patient no longer has symptoms.
Molnupiravir side effects are diarrhea, nausea, and dizziness.
o OTHER ANTIVIRALS:
There are other antivirals that can be tested against the SARS CoV-2 virus. In
alphabetical order we will mention: Amantadine, Amenamevir, Aviptadil, Baloxavir
Emtricitabine/Tenofovir disopropyl (200mg/245mg), Famciclovir, Foscarnet,
Isoprinosime (Inmunovir), Leronlimab, Lopinavir/Ritonavir, Maraviroc, Nelfinavir,
Oseltamivir (Tamiflu, Procaps), Penciclovir, Simeprevir, Ribavirin, Rimantadine,
Tenofovir alafenamide (TAF), Tilorone, Umifenovir (Arbidol).
o ANTIVIRALS AGAINST HERPES:
If there is certainty or great suspicion that there is a co-infection with Herpes zoster,
Antivirals against Herpes should be indicated as an additional treatment to the
Treatment Scheme for COVID, since it is another disease.
The recommended Antivirals against Herpes zoster are:
o VALACICLOVIR (Valtrex, Bagovir, Valextra, Vaciclovir), TB of 500 mg.
The recommended regular dose is 1000 mg 2 times a day (2000 mg daily) for 7
days. In those who weigh more than 75 kilos, the dose is 1000 mg 3 times a day
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
28
(3000 mg daily). In those who weigh between 42 and 55 kilos, or are
immunocompromised, the dose is reduced to 500 mg 3 times a day.
It has been observed that it is also useful in persistent EBV infection, in which
case the treatment time would be extended since for chronic EBV it is indicated
to take it for at least 3 continuous months and according to tolerance.
o BRIVUDINE:
Is an antiviral that has been approved in European countries for the treatment of
Herpes zoster (49). It does not yet have the approval of the US FDA.
o OTHER ALTERNATIVES AGAINST HERPES:
Other antivirals that have been approved by the FDA to treat infections caused
by Herpes zoster or Varicella-zoster (49), are:
- FAMCICLOVIR: 500 mg orally 3 times a day for 8 days.
- ACYCLOVIR: 400 mg orally 5 times a day for 8 to 10 days.
o ANTIVIRALS AGAINST CYTOMEGALOVIRUS (CMV):
If there is certainty or strong suspicion that there is a Cytomegalovirus (CMV) co-
infection, Antivirals against Cytomegalovirus should be indicated as an additional
treatment to the Treatment Scheme for COVID.
The recommended Antivirals against Cytomegalovirus are:
o GANCICLOVIR (Cymevene, Cytovene, Natclovir). Vials or Ampoule Bottle, TB
or Capsules of 250 mg and 500 mg.
For the initial treatment, intravenous administration is indicated, the regular dose
is 5 mg per kilo of weight by slow infusion over one hour, once a day, 7 days a
week. Doses of 6 mg/kg once daily for 5 days per week can also be given. In the
event that the patient presents renal insufficiency, the dose should be reduced.
For maintenance treatment, the oral dose is 1 gram every 8 hours for 7 to 14
days.
o VALGANCICLOVIR (Valcyte, Valgan, Valixa, Valgovir), TB of 450 mg.
Used to prevent and treat cytomegalovirus (CMV) infections, especially in
immunosuppressed patients. The regular dose is 900 mg a day, which can be
taken once a day or 450 mg every 12 hours.
o OTHER ALTERNATIVES AGAINST CMV:
Other alternatives for the treatment of MVC infections in immunosuppressed
patients are FOSCARNET (90 mg/kg), MARIBAVIR (Itencity), CIDOFOVIR (5
mg/kg weekly) and LETERMOVIR.
o OTHER ALTERNATIVES: as the third drug to be considered in the 1st line, one of
the following alternatives could also be chosen (in alphabetical order):
o ACEMANNAN (ALOE VERA JUICE): is a D-isomer mucopolysaccharide found
in Aloe vera leaves. it is indicated to have immunostimulatory and antiviral
properties. The way to ingest it is by taking juice or natural Aloe vera juice.
o ANTIANDROGENS: such as Dutasteride, Finasterid, Bicalutamide and
Proxalutamide.
o BARICITINIB.
o BILIVERDINA.
o BROMHEXINE.
o CEPAHARANTIN.
o CIPROFLOXACIN. It can be indicated as another antibiotic in cases where
there is Mycoplasma infection.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
29
o CISTUS INCANUS.
o CRICONEMATINE ACID plus N-METHYLGLUCAMINE (Cycloferon).
o CYTHARABINE.
o DAPSONE.
o DESMODIUM (Desmodium canadense).
o FLUCONAZOLE. It can be indicated if there is co-infection with Mycoplasma.
o G-CSF (granulocyte colony-stimulating factor).
o LAUREL (Laurus nobilis).
o LEEK (Allium porrum).
o LUTEOLIN.
o METHYLENE BLUE.
o MINT (Mint piperita).
o MONTELUKAST.
o MYRICETIN (it is a flavonoid).
o OBATOCLAX
o TERBINAFINE: it is an antimocotic, it can be indicated if there is co-infection
due to mycosis.
o THYME (Thymus vulgaris).
2nd Line of Action of the Therapeutic Plan: REDUCE PLATELET HYPERACTIVITY
AND BREAK DOWN PERSISTENT CLOTS AND BIOFILMS:
In patients who have already performed the "Therapeutic Test" or have tried a Scheme
with only 1 antiplatelet (ASA, LASA, Clopidogrel or Alternative), and persist with symptoms
associated with hypoperfusion (dyspnea on exertion, fatigue and/or muscle pain, "brain
fog", numbness or signs of ischemia in upper or lower limbs, and other symptoms), the
presence of persistent clots and biofilms should be considered, so it is suggested to opt
for a Scheme that includes 3 types of drugs with effects against persistent clots and/ or to
improve blood circulation and perfusion, these are:
1) Antiplatelets.
2) Fibrinolytics or Thrombolytics.
3) Anticoagulants or alternatives with favorable vascular or intravascular effects.
In the 3-3-3 Treatment Scheme, we suggest that the following sequence be followed:
- The Antiplatelet is indicated during the first 3 days of the Scheme.
- The Fibrinolytic is indicated during the 8 days of the Scheme.
- The Anticoagulant is indicated from the 3rd day of the Scheme.
To reduce the risk of bleeding, it is recommended not to give the 3 drugs that reduce
coagulation for several days at the same time, so in general the recommendation is to give
the Antiplatelet for only during the first 3 days.
If after evaluating the patient, it is established that there is no risk of bleeding, and the
patient is under 55 years of age, the Antiplatelet can be indicated for all 8 days that the
Scheme lasts.
If there is no risk of bleeding, but the patient is over 55 years old, the Antiplatelet can be
given during the first 6 days of the Scheme.
One day before starting to take the medications to reduce Viral Load mentioned in the 1st
Line of Action, it should be started with the Antiplatelet medicine and with the Fibrinolytic,
the objective of this is that, from before starting with the medicines against viral load, the
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
30
clots that occur in the persistent infection by SARS CoV-2 are broken down, and that serve
as protection.
Inclusion of oral fibrinolytics to break down persistent clots.
There are several studies on antithrombotic therapy for pathologies such as atrial
fibrillation, Ischemic stroke, antiphospholipid antibodies, among others. In these, double
or triple antithrombotic therapies that combine 1 or 2 Antiplatelets and 1 Anticoagulant
have been established by consensus (39,40,41), but these do not include fibrinolytics. This
would be due in large part to the fact that until now there are no approved oral fibrinolytics
or thrombolytics as drugs. Fibrinolytic medications are only available in ampoules, which
require a prescription and medical indications.
But there are oral fibrinolytics that are marketed as nutritional supplements, which do not
require a prescription to acquire them, and which are the ones we are considering in our
Treatment Schemes.
ASSESSMENT OF THE RISK OF BLEEDING.
It is emphasized that the use of Antiplatelets and Anticoagulants requires medical
indication. To apply this Scheme, which includes drugs that reduce coagulation, the patient
must have a clinical-epidemiological diagnosis of Persistent Disseminated SARS CoV-2
Infection, which implies that they have a state of hypercoagulability with thrombi or
persistent clots and symptoms associated with tissue hypoperfusion.
The doctor should ask about:
- History of gastrointestinal ulcer, history of Digestive Bleeding or presence of bloody or
black stools with the appearance of pitch or tar.
- History of gastritis or other symptoms associated with increased acid in the stomach
(gastroesophageal reflux, acid reflux).
- Coagulation disorder or use of anticoagulants already established.
- History of excessive menstruation in women (hypermenorrhea) or other gynecological
pathology associated with increased uterine bleeding.
- Bleeding gums or after a dental procedure.
- Epistaxis (nosebleeds).
- Presence of petechiae or ecchymoses (bruises).
- Presence of reddish, brownish or brown urine (which may be due to hematuria:
bleeding in the urine).
- Presence of mucus, saliva or vomit with traces of blood.
- Wounds that bleed for a long time.
In addition, before starting to take anticoagulants for several days, it is indicated that the
patient undergo laboratory tests to see the state of coagulation and prevent bleeding from
occurring.
It is recommended to perform a complete blood count and a prothrombin time.
In cases with a platelet count below normal (less than 150,000), anticoagulants or
antiplatelets should not be used.
Preferably, the platelet count should be above 200,000 to start double or triple
antithrombotic therapy.
If the platelet count is between 150,000 and 200,000, it is recommended to resort to Lysine
and Lumbrokinase (Oral Fibrinolytic), which generate a lower risk of bleeding compared to
Antiplatelets and Anticoagulants.
Ideally, the patient should have an elevated D-Dimer analysis, and that specific tests be
performed that evaluate the function of the platelets and the fibrinolysis system, such as
Viscoelastic Tests, of which there are currently with thromboelastography (TEG), rotational
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
31
thromboelastometry (ROTEM), Quantra Analyzer, Sonoclot, iCoagLab and ClotPro
(46,47).
On the other hand, the patient must be instructed that for at least 3 days before starting
this Scheme, he must suspend all types of herbs, plants, nutritional supplements, vitamins
or special diet that he is following, and must inform the doctor what you have been taking,
how much and for how long. The doctor must evaluate whether or not to maintain any of
the herbs, plants, supplements or vitamins that the patient was taking. In case of
maintaining any, it must be incorporated into the Treatment Scheme to follow.
In cases where the patient was already using ASA or an anticoagulant, consideration
should be given to incorporating it into the Treatment Scheme to be indicated.
It should be taken into account that the long-term use of various types of herb, plants,
nutritional supplements and certain vitamins can predispose to bleeding, especially if it is
associated with the use of NSAIDs (including ASA), since one of the side effects of NSAIDs
is that it generates ulcers in the stomach and duodenum. In addition, to avoid an increase
in gastric acid, it is recommended to avoid coffee, soda, drinks with caffeine or "energy
drinks", alcoholic beverages, chili peppers and spicy condiments. And the indication of
ASA or another NSAID must be accompanied by taking a gastric protector, which in the
case of COVID it is recommended that this be with Famotidine, and Sodium Bicarbonate
or Baking Soda can also be added.
2.1. ANTIPLATELET:
The first antiplatelet options are Acetylsalicylic acid (ASA) and Lysine Acetylsalicylate
(LASA). The drawback of the latter is that it is not available in several countries. Both
belong to the group of Salicylates.
o ASA (Aspirin), TB 81, 100, 325, 500 or 650 mg:
In adults, it is recommended that 1 TB of 81 or 100 mg be taken after breakfast, lunch
and dinner (243 to 300 mg per day) during the first 3 days of this Treatment Schedule.
If it is established that the patient does not present a risk of bleeding, and is under 55
years of age, the Antiplatelet can be continued during the 8 days that the Scheme
lasts. If the patient is over 55 years old, the Antiplatelet can be given during the first 6
days of the Scheme.
In adults and adolescents 15 years of age and older who weigh between 42 and 55
kilos, a dose of 1 TB of 100 mg after breakfast and dinner (200 mg daily) is suggested.
If they are TB of 81 mg, 1 TB is indicated at breakfast, 1 at lunch and 1 at dinner (243
mg per day).
In general, its use is not recommended in children under 15 years of age, due to the
risk that they may present Reye's Syndrome. But an assessment of risk and benefit
can be made.
In patients weighing more than 95 kilos, it is indicated to double the dose, it would be
2 TB of 81 or 100 mg after breakfast, lunch and dinner (486 to 600 mg per day).
Another alternative is to take 1 TB of 500mg per day, after lunch.
The indication to take it after food is made to reduce possible irritation to the stomach
and duodenum.
It should be taken into account that the consumption of ASA increases the release of
histamine, therefore, if the patient presents symptoms associated with an increase in
histamine, It is recommended to give an alternative to ASA (Aspirin).
o LYSINE ACETYSALICYLATE: LASA (Aspergic, Inyesprin forte, Antigram): Sachet of
250, 500, 900, 1000 mg or 1.62 g. There is also a presentation in ampoules, 900 mg.
It has been identified that it has a greater antiplatelet effect than ASA.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
32
It is noted that 900 mg of LASA is equivalent to 600 mg of ASA, according to this, 2
mg of ASA is equivalent to 3 mg of LASA, and 300 mg of ASA is equivalent to 450 mg
of LASA.
The dose we suggest is 1000 mg per day. If they are 500 mg sachets, take 1 after
breakfast and dinner. If they are 1000 mg sachets, you take them after lunch.
In the case of ampoules of 900 mg, 1 per day is indicated, via IM.
In those who weigh more than 95 kilos, it is suggested to increase the dose from the
third day to 500 mg after breakfast, lunch and dinner (3 times a day). Then the LASA
dose would be increased from day 3 to 6 of this Treatment Schedule to 1500 mg per
day.
LYSINE + GLYCINE ACETYSALICYLATE (LASAG). 500mg ampoules.
It is also known as Aspirin in ampoules. We recommend 1 ampoule of 500 mg per
day.
ALTERNATIVES AS A FIRST MEDICINE OF THE 2ND LINE:
In the event that the patient presents intolerance, allergy or asthma induced by ASA
(Aspirin), by Salicylates or by NSAIDs, and does not present a risk of bleeding, the
alternatives to ASA and LASA are:
o CLOPIDOGREL (Plavix, Deviplat, generic), TB of 75 mg.
The suggested dose is 1 TB of 75 mg per day for the first 3 days of this Scheme.
If the patient weighs more than 95 kilos, it is recommended to take 1 TB of 75 mg at 9
am and 9 pm (2 TB per day) the first 2 days, and then on day 3 of this Scheme, take
1 TB per day.
It is a P2Y12 Receptor Inhibitor. Other Antiplatelets in this same group are Prasugrel,
Ticagrelor, Ticlopidine and Cangrelor, but of these there are not as many studies for
its use as double or triple antithrombotic therapy.
o GINGER or Kion (Zingiber officinale) (34).
A dose of 1100 mg is recommended at the beginning of breakfast and dinner (2200
mg per day) during the first 2 days, and from the 3rd day a dose of 550 mg is added
at the beginning of lunch, then the total dose of the day to 2750 mg. In patients
weighing less than 56 kilos, continue with 2 doses of 1100 mg per day.
It can also be taken as an infusion or as Ginger Kombucha, 3 to 4 times a day.
In patients weighing 75 to 95 kilos, it is recommended that from the 3rd day a dose of
1100 mg be added at the start of lunch, thus increasing the total dose of the day to
3300 mg. In this case it would be 1100 mg at breakfast, lunch and dinner.
In those who weigh more than 95 kilos, it is suggested that from the 3rd day the total
dose of the day be increased to 4400 mg, then take 1650 at breakfast, 1100 at lunch
and 1650 mg at dinner.
It has an important anti-inflammatory effect and is useful in premenstrual syndrome. It
is mentioned that it has as much anti-inflammatory power as Ibuprofen and other
NSAIDs. It is also recommended to indicate it in cases where the patient presents an
alteration of the intestinal microbiota or SIBO.
It is also noted that it has antiplatelet effects (inhibiting platelet aggregation),
antimicrobial and anti biofilm effects.
Side effects are rare, but can include heartburn, bloating (gas), and stomach pain.
o DIPYRIDAMOLE, TB 75 mg:
The recommended dose is 3 TB per day: 1 TB at 7 or 8 am (at least 1 hour before
breakfast), at 4 pm and at 11 pm, during the first 3 days of this Treatment Scheme.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
33
It is indicated to take it between 1 to 2 hours away from food and dairy products.
In those who weigh more than 95 kilos, the dose is 4 TB per day: 2 TB at 7 am (1 hour
before breakfast), and 1 TB at 4 pm and 11 pm (away from food) for 3 days.
If the patient weighs between 42 to 55 kilos, it is recommended to take 1 tablet of 75
mg at 11 am and 10 pm (150 mg per day).
o GARLIC (Allium sativum) (34). TB 1000 mg, which is equal to 1 gram:
The recommended dose is 5,000 mg or 5 grams per day (2 g at breakfast, 1 g at lunch,
and 2 g at dinner). For patients weighing 160 to 200 pounds, a dose of 6,000 mg or 6
g per day (2 g at breakfast, lunch, and dinner) is suggested.
In patients weighing more than 95 kilos, a dose of 7000 mg or 7 g per day is suggested,
it would be 2 g at breakfast and lunch and 3 g at dinner.
If the patient weighs between 42 to 55 kilos, 4000 mg or 4 g per day (2 g at breakfast,
1 g at lunch and dinner) is recommended.
It has antiplatelet effects (inhibiting platelet aggregation), anticoagulants (prolonging
the INR), antimicrobial and anti biofilms.
It has been identified that it has an effect against Influenza A and B viruses, type 3
parainfluenza, type 3 parainfluenza, cytomegalovirus, rhinovirus and SARS CoV-2
(50). And Allicin from fresh garlic extract has been shown to have activity against
various types of viruses.
It has been described that it interacts with antiretrovirals such as Ritonavir, decreasing
its plasma concentration and can promote resistance against them.
o POLICOSANOL, TB 5, 10 or 20 mg:
It is a mixture of higher aliphatic primary alcohols isolated from sugar cane.
The recommended dose for adults as an antiplatelet agent is 1 TB of 20 mg per day,
at breakfast.
In those who weigh less than 56 kilos, the dose is 10 mg at breakfast.
It is noted that it can be used in children and adolescents from 11 years of age.
It also has effects in reducing Cholesterol and Triglycerides.
o TAXIFOLIN or DIHYDROQUERCITIN or DHQ). TB of 10, 50, and 60 mg:
The recommended dose is 1 mg per kilo of body weight per day, rounding the dose
down. In this way, in those who weigh between 56 to 75 kilos, a dose of 60 mg per
day will be indicated, which can be divided into 2 doses of 30 mg within the day, or it
can be given in 1 single dose of 60 mg up to date.
In patients weighing 76 to 95 kilos, a dose of between 75 to 90 mg per day (1
mg/kg/day), in 2 or 3 doses per day, is suggested.
In those who weigh more than 95 kilos, the dose is between 80 to 100 mg per day,
divided into 2 or 3 doses.
In those who weigh between 42 and 55 kilos, a dose of between 40 and 50 mg per
day is indicated.
It is a flavonoid, it is mentioned that it would be three times as effective as quercetin.
It can be found in conifers, such as the Siberian larch Larix sibirica.
o NARINGIN, TB of 500 and 600 mg:
The regular dose is 500mg at 9am and 9pm (1000mg daily).
In those who weigh more than 95 kilos, it is suggested to increase the dose from the
3rd day to 1500 mg per day.
In those who weigh from 42 to 55 kilos, it is indicated to start the first 2 days with only
a dose of 500 mg at 9 am, and from the 3rd day it goes up to 1000 mg per day It is a
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
34
Flavonoid of the flavonone class, with an important antiplatelet antiaggregant effect, it
is noted that its antiplatelet effect is superior to that of other flavonoids such as Diosmin
and Quercetin.
It has been identified that it has effects against SARS CoV-2 and HCV.
o GINKGO BILOBA, TB or capsules of 40, 60, 80, 120, 125 and 240 mg. Or in in Bottes
with Tincture.
The regular dose is between 120 to 250 mg a day. If taken as a tincture, the dose
would be 1/4 teaspoon 2 to 3 times a day. If the patient weighs more than 95 kilos, it
is suggested to take 240 to 300 mg per day.
It has antiplatelet (inhibiting platelet aggregation) and fibrinolytic effects. It is described
in the scientific literature that it decreases blood viscosity and increases blood flow,
which has vasodilator, venotonic, antioxidant and neuroprotective properties, and
which improves difficulty concentrating, memory and dizziness.
It is also noted that it modulates serotonin levels. Among its indications is found as a
treatment for cognitive impairment, in Alzheimer's disease and for symptoms
associated with hypoperfusion at the brain level.
It has been identified that it has antiviral activity against the Herpes zoster virus and
inhibits the formation of biofilms.
o DONG QUAI or DANG QUI (Angelica sinensis). Capsules of 250, 500, 520, 565 or
1000 mg.
Inhibits platelet aggregation. It is mentioned that it is also useful for the Herpes zoster.
o MYRICETIN. 100 mg capsules.
It is a flavonoid. It has antiplatelet and antioxidant properties.
BAYBERRY BARK, Wax Myrtle or Candleberry (Myrica Cerifera). Capsules of 475 mg
575 or 1000 mg. It is also sold in powder form, to make infusions, such as tea.
This plant contains Myricetin.
o FLUVOXAMINE (Fluvox). TB of 25, 50 or 100 mg.
It is a Selective Serotonin Reuptake Inhibitor (SSRI).
A dose of between 25 to 50 mg per day is recommended, taking it at night before going
to sleep.
In patients weighing less than 56 kilos, a dose of between 12.5 to 25 mg is
recommended.
In those who weigh more than 95 kilos, the dose can be increased to between 50 and
100 mg a day, before going to sleep.
In patients who have already taken it before and have good tolerance, they can take
higher doses.
On the contrary, if there is not good tolerance or if there is an increase in symptoms,
its intake should be discontinued.
o SERTRALINE (Zoloft, Dipresol). TB of 25, 50 or 100 mg.
It is also an SSRI. A dose of 25 mg per day, before bedtime, is recommended.
In patients weighing less than 56 kilos, it is recommended to start the first 2 days with
a dose of 12.5 mg, and from the 3rd day it is increased to 25 mg per day.
In those who weigh more than 95 kilos, the dose can be increased from the 6th day to
50 mg a day, before going to sleep.
There are several publications and studies that indicate that Sertraline has
antimicrobial effects against various fungi, parasites and bacteria (67,68,69,70).
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
35
o PAROXETINE, FLUOXETINE AND OTHER SELECTIVE SEROTONIN REUPTAKE
INHIBITORS (SSRIs).
SSRIs block or inhibit the uptake of the neurotransmitter serotonin in platelets, which
decreases serotonin levels in platelets, which causes a decrease in platelet
aggregation, but by decreasing serotonin reuptake, an increase in serotonin levels in
the blood occurs.
The SSRIs with the greatest serotonin reuptake inhibitory effect are Paroxetine,
Sertraline, Fluoxetine and Clomipramine, followed by Fluvoxamine and Citalopram,
which produce intermediate inhibition.
In veterinary medicine Paroxetine is being tested as a potential antiparasitic (68). Its
trade names are Paxil, Xerenex.
The recommended doses are half or a quarter of the regular dose. It is recommended
to take half an hour before bedtime as it can cause drowsiness.
o GRAPE SEED EXTRACT (Vitis vinifera): TB 100, 200, 250, 400, 500 mg.
The regular doce is between 200 to 500 mg every 12 hours.
o ST. JOHN'S WORT (Hypericum perforatum) (34): TB of 300, 450, 600 or 1000 mg.
The recommended dose is between 600 to 900 mg a day. it is also noted that it is
useful for treating symptoms of depression. It contains several active principles,
among which are Hypericin, Hyperforin and Hyperjaponicol B and D. It has been found
to inhibit the reuptake of serotonin at the synapse. There are studies of its use in
severe depression with favorable effects.
It has also been identified to inhibit platelet aggregation, which has antibiofilm and
antiviral activity against the Herpes zoster virus and the influenza A virus.
It is noted that it should not be taken together with Ritonavir or Paxlovid.
o Gp IIb/ IIIa RECEPTOR ANTAGONISTS (Vitis vinifera): TB 100, 200, 250, 400, 500
mg. Are antiplatelet agents that prevent platelets from binding to each other.
ABCIXIMAB and TIROFIBAN belong to this group.
o VORAPAXAR (Zontivity). 2.08mg BT:
The regular dose is 1 TB a day.
It is a new antiplatelet agent that selectively inhibits the action of thrombin. It is a
protease-activated receptor 1 (PAR-1) antagonist, which is a profibrotic agent in
several organs, so it has a protective effect against fibrosis.
o OTHERS ALTERNATIVES: Also, you can choose to use other alternatives, such as
those mentioned below (in alphabetical order):
- CALCIUM DOBESYLATE.
- CITRUS PEEL.
- DULOXETINE (Cymbalta, Duceten, Dulpicap, Ideliver, Xeristar): is a serotonin and
norepinephrine reuptake inhibitor antidepressant, also useful for chronic
neuropathic pain.
- HINOKITIOL: this compound is found in the wood of trees in the Cupressaceae
family (Japanese cypres).
- ONION (Allium cepa). Contains alliin and allicin, which have an inhibitory effect on
platelet aggregation.
- PYCNOGENOL (53): is extracted from the bark of maritime pines (Pinus pinaster)
native to France. It mainly contains procyanidins and their monomers (catechin and
epicatechin).
- SAFFRON pr HONG HUA (Crocus sativus). It has antiplatelet, antithrombotic,
antioxidant and antitumor effect.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
36
- SULFORAFANO or BROCCOLI (Brassica oleracea). It is an isothiocyanate. It is
present in cruciferous vegetables such as broccoli, cauliflower and cabbage, but
the effect of Sulforaphane is considerably reduced when the vegetable is boiled,
but not if it is prepared as a stir-fry or in the microwave. It is considered an agent
for the prevention of tumor growth (anticarcinogen). It has been identified that it has
an important inhibitory effect on platelet activation and reduces the formation of
thrombi.
- MEADOWSWEET, Reine des Prés or Ulmaria (Filipendula ulmaria or Spiraea
ulmaria). Contains Acetyl Salicylic Acid (ASA).
- WHITE WILLOW BARK or Willow Bark Tea (Salix alba). It contains several
Salicylates, such as Salicillin, which is a compound similar to Acetyl Salicylic Acid,
and which also has anti-inflammatory and analgesic effects.
- WINTERGREEN, BOXBERRY or CHECKERBERRY (Gaultheria procumbens). It is
a rich source of salicylates and procyanidins.
2.2. FIBRYNOLYTIC OR THROMBOLYTIC:
Proteolytic or fibrinolytic enzymes act by breaking down blood clots through
fibrinolysis, which consists of the degradation of the networks formed by the fibrin
protein located above all at the level of the outermost layers of the clot. It is
recommended to start with a low dose of a fibrinolytic enzyme to minimize the release
of microorganisms, cytokines and other inflammatory substances that are covered by
the fibrin-rich layers.
The most widely used Fibrinolytic Enzymes are Serrapeptase, Lumbrokinase and
Natokinase. By acting specifically by degrading fibrin, the risk that bleeding may occur
due to its use is reduced. They can be indicated at the same time. In addition to the 3
mentioned, we include Bromelain (43), but it has a lower fibrinolytic effect and would
also have anticoagulant effects.
Fibrinolytics, by breaking down clots with a high fibrin content, will improve the
penetration of drugs and supplements that act against the viral and microbial load that
infects the cells that are covered by the fibrin layers.
It is important to note that fibrinolytic enzymes should be taken on an empty stomach,
at least one hour before or two hours after meals.
o SERRAPEPTASE, (or Serrapeptidase or serratiopeptidase), TB or Capsules of 20,
30 or 40 mg. And capsules of 40,000, 60,000, 80,000 or 120,000 SU (Serrapeptase
Units) or SPU (Serratiopeptidase Units). There are also presentations that use
International Units (IU).
It is noted that 2,000 SU equals 1 mg, so 40,000 SU or SPU would equal 20 mg.
The recommended starting dose is 60 mg or 120,000 SU daily. It should be taken
on an empty stomach, it would be 20mg at 7 or 8am, 4pm and 10pm, or 30mg at
11am and 10pm. If there is good tolerance, the dose is increased from the 3rd day
to 120 mg or 240,000 SU per day, to be taken in 3 doses, it would be 40 mg at 7 or
8 am, 4 pm and 10 pm
In those who weigh from 76 to 95 kilos, it is recommended to start with 80 mg or
160,000 SU the first 2 days, it would be 40 mg at 11 am and 10 pm, and from the
3rd day it increases to 120 mg or 240,000 SU per day. It would be 40 mg at 7 or 8
am, 4 pm and 10 pm.
In people who weigh more than 95 kilos, it is recommended that they start with 120
mg or 240,000 SU per day, divided into 3 doses, and if there is good tolerance from
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
37
the 3rd day, the dose is increased to 180 mg or 360,000 SU, to take it in 3 or 4
doses a day.
If the person weighs between 42 to 55 kilos, start with 40 mg or 80,000 SU per day,
in 2 doses, it would be 20 mg at 10 am and 10 pm. If there is good tolerance, the
dose is increased from the 3rd day to 80 mg or 160,000 SU per day, in 3 to 4 doses.
It could be 20mg or 40000 SU at 7am, 11am, 4pm and 11pm.
In patients who present severe symptoms associated with hypoperfusion, the
mentioned doses can be increased by 33 to 66%.
It is noted that it has a lower fibrinolytic effect than Lumbrokinase. In practice, they
can be used together, since there would be effects in which Serrapeptase stands
out and Lumbrokinase in others.
It can also be taken together with Nattokinase, Bromelain and Papain, there is a
commercial presentation called Neprinol that contains these 4 enzymes.
It is described that it also has immunomodulatory, anti-inflammatory, mucolytic,
antifibrotic, antithrombotic and antiviral effects (74).
o L-LYSINE, TB 500 mg:
The first 2 days it is recommended to take 1 TB of 500 mg at 7 am (at least 1 hour
before breakfast), 4 pm and 11 pm (1500 mg per day), and the following 6 days
(from day 3 to 8) 1 dose is added at 11:30 am (that is, it takes 4 TB per day, which
is equivalent to 2000 mg).
In those who weigh between 76 and 95 kilos, it is recommended to increase the
dose from the third day to 2500 mg per day. It would be 500mg at 7am, 11am, 3pm,
6.30pm and 11pm.
In people who weigh more than 95 kilos, it is recommended to start with 2000 mg
a day, and from the third day they take 3000 mg a day, it would be 1000 mg at least
1 hour before breakfast (7 or 8 am), at 4 pm and at 11 p.m.
In people who weigh between 42 and 55 kilos, the dose is reduced to 1 TB at 7 or
8 am and 5 pm the first 2 days (1000 mg per day), and 1 TB at 7 am, 11:30 am, 5
pm and 11 pm (2000 mg daily) for the next 6 days (days 3 to 8).
The tablets are taken at least 1 hour before or after meals and with 1 full cup of
water. It should be included in cases where the patient has a history of having
suffered from Herpes or it is suspected that there is co-infection by it, and in which
case the daily doses would be increased by an additional 500 to 1000 mg
depending on the evaluation of the case.
o LUMBROKINASE, TB of 20 mg, equivalent to 300,000 IU or 360,000
Lumbtokinase Units:
It comes from the earthworm Lumbricus rubellus.
Suggested doses for patients with moderate to severe symptoms associated with
hypoperfusion are described below. In those with only mild symptoms, it is
recommended to reduce the doses described by 33 to 50% (between one third and
one half).
It is recommended to start with 20 mg o 300,000 UI at 7 or 8 am, 4 pm and 10 pm
for the first 2 days (60 mg per day), and from the third day take 40 mg o 600,000 UI
at 7 or 8 am, 4 pm and 11 pm (120 mg per day) until completing the 8 days of the
Treatment Scheme described in this document.
In patients weighing between 76 and 95 kilos, it is recommended to start with a
dose of 40 mg or 600,000 IU at 11 am and 10 pm (80 mg daily) and then increase
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
38
the dose from the third day to 60 mg or 900,000 IU at 7 or 8 am and 4 pm, and 40
mg at 11 pm (160 mg daily).
In those who weigh more than 95 kilos, it is recommended that they take 40 mg or
600,000 IU at 7 or 8 am, 4 pm and 11 pm (120 mg per day) the first two days, and
from the third day 80 mg at 7 or 8 am, and 60 mg at 4 pm and 11 pm (200 mg daily).
In patients weighing between 42 and 55 kilos, the dose is reduced to 20 mg or
300,000 IU at 11 am and 10 pm for the first 2 days (40 mg a day), and from the
third day take 40 mg or 600,000 IU at 7 or 8 am and 4 pm, and 20 mg at 10 pm
(100 mg daily) for up to 8 days.
It has been identified that lumbrokinase has a significant specificity for fibrin, so it
has thrombolytic activity only in the presence of fibrin, which gives the advantage
that its use has a lower risk of bleeding.
o NATTOKINASE, TB or Capsules, of 50, 100 and 200 mg, or of 1000, 2000 and
4000 FU or UF (Fibrinolytic Units), being the equivalence between FU (or UF) and
mg variable according to the company that produces it (from 15 to 30 FU/UF for
each mg).
Typically, 100 mg equals 2,000 FU.
The regular dose for adults is between 5 to 9 mg per kilo of weight per day.
In patients weighing between 56 and 75 kilos, a dose of 100 mg or 2000 FU is
recommended for the first 2 days at 7 or 8 am, 4 pm and 10 pm, that is, 300 mg per
day, which is generally equivalent to 6000 FU. From the 3rd day the dose is
increased to 400 mg per day, it would be 200 mg at 11 am and 10 pm.
In those who weigh between 76 and 95 kilos, the recommended dose is 200 mg at
11 am and 10 pm, that is, 400 mg per day, which is equivalent to 8,000 UF per day.
And from the 3rd day the dose is increased to 500 mg per day. It would be 100 mg
at 7 or 8 am, and 200 mg at 4 and 10 pm.
In patients weighing more than 95 kilos, a dose of 200 mg is recommended at 11
am and 10 pm, that is, 400 mg per day. If there is good tolerance, it is suggested
to increase the dose from the 3rd day to 600 mg per day, it would be 200 mg at 10
am, 4 pm and 11 pm.
In patients weighing between 42 and 55 kilos, the dose is reduced to 100 mg at 11
am and 10 pm, which is equivalent to 200 mg or 4000 UF per day. If there is good
tolerance, the dose is increased from the 3rd day to 300 mg per day, it would be
100 mg at 7 or 8 am, 4 pm and 10 pm.
It is a fibrinolytic or proteolytic enzyme produced by the bacterium Bacillus subtilis
during the fermentation of soybeans to produce the food called Natto. Natto is the
richest food we find in menaquinone-7, which is a subtype of vitamin K2.
Because it is obtained by fermentation, it is recommended not to indicate it in
patients who present symptoms associated with an increase in histamines, allergies
or MCAS.
o BROMELAINE, TB or Capsules of 500, 750 or 1000 mg:
The regular dose is 500mg at 11am and 10pm (1000mg daily).
In patients weighing between 76 and 95 kilos, it is recommended to increase the
dose from the third day to 1500 mg per day (500 mg at 7 or 8 am, 4 pm and 11 pm).
If the patient weighs more than 95 kilos, a dose of 500 mg is recommended at 7 or
8 am, 4 pm and 10 pm (1500 mg per day) from the first day and for 8 days.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
39
If the patient weighs less than 56 kilos, it is recommended to start with a dose of
500 mg a day, at 11 am, for the first 2 days, and from the third day take 500 mg at
11 am and 10 pm (1000 mg up to date).
This proteolytic enzyme is obtained from the juice of the fruit or the stems of the
Pineapple (Ananas comosus). It should be taken into account that the use of
Bromelain is associated with an increase in the release of histamine.
o SEAPROSE S, TB or 30 mg capsules.
A dose of 90 mg per day is suggested. One study indicated that it has a better effect
than serratiopeptidase, and is well tolerated.
o THROMBOLYTICS FOR INDOVENOUS USE:
The most frequently used are
3rd Generation Thrombolytics:
- TENECTEPLASE (TNK-tPA, TNKase)
- RETEPLASE (rPA, Retavase)
2nd Generation Thrombolytics:
- ALTEPLASE (tPA or rTPA, Activase).
- ANISTREPLASE (APSAC).
1st Generation Thrombolytics:
- STREPTOKINASE (SK or STK)
- UROKINASE (UK)
o PENTOXIFYLLINE, TB 400 mg.
The regular dose is 400 mg every 12 hours (800 mg/day).
In people who weigh more than 95 kilos it is recommended that from the fourth day
they take 400 mg every 8 hours (1200 mg/day).
In osteonecrosis of the jaws and in tissue fibrosis induced by radiation therapy,
Pentoxifylline is indicated together with Vitamin E (tocopherol) at a dose of 400 IU
every 12 hours.
It is contraindicated in patients suffering from peptic ulcer, with a history of
gastrointestinal bleeding and those who are at risk of bleeding from other causes.
And it should be avoided to give it together with other contraindicated medications
in patients with a diagnosis of peptic ulcer or a history of gastrointestinal bleeding,
such as aspirin and other NSAIDs.
It is noted that it is a non-specific inhibitor of phosphodiesterase (PDE) erythrocyte,
increasing the activity of cyclic-AMP. It has several favorable effects on blood
circulation and tissue perfusion, improves the flexibility of erythrocytes, reduces
blood viscosity, reduces plasma fibrinogen, and increases the activity of the
fibrinolysis system. It is indicated especially when there are moderate to severe
symptoms or signs associated with hypoperfusion (fatigue, brain fog, numbness,
paleness and cold in the limbs).
Other phosphodiesterase inhibitors are Theophylline and Rolipran.
o N-ACETYL CYSTEINE (NAC), in Sachets, or 600 mg Tablets.
High-dose NAC is reported to aid in the breakdown or rupture of biofilms that form
persistent microorganisms.
A dose of 4,800 mg per day, in doses of 1,200 mg every 6 hours, is suggested.
In those who weigh more than 95 kilos, the dose can be increased to 7,200 mg per
day, in doses of 1,800 mg every 6 hours.
In patients weighing between 42 and 55 kilos, the dose is reduced to 3,600 mg per
day, in doses of 1,200 mg every 8 hours.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
40
It should always be taken on an empty stomach, at least 1 hour before or after food.
It can produce an increase in Histamine and symptoms associated with intolerance
(headache, vasomotor rhinitis, pruritus).
o SULODEXIN. TB of 15 mg or 250 LSU (Liphasemic Units, equivalent to
approximately 25 mg, since 10 LSU are approximately equivalent to 1 mg).
It is regularly indicated in doses of 60 mg per day. It would be given 2 TB of 15 mg
twice a day. If the presentation is in TB of 250 LSU, the dose is 1 TB twice a day.
If the patient weighs more than 95 kilos, the dose can be increased to 90 mg per
day, in this case the patient would take 2 TB of 15 mg 3 times a day. And in the
case of 250 LSU TB, the dose would be increased to 1 TB three times a day.
o SUPERPEPTASE (or superpeptase peptidase), TB 120,000: differs from
Serrapeptase by being made by the fermentation of Aspergillus melleus and
Aspergillus oryzae. Serrapeptase (or serratiopeptidase) is made by fermenting
Serratia marcescens.
o GINSENG or KOREAN GINSENG or RED (Panax ginseng). Capsules of 400, 500,
518, 550, 1000, 1500, 2400 mg.
Reduces platelet aggregation and increases Prothrombin Time.
o WHITE MULBERRY or MULBERRY (Morus alba). TB or capsules of 40, 60, 120,
240 and 500 mg.
It has been identified as inhibiting platelet activation, TXB2 formation, serotonin
secretion, aggregation and thrombus formation, so the extract of this plant could be
considered an antiplatelet and antithrombotic agent.
o CAYENNE PEPPER (Capsicum annuum): Capsules or TB of 360, 450, 500, 515,
530, 600 or 900 mg.
The regular dose ranges from 1000 to 2000 mg per day.
Its powder presentation can also be used, and it is added to juices or food. Contains
Capsaicin and Piperine.
o RUSCO or BUTCHER'S BROOM (Ruscus aculeatus). Capsules or TB of 200, 400,
470, 500 or 625 mg. The regular dose is between 500 to 1000 mg per day
o OTHERS OTHER COMPOUNDS WITH FIBRINOLYTIC ACTION: below are
mentioned in alphabetical order, other drugs, herbs or supplements that among
their effects is to increase the degradation of fibrin:
o DEFIBROTIDE. It is said to protect endothelial cells and prevent thrombosis.
o ESCINA or Aescina, is an active principle obtained from Horse Chestnut. It is
a phlebotonic and improves blood circulation.
o HAMAMELIS or Witch-hazels (Hamamelis virginiana), improves venous
circulation and the resistance of blood vessels.
o HORSE CHESTNUT (Aesculum hippocastanum). It has antithrombotic effects
and interacts with anticoagulants and antiplatelets.
o PAPAIN. Enzyme present in papaya (Carica papaya).
o PEPTIDASA.
o PROTEASE.
o SAGE or SALVIA (Salvia officinalis).
o VÍPERA TORVA, improves circulation in the lower limbs.: Papain, Protease,
Peptidase, Amylase.
2.3. ANTICOAGULANT:
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
41
In this Scheme the Anticoagulant is indicated from the 3rd day or day 3 of the treatment
Scheme. If you want to prolong the anticoagulant treatment, after the 8 days that the
first part of this Scheme lasts, this should be given after a medical evaluation.
The most commonly used anticoagulants are:
o APIXABAN (Eliquis, Sintrom, Mantixa, Elimbosis, Atreran, Hyphen). TB of 2.5 and 5
mg.
The suggested dose is 2.5 mg in the morning and 2.5 mg in the evening (5 mg daily).
In those who weigh between 76 and 95 kilos it is suggested that they take 5 mg in
the morning and 2.5 mg in the evening (7.5 mg per day).
In those who weigh more than 95 kilos, 5 mg in the morning and at night (10 mg per
day) is suggested.
It is an inhibitor of factor Xa (FXa), they are also called Direct Oral Anticoagulants
(DOAC).
o ENOXAPARIN, (Clexane, Clenox, Lovenox), Ampoules of 40 and 60 mg, for its
application via Sub-Cutaneous (SC), they are usually applied at the level of the
subcutaneous cellular tissue of the abdomen.
The usual dose is 1 SC ampoule of 40 mg per day. In those who weigh more than
95 k. the dose would be 1 ampoule of 60 mg per day.
The use of Heparins is recommended in cases where there is a significant
compromise of ventilation perfusion at the pulmonary level, this is identified by a
nuclear test known as V/Q Scan. On the other hand, in 2020, a study was published
indicating that Heparin and Enoxaparin inhibit the invasion of cells by
SARS CoV-2 by up to 80% at doses achievable through prophylaxis (42).
o OTHER LOW MOLECULAR WEIGHT HEPARINS (LMWH), In addition to
Enoxaparin, other LMWHs are:
- ARDEPARIN (Arcalyst, Normiflo).
- BEMIPARIN (Hibor, Phivor).
- CERTOPARIN (Troparin).
- DALTEPARIN (Fragmin, Boxol).
- NADROPARIN (Fraxiparina).
- PARNAPARIN (Fluxum, Tromboparin).
- REVIPARIN (Clivarina).
- TINZAPARIN (Innohep).
o RIVAROXABAN (Xarelto, Xaroban, Axabin, Xcept, Rivaxa, Coagriv). TB 10, 15 or
20 mg.
The suggested dose in this scheme is 5 mg per day in a single dose.
In those who weigh between 76 and 95 kilos, it is suggested that they take 5 mg in
the morning and at night (10 mg per day).
If you weigh more than 95 kilos, 10 mg in the morning and 5 mg in the evening (15
mg per day) are suggested.
It is also a factor Xa (FXa) inhibitor like Apixaban, but there are fewer studies done
and it has a higher cost.
Other Fxa inhibitors are: EDOXABAN, BETRIXABAN, DAREXABAN and
OTAMIXABAN.
o DABIGATRAN (Pradaxa, Dabidane, Dabired). TB or Capsules of 110 and 150 mg:
the recommended dose it is between 110 to 150 mg a day. If you weigh between 48
to 70 kilos the dose would be 110 mg a day. It is a direct thrombin inhibitor, for oral
use. Those for parenteral use are HIRUDIN, BIVALIRUDIN, ARGATROBAN,
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
42
EFEGATRAN, INOGATRAN, MELAGATRAN and their prodrug XIMELAGATRAN.
Thrombin converts fibrinogen to fibrin, for thrombus formation.
ALTERNATIVES TO ANTICOAGULANT:
In the event that the presence of hypercoagulability and thrombophilia is not clear, or if
there is an indication to exercise caution or avoid the use of anticoagulants, or there is
difficulty in their prescription, or if deemed appropriate according to the case, it can be
opt for one of the following alternatives instead of the anticoagulant as the second drug
of this 2nd Therapeutic Line:
o ICOSAPENT ETHYL, OR ETHYL-EICOSAPENTANOIC ACID (E-EPA) (Vascepa),
1 Gram Capsules (1000 mg).
It is a drug approved by the FDA, indicated to treat dyslipidemia and
hypertriglyceridemia and its use reduces the risk of cardiovascular events.
The regular dose indicated is 2 capsules of 1 gram twice a day with food (4 grams a
day).
In those who weigh more than 95 kilos, a dose of 6 grams daily is suggested.
It is indicated to take it with food.
It provides only EPA, without DHA (docosahexaenoic acid), which indicates that it
has the advantage of not raising LDL levels, which is the so-called bad cholesterol.
o EPA (Eicosapentaenoic Acid).
It's EPA alone (no DHA). It can be obtained as a nutritional supplement. Among the
brands or names as marketed is VegEPA, which contains 560 mg of EPA per
capsule.
A dose of 2000 mg of EPA per day is suggested, which is equivalent to taking 4
capsules per day.
In those who weigh more than 95 kilos, a dose of 5 capsules daily is suggested.
If the adult weighs between 42 to 55 kilos, a dose of 3 capsules per day is suggested.
o OMEGA 3, TB or capsules, usually of 1,000 mg total:
Contains EPA and DHA, recommending that it contains a high amount of EPA,
between 400 and 562 mg per capsule.
As for the daily dose, it is recommended to reach 2000 mg of EPA and 1000 mg of
DHA, this is generally equivalent to taking between 3 to 4 capsules a day of Omega
3 of 1000 mg.
This supplement is especially recommended when there are neurological symptoms.
o LIPOSOMAL GLUTATHIONE, presentation in bottle with dispenser for pumps of
100 mg each. There is also a presentation in Patches.
It is a powerful antioxidant and it also has an effect on the platelets. Presentation in
very small liposomes is recommended to improve absorption. The dose indicated by
the manufacturer is 200 mg (2 pumps orally) twice a day. It should be kept in the
mouth for 30 seconds before swallowing. It should be taken on an empty stomach,
we recommend that it be at least 30 minutes before meals.
o DIOSMINA + HESPERIDINE o FFPM (Purified and micronized flavonoid fraction).
TB or Capsules with 450 or 900 mg of Diosmin, AND 50 or 100 mg of Hesperidine.
The capsules contain 90% DIOSMIN and 10% HESPERIDINE.
They are flavonoids that improve the resistance of the capillaries, they are indicated
for the relief of edema and symptoms related to chronic venous insufficiency. It also
has anti-inflammatory properties.
Diosmin is present in the fruit of the sweet orange.
The regular dose is between 450/50 mg 2 times a day, which is equivalent to 900/100
mg a day. If the patient weighs more than 95 kilos, the dose can be increased to
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
43
900/100 mg every 12 hours.
o PIRACETAM, TB 800 mg, and it is also sold in bulk as a powder:
The indicated dose is 2400-3200 mg per day. I would take 1 TB of 800 mg every 8
hours, or 2 TB of 800 mg every 12 hours. If the patient weighs more than 95 kilos,
the dose can be increased to 4800 mg per day, he would take 2 TB of 800 mg every
8 hours. If you take 4800 a day, and you are going to continue taking it for more than
3 weeks, it is indicated that from the third week reduce the dose to between 2400 to
3200 mg a day, it would be 1 TB of 800 mg every 8 hours, or 2 800 mg TB every 12
hours. It is noted that, to stop taking it, you should proceed with a gradual reduction
in the dose at the rate of 1200 mg every 3 days. This medicine is indicated in cases
where the patient persistently presents the so-called brain fog, characterized by the
presence to a greater or lesser degree of memory loss, disorientation, confusion,
difficulty concentrating, difficulty finding words, attention problems. and other
neurological symptoms.
o COLCHICINA. TB of 0.5 or 0.6 mg.
In medical practice, its indication has been incorporated for a few years in the stages
after acute myocardial infarction, since it has been identified that its use reduces the
frequency of ischemic cardiovascular events.
The suggested regular dose in Acute or Chronic COVID is 0.5 or 0.6 mg at 9 am and
9 pm.
In those who weigh more than 95 kilos, it is suggested to increase the dose to 1 or
1.2 mg at 9 am and 0.5 or 0.6 mg at 9 pm.
o R-ALPHA LIPOIC ACID (R-ALA): TB of 200, 250, 300 or 600 mg:
It is pointed out that ALA exists as R-ALA and S-ALA, and that S-ALA is ineffective,
so R-ALA must be purchased, and not products that are marketed only as ALA, since
they would also contain HALL.
The dose we recommend is 300 mg during the first 2 days, and between 500 and
600 mg from the third day.
In those who weigh more than 95 kilos, it is suggested to increase the dose from the
3rd day to between 750 and 1000 mg per day.
In those who weigh less than 56 kilos, the dose of between 200 and 300 mg per day
is maintained every day.
It is recommended to take it together with Niacin at a dose 50 to 100% higher than
that of R-ALA.
It is noted that at doses of 1200 to 1800 mg per day it can cause abdominal pain,
nausea, dizziness, allergic reactions, hypoglycemia.
An antioxidant effect has been identified, and cases of chronic neuropathies that
have responded favorably have been reported. It is mentioned that it reduces the
absorption of iron, so its use for several weeks could cause anemia.
o HAWTHORN, Hawthorn berry or Espino (Crataegus monogyna, some point out that
it is the Crataegus oxyacantha), TB or capsules of 300, 400, 425, 500, 565, 580 and
750 mg: The regular dose is between 750 to 1500 mg a day. There is also
presentation in bottles of the Tincture or the Extract. Contains tannins, flavonoids,
pigments and vitamins.
o BEET OR BEETROOT JUICE, is a food rich in Lysine and Nitrates (NO3-) which are
precursors of Nitric Oxide (ON). It has been identified in studies that it improves
performance and endurance for physical exercise (71). It also improves blood
circulation and reduces blood pressure in healthy adults. Its frequent consumption
will make the urine and feces look reddish.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
44
o OREGANO OIL (Origanum vulgare). Dropper bottle or Capsules of 100, 150 or 180
mg.
A usual dose is between 300 to 600 mg per day, divided into 3 doses.
They contain the phenols Carvacrol and Thymol. It has been identified that both have
antibacterial, antiparasitic, antifungal, antioxidant activity and inhibit the formation of
biofilms.
It is not recommended to be taken by patients with peptic ulcer disease, gastritis,
ulcerative colitis, irritable bowel disease, liver disease, neurological disease or
epilepsy.
o BACOPA MONNIERI or BRAHMI, TB or Capsules of 100, 250, 300, 450, 500, 750
and 1,000 mg.
It is taken between 600 to 1500 mg a day. If the patient weighs more than 95 kilos,
the dose can be increased to between 900 to 1800 mg per day.
o ELEUTHERO, SIBERIAN GINSENG or CIWUIJIA (Eleutherococcus senticosus).
Is often considered an adaptogen, that is, it increases resistance to physical,
environmental and emotional stressors. Taking it along with drugs that also slow
blood clotting is said to increase the risk of bruising and bleeding.
o CINNAMON (Cinnamomum cassia). Capsules of 500, 1000, 1500 or 2000 mg.
It has anticoagulant effects.
o NAFTIDROFURIL, TB of 100 and 200 mg: it is a cerebral and peripheral vasodilator
whose mechanism of action is related to the blockade of serotonergic receptors
(5HT2) located in vascular smooth muscle. It is used in the treatment of peripheral
and cerebrovascular disorders. The regular dose is between 300 to 600 mg/day,
given every 8 hours.
o NICERGOLINA: TB of 5 and 10 mg: the regular dose is 5 to 10 mg 3 times a day.
To facilitate absorption, ingestion of the drug away from meals is preferable. The
effect may take time to manifest itself after a certain time of treatment. It is a
derivative of ergot of rye. It has been used for decades to treat cognitive, affective,
and behavioral disorders in the elderly.
o EVENING PRIMROSE OIL or EPO (Oenothera Biennis). Look for the presentation
in Evening Primrose Oil Pearls of 100, 250 or 300 mg. It contains as active principle
Gamma Linolenic Acid (GLA). The regular dose is 2 to 4 grams a day. If the patient
weighs more than 95 kilos, the dose can be increased from 4 to 6 grams per day.
o RED YEAST RICE: or Koji. It is a fermented rice that acquires its red color when
cultivated with the Monascus purpureus yeast. It is a supplement that is used as a
substitute for statins. It is mentioned that it has fewer side effects than commercial
statins. Contains Monacolin K, which inhibits cholesterol synthesis.
o STATINES: It should be taken into account that due to its use some people may
present muscle pain, weakness, rhabdomyolysis, peripheral neuropathy,
paresthesias, headache, dizziness and the appearance of type 2 diabetes mellitus.
Cases of memory loss have also been reported in most of them involved in the
lipophilic statins Simvastatin and Atorvastatin. And cases of emotional or behavioral
disturbances are mentioned.
Currently, the following options are available:
o Hydrophilic statins: PRAVASTATIN and ROSUVASTATIN.
o Lipophilic statins: SIMVASTATIN, ATORVASTATIN, LOVASTATIN and
FLUVASTATIN.
Atorvastatin is the most widely used, it is recommended in doses between 20 to 40
mg per day.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
45
o AMINAFTONE: TB de 75 mg.
It is a phlebotonic, capillaroprotector and vasoprotector. It works by improving the
venous capillary circulation. Used for the symptomatic treatment of chronic venous
insufficiency of the lower extremities and in the clinical manifestations of capillary
fragility.
Typically, a loading dose of 1 TB of 75 mg every 8 hours (225 mg daily) followed by
a maintenance dose of 1 TB of 75 mg every 12 hours (150 mg daily) is indicated.
o KOMBUCHA, is is a fermented drink with probiotics and prebiotics that regulates the
intestinal flora. It is an antioxidant, has vasodilator, anti-inflammatory and antiplatelet
effects. There are presentations in which ginger, lemon, apple, turmeric, orange,
pineapple or others are added. In particular, Ginger Kombucha has an anticoagulant
effect, due to the added effect of Ginger in reducing coagulation. Being fermented
can produce an increase in histamine.
o TRIMETAZIDINE, is described as a cellular protector, which decreases intracellular
acidosis. It is indicated in doses of 20 mg every 8 hours (60 mg a day). It is useful for
the treatment of nocturnal muscle cramps.
o ASTAXANTINA, is a carotenoid. It is a powerful antioxidant. In research studies, it
has been identified to have a protective effect and increase the efficiency of
mitochondria (54,55,56).
o TMG (trimethylglycine) or anhydrous BETAINE. It is noted that it facilitates
methylation processes, which is an important process for DNA repair and for the
conversion of homocysteine to methionine, thus supporting its reduction to healthy
levels of homocysteine. A dose of 1500 mg per day is suggested, taken with 1 glass
of water. Contains Glycine
o ELDERBERRY, SAMBUCUS or BLACK ELDERBERRY (Sambucus nigra).
o OTHERS: other alternatives with anticoagulant effects, or with favorable effects at
the level of the walls of the blood vessels or, in the flow or the viscosity of the blood
are the following (in alphabetical order):
- ACETAZOLAMIDE (Diamox).
- ACAÍ BERRY or AZAÍ (Euterpe oleracea).
- AGRIMONY (Agrimonia pilosa). It has anticoagulant and antiplatelet action.
- ALFALFA or Lucerne (Medicago sativa).
- ALOE VERA. Contains Emodin.
- AMENTOFLAVONE. It is a flavonoid.
- AMLODIPINE. It is a calcium antagonist, it is indicated as a treatment for
Raynaud's Phenomenon at doses between 10 and 20 mg per day.
- APRICOT. Contains Vitamin A and antioxidants.
- ARNICA.
- ARTICHOKE (Cynara scolymus).
- ANISE OR ANISE SEED (Pimpinella Anisum).
- APIGENIN. It is a flavonoid. Antiviral effects have been identified against HCV and
Enterovirus. It inhibits platelet aggregation and is mentioned to induce
vasorelaxation.
- ASTRAGALUS, Mongolian milkvetch or Huáng qi (Astragalus membranaceus)
(35). Inhibits thrombosis and platelet aggregation.
- BAKUCHI, BABCHI, BAKUCHIOL or BU GU ZHI (Psoralea corylifolia).
- BASIL or SWEET BASIL (Ocimum basilicum).
- BC 007.
- BILBERRY, MYRTILLE, European blueberry or Blaeberry (Vaccinium myrtillus).
- BLACK CARDAMOM (Amomun subulatum).
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
46
- BLACKCURRANT or (Cassis Ribes nigrum).
- BLADDER WRACK or FUCUS (Fucus vesiculosus).
- BLUE HUCKLEBERRY or Northern Highbush Blueberry (Vaccinium
corymbosum).
- BOG BILBERRY, BOG BLUEBERRY, Bog whortleberry or Northern bilberry
(vaccinium uliginosum).
- BOLDO (Peumus boldus).
- BOSENTAN. It is a dual antagonist of the endothelin receptor, used in the
treatment of pulmonary hypertension and Raynaud's disease.
- BUCKBEAN or BOGBEAN (Menyanthes trifoliata).
- BURDOCK (Arctium lappa).
- CARBO VEGETABILIS, homeopathic medicine extracted from Carbo Ligni
Officinalis, a charcoal that comes from the combustion of white resin-free wood,
such as poplar or willow. Indicated in patients with symptoms of tissue
hypoperfusion, improves oxygenation of the tissues.
- CARDAMOM, GREEN CARDAMOM or TRUE CARDAMOM (Elettaria
cardamomum).
- CARVEDILOL. It is a non-selective beta-blocker and vasodilator that reduces
peripheral vascular resistance. It is indicated for heart failure and hypertension.
- CAPSAICIN, active principle of Cayenne Pepper.
- CHAMOMILE or Camomile (Matricaria recutita or Chamomilla)
- CHAPARRAL, Gobernadora o Creosote bush (Larrea tridentata).
- CHERVIL o French parsley (Anthriscus cerefolium).
- CHINESE HAWTHORN or SHAN ZHA (Crataegus pinnatifida).
- CHIRATA (Swertia chirata).
- CHLORELLA (Chlorella vulgaris). Chlorella is a genus of unicellular green algae.
It should be avoided by people who are allergic to shellfish and children under 12
years of age. It has a high concentration of chlorophyll, which is a powerful
antioxidant agent.
- CHLOROPHYLL.
- CILOSTAZOL, has antiplatelet and vasodilator effects.
- CLOVE (Syzygium aromaticum).
- COENZYME Q10 or CoQ10.
- CORDYCEPS (Cordyceps sinensis). It is mentioned that it is useful for cases with
cardiac arrhythmia. It contains cordyceps acid, glutamic acid, vitamins B1, B2 and
B12, and various minerals (sodium, zinc, iron, copper, manganese and selenium).
- CRANBERRY, Large Cranberry or American cranberry (Vaccinium
macrocarpon).
- DEVIL'S CLAW (Harpagophytum procumbens). It has been identified that it has
anti-inflammatory effects, so it is indicated in rheumatic diseases and muscle pain.
The regular dose is 4.5 grams a day.
- DMSO (Dimethyl Sulfoxide).
- ELLAGIC ACID. It is a polyphenol that is present in many red fruits
(Pomegranates, Strawberries, Raspberries, Blueberries, Blackberries).
Decreases platelet aggregation and fibrinogen concentration. It has been
identified to possess antifungal activities against drug-resistant Candida.
- EUROPEAN CRANBERRY or SMALL CRANBERRY (Vaccinium oxycoccos).
arándano agrio
- FENNEL (Foeniculum vulgare). It is usually consumed in the form of an infusion,
such as tea. Reduce blood clotting.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
47
- FENUGREEK (Trigonella foenum-graecum).
- FEVERFEW (Tanacetum parthenium).
- FISETINA, is a flavonol, a chemical substance that belongs to the flavonoids, a
group of polyphenols.
- FLAX or LINSEED (Linum usitatissimum).
- GOJI BERRY (Lycium barbarum).
- GOLDENSEAL or orangeroot (Hydrastis canadensis).
- GOTU KOLA or Asiatic pennywort (Centella asiática). Is rich in asiaticoside and
madecasósido.
- GRAPEFRUIT (Citrus × paradisi).
- GREATER CELANDINE (Chelidonium majus). Contains Chelidonic Acid.
- GUARANA (Paullinia cupana). Decreases or shortens clotting time.
- GUAVA or GUAVA LEAF EXTRACT (Psidium guajava).
- GUAYUSA (Ilex guayusa). It has antioxidant properties, beneficial effects at the
vascular level, antimicrobial effects and inhibits the formation of biofilms.
- GUGGUL or Indian bdellium-tree (Commiphora wightii or mukul).
- HARITAKI (Terminalia chebula).
- HONEYSUCKLE (Lonicera japonica). It has antiplatelet effects.
- HOP or HOPS: this is what the Hop plant (Humulus lupulus) is called. It is
traditionally used to add bitterness and flavor to beer. It contains isoflavonoid
phytoestrogens, which have been associated with a reduction in the incidence of
cardiovascular diseases. It has been identified to induce vasorelaxation with
vasodilation mediated by activation of NOS, cyclooxygenase products, and Ca
(2+) pathways.
- HORNY GOAT WEED, EPIMEDIUM or barrenwort. Used in China for centuries
to treat low libido, erectile dysfunction, fatigue, pain, and other conditions
- HYSSOP (Hyssopus officinalis).
- ILOPROST. Synthetic analog of prostacyclin, inhibits platelet aggregation, dilates
arterioles and venules, decreases vascular permeability. It is indicated in
Raynaud's phenomenon and in certain types of pulmonary arterial hypertension.
- ISOTRETINOINA.
- KAEMPFEROL, is a Flavonoid.
- KELP or Algivit. alga perteneciente a la clase Phaeophyceae.
- KIWI.
- LACHESIS MUTUS, homeopathic medicine.
- LECITHIN or SOY LECITHIN, is a phospholipid, favors liver function avoiding or
reversing fatty liver and helps blood circulation.
- LEMON (Citrus limon).
- LEMON BALM or MELISSA (Melissa officinalis). It is mentioned that it is useful for
the treatment of tachycardias of nervous origin, as an antidepressant and
anxiolytic.
- LEMON VERBENA o Verbena (Aloysia citriodora).
- LINDEN FLOWER (Tilia cordata).
- LION'S MANE (Hericium erinaceus).
- LOSARTAN. It is an ACEI, it is indicated for the treatment of Raynaud's
Phenomenon at doses between 12.5 and 50 mg per day.
- MAGNESIUM.
- MAGNESIUM GLYCINATE, is formed by molecules of magnesium and glycine. It
is very well absorbed and highly bioavailable.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
48
- MAGNESIUM L-THREONATE, threonate is formed when magnesium combines
with threonic acid, a component of vitamin C. This form can effectively increase
magnesium levels in the brain and encourages magnesium to enter the
mitochondria directly.
- MAITAKE (Grifola frondosa).
- MELATONIN. It is noted that it reduces blood clotting, so it can enhance the effect
of anticoagulants.
- MELILOTO (Melilotus officinalis).
- MIRTAZAPINE (antidepressant).
- MITOQUINOL or Mitoquinone Mesylate (MitoQ), is a synthetic analogue of
Coenzyme Q10 that has an antioxidant effect.
- MOTHERWORT (Leonurus cardiaca).
- MSM, or METHYLSULFONYLMETHANE, or organic sulfur.
- MYRRH (Commiphora myrrha).
- NETTLE (Urtica dioica).
- MOUNTAIN-ASH or ROWAN (Sorbus aucuparia).
- MYRRH (Commiphora myrrha). it inhibits platelet aggregation and has
antithrombotic activity.
- MYRTILE (Vaccinium myrtillus).
- N-ACETYLGLUCOSAMINE, also called GlcNAc or NAG.
- NIFEDIPINE. It is a calcium antagonist, it is indicated as a treatment for Raynaud's
Phenomenon starting with doses of between 20 to 30 mg, and with maintenance
doses of between 60 to 120 mg per day. It is indicated that it also inhibits platelet
activation.
- NIMODIPINE. It is a calcium channel blocker, originally developed for the
treatment of high blood pressure. It improves cerebral blood flow with beneficial
effects for neurological symptoms due to hypoperfusion. It is reported to be useful
in CFS/ME and Fibromyalgia.
- NSAIDs (Non-Steroidal Anti-Inflammatory Drugs). Like Ibuprofen, Diflunisal,
Naproxen, Indomethacin, others.
- OYSTER MUSHROOM or Hiratake (Pleurotus ostreatus).
- PARIETARIA or Pellitory of the Wall (Parietaria officinalis)
- PARSLEY (Petroselinum crispum).
- PASSION FLOWER or PASSIFLORA (Passiflora).
- PAU D´ARCO, Lapacho or Terrestrial Racines (Tabebuia impetiginosa).
- PINE BARK, Maritime pine or Pycnogenol (Pinus pinaster).
- POMEGRANATE, in EXTRACT or PEEL (Punica granatum). The peel or bark of
the pomegranate contains Ellagic Acid. It has anti-inflammatory properties and
activity against various enteroviruses.
- PURPLE LOOSESTRIFE Salicaria Púrpura (Lythrum salicaria).
- PROPOLIS. It contains the polyphenol caffeic acid phenethyl ester (CAPE) which
has antifungal activities against drug-resistant Candida.
- PRUNELLA VULGARIS. It has antioxidant effect and improves blood circulation.
- PTEROSTILBENO, a natural polyphenol with antitumor and antiplatelet effects.
The regular dose is 100 mg every 12 hours.
- PYRROLOQUINOLINE QUINONE (PQQ). It is a cofactor that participates in the
production of energy in the mitochondria and is an antioxidant. The suggested
dose is 20 mg. In people over 35 years of age, if it is accompanied by 300 mg of
CoQ10, it is indicated that better results are obtained.
- PURPLE CORN (Zea mays).
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
49
- RACETAMOS: the first and best known is Piracetam, others are Aniracetam,
Oxiracetam, Levetiracetam, Nefiracetam, among others.
- RANOLAZINE (Ranexa). Drug indicated for the treatment of chronic angina
pectoris.
- RED CABBAGE, PURPLE CABBAGE or Kale (Brassica oleracea).
- RED CLOVER (Trifolium pratense)
- REISHI (Ganoderma lucidum).
- RHODIOLA or GOLDEN ROOT (Rhodiola rosea). It is a plant considered
adaptogenic. It is indicated against fatigue, stress, for hypoxia, to improve mood.
- ROSEMARY (Salvia rosmarinus or Rosmarinus officianalis). Contains rosmarinic
Acid, phenolic acids, flavonoids, diterpene and triterpenes. It has been identified
that it inhibits platelet aggregation.
- ROSMARINIC ACID.
- ROYAL JELLY.
- RUTA or RUE (Ruta graveolens).
- SAFFLOWER (Carthamus tinctorius).
- SAN LENG or Cu Zhi (Scirpus, Sparganium stoloniferum or emersum).
- SAW PALMETTO (Serenoa repens).
- SCHIZANDRA (Schizandra chinensis).
- SHE GAN (Belamcanda chinensis).
- SIDA ACUTA or Wire weed.
- SILDENAFIL. It is a phosphodiesterase-5 inhibitor. It is also indicated as a
treatment for Raynaud's Phenomenon.
- SILYMARIN. It is a flavonoid.
- STRAWBERRIES (Fragaria × ananassa).
- SOYBEAN (Glycine max).
- SUMA or Brazilian Ginseg (Pfaffia paniculata). Contains germanium and
phytosterols.
- SWEET WOODRUFF (Galium odoratum).
- TANNIC ACID, present in Red Wines, especially those made from Malbec grapes.
- TARRAGON o ESTRAGON (Artemisia dracunculus).
- TART CHERRY, SOUR CHERRY OR CHERRY TART (Prunus cerasus).
Contains Flavonoids, Vitamin C, Polyphenols.
- TEMPOL.
- TROXERUTINE. It is a flavonol derived from Rutin. It can be isolated from the
Sophora japonica plant. It is said to protect small blood vessels and stabilize the
endothelial membrane. Applied as a cream on the skin, it acts at the capillary level.
- TURNIP or white turnip (Brassica rapa subsp. rapa).
- XUAN SHEN or Scrophularia Root (Scrophularia Ningpoensis).
- VALERIAN (Valeriana officinalis).
- VINE or RED VINE (Vitis vinifera).
- VINCAMINA, is the main compound of the VINCA MINOR plant. It has peripheral
vasodilator activity, it is used in cognitive impairment, vascular insufficiency or
cerebral ischemia.
- VINE or RED VINE (Vitis vinifera).
- VITAMIN E or Tocopherol (It is composed of 4 tocopherols and 4 tocotrienols). It
has been
identified as having effects by inhibiting platelet aggregation.
- VITAMIN K.
- WHITE OAK BARK (Quercus alba).
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
50
- WHITE WILLOW (Salix alba).
- WILD PANSY FLOWER or PENSAMIENTO (Viola tricolor).
- WORMWOOD o Wermout (Artemisa absithium), is indicated in intestinal
parasites, to treat blood stagnation, menstrual irregularities and as an insecticide
against moths.
- YARROW or Common Yarrow (Achillea millefolium).
There are several other nutritional supplements, medications and plants that have
anticoagulant or antiplatelet or fibrinolytic effects within their effects, being the
indication to see if they are included in this Scheme, if not, their use should be
suspended so as not to increase the risk of hemorrhage.
3rd Line of Action of the Therapeutic Plan: TREAT NUTRIENT DEPLETION,
OXIDATIVE STRESS AND IMMUNE DYSFUNCTIONS.
3.1. B-COMPLEX VITAMIN:
In clinical practice, it has been observed that the B complex vitamins that are most
required are B12 (cobalamin), B1 (thiamin), B6 (pyridoxine), B3 (niacin or nicotinic
acid), B9 (folic acid) and Biotin (B7 or Vitamin H). It should be taken into account that
the deficiency of vitamins B9, B12 and B6 are a cause of thrombophilia and an
increased risk of presenting cardiovascular diseases associated with an increase in
the blood of the amino acid Homocysteine.
To better evaluate the effects of these vitamins on symptom improvement, it is
recommended not to take them for the first 3 days of this Treatment Scheme, then,
you only start taking them on day 4.
The recommended doses to take from day 4 to 8 (5 days) of the Treatment Scheme
are as follows:
3.1.1. VITAMIN B12: COBALAMIN OR CYANOCOBALAMIN, Sublingual, or in
Ampoules for intramuscular application:
To better evaluate the effects of these vitamins in the improvement of symptoms, it is
recommended not to take them the first 3 days of this Treatment Scheme, then, just
start taking them on day 4.
The recommended dose is 3,000 mcg (3 mg) per day for 5 days, or 5,000 mcg (5 mg)
every other day, or just 1 ampoule of 10,000 mcg (10 mg) for 5 days. Ampoules or
pills that contain, in addition to B12, vitamins B1 and B6 can be used. There are
several presentations that contain these 3 vitamins.
If the patient presents symptoms associated with neuropathy, it is recommended to
take twice the doses mentioned, in the case of the 10,000 mcg ampoule, a second
ampoule would be placed 2 days after the first ampoule was placed.
If the patient is identified as having very high Vitamin B12, this may indicate that they
have an alteration of the intestinal microbiota or SIBO.
Methylcobalamin is one of the active forms of vitamin B12 and it has been proposed
that it could act directly, without the need to be processed. However, the studies
carried out indicate that all forms of Vitamin B12 follow the same transformation
process in our body.
It should be noted that Metformin, Colchicine and proton pump inhibitors (PPIs) such
as Omeprazole and Lanzoprazole, can reduce their absorption. It is also mentioned
out that Vitamin C can reduce the amount of vitamin B12 available in the body, and to
avoid this, vitamin C is taken after 2 or more hours of taking vitamin B12.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
51
3.1.2. VITAMINA B1 or THIAMINE DERIVATES:
VITAMIN B1: THIAMINE: TB or Ampoules.
The recommended dose to be taken from day 4 to 8 (5 days) of the Treatment
Schedule is: The recommended dose to take from day 4 to 8 (5 days) of the Treatment
Scheme is: 600 mg per day on days 4 and 5, 1200 mg on days 6 and 7, and 1800 mg
on day 8 [58].
Vitamin B1 is essential in brain function due to the role of coenzyme thiamine
diphosphate (ThDP) in glucose and energy metabolism.
BENFOTIAMINE: TB of 100, 150, 200, 250 and 300 mg.
It is a fat-soluble synthetic derivative of Thiamine, which allows it to cross cell
membranes, but it is noted that it does not cross the blood-brain barrier (BBB). It is
indicated for the treatment of diabetic neuropathy.
The recommended dose is between 450 to 750 mg per day, divided into 3 doses per
day.
ALYTHIAMINE: 50 mg TB.
It is also a fat-soluble synthetic derivative of Thiamin and it does cross the BBB, which
is why higher levels of Thiamin are achieved in the brain. The recommended dose is
between 50 to 100 mg per day, divided into 2 doses per day.
SULBUTHIAMINE (Arcalion, Enerion, Sulverion): 200 mg TB.
It is a synthetic derivative of Thiamine that also crosses the BBB, increasing Thiamine
levels in the brain. It is indicated for asthenia, fatigue, apathy and symptoms
associated with depression.
The dose we recommend is 400 mg at breakfast and 200 mg at lunch from days 4 to
8 of this Scheme. It should be taken with plenty of water.
OTHER THIAMINE DERIVATIVES: FURSULTIAMINE and DIBENZOYLTHIAMINE.
3.1.3. VITAMIN B6: PYRIDOXINE: TB or Ampoules.
The recommended dose is between 200 to 300 mg a day.
3.1.4. VITAMINA B3 or DERIVATES:
VITAMIN B3: NIACIN, NICOTINIC ACID or INOSITOL HEXANICOTINATE. TB of
100, 250 or 500 mg.
If you have not taken Niacin before, it is suggested to start with doses during the first
2 days of 100 mg every 8 or 12 hours (2 to 3 times a day), which is equivalent to a
dose of between 200 and 300 mg per day. These first days the patient can often
present flushing, redness and tingling 15 to 20 minutes after taking Niacin, and for
about 45 minutes. This effect decreases over the next 3 doses you take. If there is
good tolerance and there is no longer a flush, from the third day the dose is increased
to between 300 and 500 mg twice a day (600 to 1000 mg a day).
In those who weigh more than 95 kilos, it is suggested to increase the dose from the
3rd day to between 750 and 1200 mg per day.
In adults weighing less than 56 kilos, it is recommended to start with only 100 mg per
day, preferably divided into 2 doses per day of 50 mg each. And from the third day the
dose is increased to between 200 and 300 mg per day twice a day, which is equivalent
to a dose of between 400 and 600 mg per day.
It is indicated to take it after food.
INOSITOL HEXANICOTINATE, or Inositol Hexanicotinate or No Flush Niacin. It is a
formula that contains Niacin that does not cause flushing. It contains 6 molecules of
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
52
Niacin and 1 of Inositol, so each 625 mg of inositol hexanicotinate contains 500 mg of
niacin and 125 mg of inositol. It is indicated to control cholesterol levels and promote
blood circulation.
NICOTINAMIDE, also known as NIACINAMIDE, which is a form of Vitamin B3, can
also be used. 1000 mg twice a day is indicated.
NMN (Nicotinamide Mononucleotide): Capsules or TB of 125, 150, 250 or 500 mg.
It is a nucleotide formed from Ribose and Nicotinamide. It has the effect of reducing
oxidative stress and age-related vascular dysfunction.
The regular dose of NMN is 250 to 500 mg per day. In those weighing more than 90
kilos, 750 mg per day can be given.
NICOTINAMIDE RIBOSIDE (NR): TB or capsules of 100, 250, 300 or 500 mg.
It is an analog of vitamin B3, stimulates the production of NAD+, helps cells to
regenerate and reduces cell aging.
It is administered at a dose of 750 to 1,500 mg daily.
NAD+ (Nicotinamide Adenine Dinucleotide): Vial or vial of 10 ml, with 200 mg/ml.
It is a coenzyme that contains vitamin B3 and whose main function is the exchange of
electrons and hydrogen ions in the production of energy in cells and participates in cell
repair.
3.1.5. VITAMIN B9, FOLINIC ACID or L-METHYLFOLATE:
VITAMIN B9: FOLIC ACID. TB of 0.4, 0.5, 0.8, 1 or 5 mg.
For this Scheme, a dose of 2 mg per day is recommended.
In patients weighing between 75 to 95 kilos, it is indicated to take 3 mg per day.
And in those who weigh more than 95 kilos the suggested dose is 4 mg a day.
In patiens with high levels of homocysteine, it is suggested to double the doses
mentioned for the duration of this Scheme.
Its indication is recommended in patients who are taking drugs against malaria or
malaria and in all pregnant women.
FOLINIC ACID, LEUCOVORINE, Calcium Folinate or Factor Citrovorum. 15mg BT.
There are also Ampoules of 5, 50 and 100 mg x 10 ml.
The recommended dose is 1 TB of 15 mg 3 times a week.
L-METHYLFOLATE, LEVOMEFOLIC ACID or 5-MTHF: TB or Capsules of 5, 7.5, 10
or 15 mg.
The suggested dose is 10 to 15 mg daily.
It is the main active form of folic acid. In addition to being indicated as a nutritional
supplement, it is noted that by crossing the blood-brain barrier it is useful for improving
mood.
It is also useful in cases where homocysteine is elevated, since it participates in its
methylation.
3.2. FAMOTIDINE (Pepcid, Zantac). TB of 20 or 40 mg.
Its indication in this Scheme is given in part as a gastric protector for the use of ASA
or LASA. But Famotidine stands out for its important action as a blocker or antagonist
of Histamine H Receptors, and it has also been identified as having antioxidant
properties by eliminating reactive oxygen radicals, especially the hydroxyl ion, and
reduces the levels of type I interferon in patients with COVID.
Studies have been reported that identify favorable effects of its use in patients with
COVID-19 (44,45,64).
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
53
Due to the aforementioned, in patients with Acute and Chronic COVID or Long COVID,
Famotidine has several advantages over Omeprazole, Lansoprazole and other Proton
Pump Inhibitors (PPIs), which are also associated with a greater degree of reduction
in the absorption of Vitamin B12.
For this Treatment Scheme that lasts 8 days, it is indicated to take 60 mg at 7:30 am,
3 pm and 11 pm (3 times a day).
In patients weighing more than 75 kilos, the suggested dose is 80 mg at 7 or 7:30 am,
3 pm and 11 pm (240 mg per day). In those who weigh more than 95 kilos, you can
choose to increase the dose up to 100 mg 3 times a day. And if the patient weighs
less than 56 kilos, it is indicated to lower the dose to 40mg every 8 hours (120mg a
day).
According to the studies carried out, the use of Famotidine at these doses is well
tolerated and does not cause relevant side effects.
Human studies show that only about 9% of an intravenous dose of Famotidine crosses
the blood-brain barrier (BBB). For this reason we recommend using it together with
1st Generation Antihistamines, which do cross the BBB.
Regarding the care to be taken, it has been identified that it presents a possible risk
of inducing a prolongation of the QT interval, it is not a defined risk, but caution is
recommended or avoid taking it together with drugs that have a defined risk of
prolonging the interval QT such as Amiodarone, Azithromycin, Cilostazol, Citalopran,
Ciprofloxacin, Clarithromycin, Chloroquine, Chlorpromazine, Donepezil, Escitalopram,
Erythromycin, Fluconazole, Haloperidol, Levofloxacin, Moxifloxacin, Ondansetron,
Sevofloran, Sulpiride.
ALTERNATIVES AS GASTRIC PROTECTOR AND ANTIHISTAMINE H2:
In countries where Famotidine is not available, the alternatives as a gastric protector
for the use of Aspirin, LASA or other NSAIDs, and also as an H2 Antihistamine, we
have:
o NIZATIDINE (Axid). TB of 150 or 300 mg.
It is another H blocker. The recommended dose is 150 mg at 10 am and 10 pm.
For those who weigh more than 75 kilos, the dose is 300 mg at 10 am and 10 pm.
o RANITIDINE. TB of 150 or 300 mg.
It is indicated at doses of 150 mg at 10 am and 10 pm. For those who weigh more
than 75 kilos, the dose is 300 mg at 10 am and 10 pm.
The presentation in Tablets of this medication has been withdrawn in several
countries, due to the identification of impurities. It is mentioned that it has been
found to benefit patients with Infectious Mononucleosis and has been indicated for
patients with CFS/ME at a dose of 150 mg twice a day.
o ROXATIDINE. TB of 150 mg: at a dose of 150 mg at 10 am and 10 pm.
o CIMETIDINE (Tagamet). TB of 200, 400 or 800 mg: at a dose of 400 every 8 hours
a day. For those who weigh more than 95 kilos, the dose before bed is increased
to 800 mg. It is mentioned as an alternative to use in patients with Infectious
Mononucleosis.
ALTERNATIVES AS GASTRIC PROTECTORS.
As alternatives to Famotidine, as gastric protectors, we have:
SODIUM BICARBONATE OR BAKING SODA. Capsules of 325, 500, 650, 870, 1000,
1500 and 1600 mg. Or powdered, in jars or packets for use in the kitchen.
Sub-Acute and Chronic COVID: Therapeutic Plan for Patients with Persistent Symptoms of COVID. ResearchGate.
Aguirre-Chang, Gustavo and Trujillo, Aurora. April 2021.
54
Its chemical formula is NaHCO3. It is also known as Bicarbonate of Soda or Baking
Soda. If it is taken in powder, its taste is not pleasant.
The recommended dose to take during the 8 days of this Protocol is between 0.10 to
0.15 mg per kilo of weight per day. The daily dose is divided into 2 or 3 doses to be
taken during the day. It is recommended to take it 1 to 2 hours after meals, on an
empty stomach, and should not be taken with other medications.
Taking into account the aforementioned, the recommended dose is between 3 to 3.3
grams (it can be in capsules, or 3 g in powder that would be 1/2 teaspoon) to be taken
with 1 glass of water, at 10am and 10pm during the 8 days that this Protocol lasts.
In patients weighing more than 75 kilos, they are instructed to add a third dose at 4pm
the first 3 days, and in the following 5 days they take 2 doses a day, at 10am and
10pm. Patients weighing more than 95 kilos continue with 3 shots a day, at 10am, 4pm
and 10pm, during the 8 days of this protocol.
It is recommended that the daily intake of Bicarbonate not exceed 10 continuous days
without a medical indication.
It is contraindicated in patients with hypocalcemia and hypochlorhydria.