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Sub-Acute and Chronic COVID:
THERAPEUTIC PLAN FOR PATIENTS WITH POST ACUTE COVID
SYNDROME (PACS) OR LONG COVID.
In a similar way as in Acute COVID, treatments against Viral Load and Persistent
Clots are the main Objectives of the Therapeutic Plan.
Aguirre-Chang, Gustavo and Trujillo F., 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 Post Acute COVID Persistent Symptoms,
PACS, Chronic 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 Post Acute COVID
Persistent Symptoms, and if there are 3 or more persistent symptoms, we give the
clinical diagnosis of Post Acute COVID Syndrome (PACS), which It is also known as
Long COVID or Persistent COVID. In all these cases, the existence of co-infections
should be investigated, mainly by Herpervirus, and also the overgrowth of
microorganisms from the intestinal, oral, renal microbiomes and other locations, in
addition to the presence of Biofilms at the level of various parts of the body, such as at
the oral level, where the Biofilm is dental plaque, at the intestinal level, where it is
accompanied by dysbiosis, at the vascular level, where BioClots are formed, and in other
places in the body. The existence of nutrient depletion, immune dysfunctions and
sequelae should also be investigated.
After having made the clinical-epidemiological diagnosis, the conventional medical
procedure tells us that we must resort to tests to help diagnose to identify if there is a
persistent infection by SARS CoV-2, in which case the diagnosis of Chronic COVID
would be given if it has been evolving for more than 12 weeks or 3 months. At this point,
we must point out that there are several useful conventional tests for the diagnosis of
other infectious diseases that have been known for years, but for a new and still partially
understood infectious disease like COVID, adequate tests for its diagnosis have not yet
been developed. It is understood that the scientific community must first advance in the
knowledge of the etiopathogenesis of PACS or Long COVID, and according to this, new
procedures will be generated to be able to make its diagnosis.
Sub-Acute and Chronic COVID: Therapeutic Plan for patients with Post Acute COVID Syndrome (PACS) or Long
COVID. ResearchGate. Aguirre-Chang, Gustavo and Trujillo F., Aurora. April 2021.
2
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
is expected that they will be negative if requested in a patient with PACS or Long 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.
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 was established in which there
are indicated 3 Therapeutic Lines of Action.
As for Sub-Acute and Chronic COVID, as it is a continuation of the same COVID
disease, in general this Therapeutic Plan is maintained with the 3 Objectives or 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 REGIME FOR POST-ACUTE COVID PERSISTENT SYMPTOMS, PACS
OR LONG COVID.
After evaluating a patient with Post-Acute COVID Persistent Symptoms, PACS or Long
COVID, as the next step it is indicated to request diagnostic aid tests to confirm that
Sub-Acute and Chronic COVID: Therapeutic Plan for patients with Post Acute COVID Syndrome (PACS) or Long
COVID. ResearchGate. Aguirre-Chang, Gustavo and Trujillo F., Aurora. April 2021.
3
there is a Persistent Intracellular Infection by the SARS CoV-2 virus, with which the
diagnosis of Chronic COVID would be established if it has more than 3 months since the
onset of symptoms, or Sub-Acute COVID if it has between 1 to 3 months of symptoms.
As 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 which
has decades of experience in its use in humans, What we have indicated since May
2020 is a Treatment Regime that includes IVM, for PACS and Sub-Acute and Chronic
COVID.
We present this First Treatment Regime 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 the PACS 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 PACS.
"THERAPEUTIC TEST" AND FIRST TREATMENT REGIME FOR PATIENTS WITH
POST ACUTE COVID PERSISTENT SYMPTOMS, LONG COVID OR PACS.
In September 2020, we made available the First Treatment Regime or Protocol for
patients with Post Acute COVID Persistent Symptoms, Long COVID or PACS (21), and
in which the 3 Lines of Action of the Therapeutic Plan for 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 is the main one and the one that should be emphasized, since it
is aimed at reducing the Viral Load, which is the main cause that triggers the problems
covered by 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 Regime or
"Therapeutic Test" for patients with Post Acute COVID Persistent Symptoms.
RESULTS OF THE APPLICATION OF THE "THERAPEUTIC TEST" IN 390 PATIENTS
WITH POST ACUTE COVID PERSISTENT SYMPTOMS, LONG COVID OR PACS.
In our experience of 390 patients with Persistent Symptoms of COVID who received a
clinical epidemiological diagnosis of PACS, and the "Therapeutic Test" was applied, at
the end of the 6 to 16 days that the Test lasts, 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%;
Sub-Acute and Chronic COVID: Therapeutic Plan for patients with Post Acute COVID Syndrome (PACS) or Long
COVID. ResearchGate. Aguirre-Chang, Gustavo and Trujillo F., 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 POST ACUTE COVID PERSISTENT SYMPTOMS
% 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
- 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 Post Acute COVID Persistent Symptoms 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
Sub-Acute and Chronic COVID: Therapeutic Plan for patients with Post Acute COVID Syndrome (PACS) or Long
COVID. ResearchGate. Aguirre-Chang, Gustavo and Trujillo F., Aurora. April 2021.
5
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 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 WITH DRUG-RESISTANCE.
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, that is, Drug-Resistance is
generated, which can be to multiple drugs.
TREATMENT REGIME TO FOLLOW AFTER APPLYING THE “THERAPEUTIC TEST”
FOR POST ACUTE COVID PERSISTENT SYMPTOMS.
After having finished applying the "Therapeutic Test" or First Treatment Regime, using
IVM, ASA, Famotidine, Sodium Bicarbonate and the described diet, according to our
experience, 25% or more of the patients will still present Post Acute COVID Persistent
Symptoms.
In these cases, it should be evaluated if they are symptoms associated with the presence
of tissue hypoperfusion, these symptoms are mainly: 1) Fatigue that increases with
exertion, 2) Brain fog, 3) Stiffness, numbness, or lack of flexibility in the fingers on
waking from bed, with increased discomfort or pain when moving them, 4) Numbness,
numbness, or tingling in the fingers of the hands when waking up from bed, 5) Excessive
cold in the hands and feet, 6) Chilblain-type lesions or Erythema perneum or COVID
Fingers, especially on the feet, 7) Bluish or purple coloration of the hands and feet, which
mainly affects the fingers, 8) Dyspnea or shortness of breath. 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 Famotidine 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
Sub-Acute and Chronic COVID: Therapeutic Plan for patients with Post Acute COVID Syndrome (PACS) or Long
COVID. ResearchGate. Aguirre-Chang, Gustavo and Trujillo F., Aurora. April 2021.
6
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 Microclots.
In these cases, due to the fact that, with the First Regime or "Therapeutic Test" the
recovery of the patient was not achieved, we indicate a Regime that contains at least 3
medications or dietary or nutritional supplements for each of the 3 Lines of action or
Objectives of the Therapeutic Plan. That is, it is included in the Regime at least:
1) 3 drugs to Reduce Viral Load,
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 Regime prepared for cases in which the patient's recovery was not achieved
by applying regime 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, regime that include 3 or more drugs against Viral Load, correspond to Treatment
Regime for patients with: Drug-Resistant and Undercover Viral Load.
Designation of the Regime to follow.
To give a name to the Treatment Regime 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 Regime would be the one that includes 3 drugs from each Line
of Action. In this case, the regime is called 3-3-3 and it is the recommended regime 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 regime with a greater number of medications or
supplements.
According to the number of drugs in each Action Line, the regime will be given a name.
Thus we have, regime 3-6-6, 3-6-9, 6-6-9 and 6-9-9.
Duration of the Regime.
The duration established for the first part of this regime 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 regime 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:
Sub-Acute and Chronic COVID: Therapeutic Plan for patients with Post Acute COVID Syndrome (PACS) or Long
COVID. ResearchGate. Aguirre-Chang, Gustavo and Trujillo F., Aurora. April 2021.
7
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 regime, 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 regime.
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 REGIME 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 Regime.
In the following paragraphs, the doses of each drug or supplement included in the 3-3-3
Treatment Regime 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 Regime 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 regime (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.
Sub-Acute and Chronic COVID: Therapeutic Plan for patients with Post Acute COVID Syndrome (PACS) or Long
COVID. ResearchGate. Aguirre-Chang, Gustavo and Trujillo F., Aurora. April 2021.
8
Table 4
3-3-3 TREATMENT REGIME/PROTOCOL FOR PATIENTS
WITH PACS, LONG COVID OR CHRONIC COVID
WITH VIRAL LOAD DRUG-RESISTANT AND UNDERCOVER
1st Line of Action/Objective: REDUCE THE VIRAL LOAD:
1.1 IVM (or Pyronaridine+Artesunate, Artemisinin, Monolaurin, Pelargonium, MOX).
1.2 NITAZOXANIDE (or EGCG, High dose Ozone or 10 Pass or EBOO, Lithospermum
e. or Gromwell, IVIG, last mAbs, Chinese Skullcap or Baicalin, Niclosamide,
Hydrogen Peroxide, Methylene Blue, Olive Leaf Extract).
1.3 ZINC (or Emtricitabine/Tenofovir, Nirmatrelvir/Ritonavir, Black seed oil: Nigella
sativa, Vitamin C, Spironolactone, Metformin, Plitidepsin, Rutin, Theracurmin).
2nd Line de Action/Objective: 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, Taxifolin, Policosanol, Naringin).
2.2. 2 FIBRYNOLYTIC: SERRAPEPTASE + NATTOKINASE or Lumbrokinase or
Lysine (or Bromelain, Seaprose S, Superpeptase, Thrombolytics IV, Pentoxifylline)
2.3. SUPPLEMENT WITH EFFECT ON THE CIRCULATION: Liposomal Glutathione,
E-EPA or EPA, Omega 3, Diosmin + Hesperidin (or Vitamin D, Nebivolol, Statins
or Red Yeast Rice, Colchicine, Melatonin, R-ALA, Piracetam, Sidenafil).
OR ANTICOAGULANT: Apixaban, Rivaroxaban, LMWH, Dabigatrane.
3ra Line de Action/Objective: TREAT NUTRIENT DEPLETION, OXIDATIVE STRESS
AND IMMUNE DYSFUNCTIONS:
3.1. B COMPLEX VITAMINS: B3 (Niacine) or derivative, Vit. B12 (sublingual or in
intramuscular ampoule), B1 or derivative, B6, and B9 (Folic Acid or Folinic Acid).
3.2. FAMOTIDINE (or Baking Soda or Sodium and/or Potassium Bicarbonate).
3.3. 2 or 3 ANTIHISTAMINES: indicated:
1 Classic 1st Generation H1 Blocker is indicated before bedtime
(Diphenhydramine or Hydroxyzine or Promethazine),
1 Derivate (Dimenhydrinate or Cinnarizine or Ciproheptadine) at lunch and,
1 2nd or 3rd Generation H1 Blocker at breakfast and lunch (Fexofenadine,
Levocetirizide, Desloratadine, Cetirizide, Acrivastine or Rupatadine).
It can also include: Quercetin 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 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 F., Aurora. Sub-Acute and Chronic COVID: Therapeutic
Plan for patients with Post Acute COVID Syndrome (PACS) or Long COVID. ResearchGate. April, 2021.
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.
Sub-Acute and Chronic COVID: Therapeutic Plan for patients with Post Acute COVID Syndrome (PACS) or Long
COVID. ResearchGate. Aguirre-Chang, Gustavo and Trujillo F., Aurora. April 2021.
9
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 quercetin,
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/
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/
https://www.alldaychemist.com/catalogsearch/result/?q=IVERMECTIN
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 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 LIPOSOMAL ARTEMISININ (Qinghaosu). Capsules of 100, 200, 300, 450 mg.
It is the active ingredient contained in the Artemisia annua plant.
It is noted that its therapeutic efficacy is limited due to its low bioavailability, which
is why its presentation as liposomal artemisinin is indicated, which increases
absorption at the level of the gastrointestinal tract.
Sub-Acute and Chronic COVID: Therapeutic Plan for patients with Post Acute COVID Syndrome (PACS) or Long
COVID. ResearchGate. Aguirre-Chang, Gustavo and Trujillo F., Aurora. April 2021.
10
The recommended regular dose is between 500 to 900 mg 2 times a day. It is
indicated to take it away from food, at least 2 hours before or after.
Because it is effective in Borrelia infections, its inclusion is recommended in cases
of Lyme disease.
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 3 days, and then increase to 3000 mg per day (1000 mg at
breakfast, lunch and dinner).
If you weigh less than 56 kilos, it is recommended to start with 1500 mg (500 mg
every 8 hours) for 3 days, and then go up to 2500 mg a day.
If the patient weighs more than 95 kilos, the dose is increased to 4000 mg.
It is recommended to take it with foods rich in fat.
It is a monoester formed from glycerol and lauric acid. The richest dietary source
of Monolaurin is coconut oil.
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.
This is an alternative that we recommend including in children under 10 years of
age, because it is available in syrup and because of the more than 120 years of
experience in its use, which provides security.
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.
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 regime 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.
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- Selamectin (37).
Todas las mencionadas pertenecen al grupo de las Avermectinas
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.
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 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 900 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 Artemisinin.
o SULFATE OF QUININE TB of 200 mg.
Its use is reported for leg cramps. The usual recommended dose is 300 mg per
day. In those who weigh more than 95 kilos, it is suggested to increase the dose
to between 400 to 450 mg per day.
o CINCHONA, QUININE or QUINA (Cinchona officinalis). 500, 1000mg. It is also
found in TONIC WATER (83 mg per liter) and in Supplements indicated for leg
cramps (Leg Cramps, Hyland's).
The recommended dose is 1000 mg a day after lunch or dinner.
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It has been found to be useful for the treatment of leg cramps that occur mainly at
night.
If you are going to drink Tonic Water for cramps, it is suggested to drink 3 glasses
at 2 and 5pm. For those who weigh more than 75 kilos, 3 glasses are added at
8pm. But it should be noted that the concentration is low.
It was one of the most used substances in the treatment of malaria or malaria.
It has antipyretic, antimalarial, digestive and healing properties. It is also
recommended for the treatment of varicose veins in the lower limbs and
hemorrhoids.
o HYDROXYCHLOROQUINE (HCQ) (Plaquenil, Dolquine, Reumazine), 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 Regime, 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 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 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 WORMWOOD o Wermout (Artemisa absithium).
Is indicated in intestinal parasites, to treat blood stagnation, menstrual
irregularities and as an insecticide against moths.
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 Cloroquine.
o Halofantrine.
o Mefloquine.
o Pirimetamina (Daraprim). 25mg BT. It is the drug of choice for
Toxoplasmosis.
o Primaquine.
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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
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 EGCG (EPIGALLOCATECHIN-GALLATE), Capsules of 150, 200, 300, 315, 350,
400, 500, 600, 725, 735 mg.
Is the most abundant catechin in Green tea. It is a Flavonoid Polyphenol. Activity
against SARS-CoV-2 Protease 3CL has been identified, as has the flavonoid
Theaflavin.
It is one of the main components of the Vedicinals-9 nutraceutical.
The regular dose is 600 mg a day. It should be taken on an empty stomach, it can
be one dose at 11 am, or divided into 2 doses at 11 am and 10 pm.
In those who weigh more than 75 kilos the suggested dose is 800 mg a day, it
would be 400 mg at 11 am and 10 pm.
In those who weigh less than 56 kilos, it is recommended to lower the dose to
between 400 and 500 mg per day.
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EGCG inhibits the formation of amyloid deposits and decreases its cytotoxic
effects on neurons, which is why it is said to have a neuroprotective effect and
delay amyloid formation in Alzheimer's disease.
It has been shown in studies that taking it together with Vitamin C and Xylitol
improved the absorption of green tea catechins by 6 to 11 times (84). Fish oil has
also been reported to improve the oral bioavailability of EGCG.
o GREEN TEA (Camellia sinensis) (34).
Its main active component is EGCG. It has also been identified as containing L-
theatin, Theaflavin, Apigenin and a smaller amount of vitamin K and antiplatelet
polyphenols.
It is reported to have an antioxidant and antiviral effect against HSV-1 and 2
viruses, and against SARS CoV-2 (50).
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 OZONO THERAPY (80,81).
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, and even more so if there is Drug-resistance.
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.
10 PASS OZONE or Ten Pass Ozone, Multi Pass or L1. It is a high-dose ozone
therapy (OHT) and involves drawing 200 ml of blood 10 times and mixing it with
ozone. It is noted that one 10-step ozone session is equivalent to about 30
conventional EV Ozone sessions.
HIGH DOSES OF O3UV or HDO3UV, is a high dose ozone therapy, it is pointed
out that it is an alternative to the 10 Steps. In this case, 300 ml of blood is
extracted and it is ozoned in a single "step". In addition to Ozone, the blood is
exposed to ultraviolet (UV) light therapy twice.
HIGH DOSE OZONE + UV LIGHT, is a procedure similar to the one described in
the previous point, it also provides high dose ozone and UV light. It is a less
complex procedure than the 10-step Ozone, so it has a lower cost.
OXYGEN-OZONE AUTOHEMOTHERAPY (O2-O3-AHT) or Major Ozonized
Autohemotherapy (AHTM or MAH). It is the conventional or traditional procedure.
The procedure consists of extracting 200 ml of blood, mixing it with ozone and
reinserting the patient. Normally, 2 weekly sessions of 30 minutes each are
indicated. Improvements are usually evident from the second to sixth session.
OZONIZED OIL, ozone is diffused in olive oil, and in cases of Anosmia, Hyposmia
or Brain Fog it is administered through a nasal cannula.
EBOO or EBO2 (Extracorporeal Blood Oxygenation and Ozonation): is a
procedure that involves taking blood from the body, passing it through a dialysis
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filter, the blood is then ozonized and infused back into the body through another
catheter in the other arm.
There is also the EBOO-F, which includes Filtration, using blood filters.
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 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.
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 regime
or Protocol, in addition to the Antiplatelet.
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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 regime 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 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
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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 FDA recommended dose is 500 mg as an intravenous infusion over 30
minutes. If a higher Viral Load is suspected, a higher dose of 1000 mg would be
justified.
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, anti biofilms effect and
generates a decrease in IgE.
It is one of the main components of the Vedicinals-9 nutraceutical.
A daily dose of 600 mg is suggested. Higher doses would not be useful.
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).
Chinese Skullcap also contains Wogonin which has been identified as having an
antiviral and anticoagulant effect as well.
o NICLOSAMIDE (Niclosan, Niclocide Hexin) (37,54), TB of 500 mg.
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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.
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 METHYLENE BLUE. Powdered.
It is indicated to prepare a 1% solution, this is obtained by mixing 1 gram of
methylene blue in 100 ml of water.
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It is recommended to start with 2 drops in the morning, and increase the dose by
1 drop every 2 days until reaching 18 drops. In those who weigh more than 75
kilos continue to increase 1 drop every 2 days until reaching 22 drops. It is taken
for 6 days and the 7th day is not taken.
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 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 regime
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 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
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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 Treatment Regime or
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 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
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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 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 STELLATE GANGLION BLOCK (SGB). Used in conditions associated with
increased activity of the sympathetic nervous system.
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 CAR T CELLS ANTI CD-19. CAR T cells (chimeric antigen receptors) are
genetically modified T cells so that when infused they act against the CD19
antigen (Cluster of Differentiation 19). It is a therapy aimed at depleting B
lymphocytes, to eliminate aberrant cells, which in several diseases considered
autoimmune, such as Lupus, produce autoantibodies, which instead of
defending the body against pathogenic microorganisms, attack the cells and
tissues of the body itself.
o COMPRESSION STOCKINGS or COMPRESSION SOCKS. They improve
muscle contraction and increase blood flow.
There are also COMPRESSION GLOVES for the hands.
o COVID CONVALESCENT PLASMA.
o CRANIO-SACRAL THERAPY.
o CRYOTHERAPY.
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.
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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 LOW MAGNITUDE MECHANICAL STIMULATOR (LMMS or whole body
vibration therapy).
o non-invasive brain stimulation
o PHOTOTHERAPY.
o PLASMAPHERESIS (PLEX).
o RED LIGHT THERAPY. PHOTOBIOMODULATION.
o SOT, is Supportive Oligonucleotide Technique, or SOT for its initials. It was
also known as Antisense Oligodeoxynucleotide Therapy (AOT).
o STEM CELLS. In severe cases that do not respond to treatment, allogeneic
hematopoietic stem cell transplantation could be used (83), which is the
indicated treatment in chronic active EBV infections, which is a serious
disease.
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 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.
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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 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 regime. 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 between 500 to 750 mg per
day.
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 RESVERATROL. TB of 100, 125, 200, 250, 500 or 1000 mg.
The regular dose is 500 mg daily.
In adults who weigh more than 95 kilos, the dose can be increased to 500 mg
every 12 hours (1000 mg daily).
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 as having antiviral effects against different viruses, including
SARS CoV-2, HSV and EBV.
PTEROSTILBENE is its structural analog, it is metabolically more stable and has
almost similar antiviral properties.
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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. It is mentioned that it is useful for
Chronic Lyme.
Its side effects include gastritis and stomach aches.
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.
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:
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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 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 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 regime, 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
regime 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 VALPROIC ACID.TB of 250 mg.
The regular dose is 250 mg 2 to 3 times a day.
It is noted that it has antiviral effects against Herpesviruses.
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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.
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.
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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 regime, 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 EMTRICITABINE/ TENOFOVIR DISOPROXIL FUMARATE or FTC/TDF
(Truvada, generic versions). 200mg/300mg, 167mg/250mg, 133mg/200mg or
100mg/150mg tablets.
It is an antiviral drug available in tablets composed of the fixed-dose combination
(FDC) of these 2 drugs. It is used for Pre-Exposure Prophylaxis (PrEP) in people
who are negative for HIV infection but who have risk behaviors, it is indicated with
the objective that people do not acquire the infection. It is also being indicated in
chronic hepatitis due to the Hepatitis B virus. It is included in the World Health
Organization's List of Essential Medicines, which are the most effective medicines
and insurance needed in a health system.
Emtricitabine is commonly referred to as FTC, from its chemical name of 2',3'-
dideoxy-5-Fluoro-3'-Thiacytidine.
The recommended dose for adults and pediatric patients weighing at least 35 kg
is 1 tablet of 200mg FTC/ 300mg TDF) once daily, it can be taken with or without
food.
In adolescents and children who weigh between 28 to 34 kilos and who can
swallow the tablet, 1 tablet of 167 mg/250 mg once a day is indicated.
However, in several countries its administration in young children is not yet
authorized.
As Tenofovir can cause tubular damage at the level of the kidneys and in some
cases could cause some degree of renal failure, it is recommended not to take it
together with potentially nephrotoxic drugs, such as Diclofenac, Ibuprofen,
Indomethacin, Meloxicam, Naproxen, Piroxicam and other NSAIDs.
It also presents a risk of nephrotoxicity and/or lactic acidosis if it is indicated
together with metformin, amikacin, gentamicin, vancomycin, rifampicin, St. John's
wort, and antivirals that may affect renal function.
In those over 50 years of age, patients with diabetes mellitus, with arterial
hypertension or with some renal disease, before starting to take these antivirals,
their renal function should be evaluated to determine their indication, for which
creatinine analysis is requested. serum or estimated glomerular filtration rate
(eGFR).
In the case of those under 50 years of age, without diabetes, hypertension or any
kidney pathology, if taking these antivirals for more than 9 days is going to be
indicated, their kidney function should be evaluated in the same way.
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Its most frequent adverse effects are stomach discomfort or pain that eases when
going to the bathroom, nausea, loss of appetite, semi-liquid stools, diarrhea, skin
reactions, headache, tiredness, sore throat, and fever.
In Chronic COVID or Long COVID we suggest indicating it for between 1 to 6
months to guarantee the eradication or reduction to the minimum possible of the
Viral Load. Even in cases of Multidrug-Resistance (MDR) the treatment can be
extended for a longer time and can be accompanied by other medications against
the Viral Load.
o NIRMATRELVIR + RITONAVIR or NIR-RIT: TB 150 mg/100 mg (Paxlovid. Lower
Cost Generic Versions: Paxovir, Axlovir, Bexovid, Jupitavir, Nevirax, Packovid,
Paxzen, Nirmatrelvir and Ritonavir in separate boxes).
For Acute COVID it is not yet 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 PACS, Long COVID or Chronic COVID it is not recommended to take it for
only 5 days, since if the patient still presents symptoms after 5 days, it is very
likely that there will be a reactivation of the infection or a rebound of symptoms,
which also indicates that a degree of drug resistance has occurred. To avoid this,
it is recommended to take it until 10 to 15 days after the patient no longer
presents symptoms and feels recovered, this is generally equivalent to between
20 to 25 days of treatment , however, side effects limit its use for several days,
therefore, to reduce the probability of a Reactivation of the infection by
discontinuing treatment, in these cases, we are indicating that when finishing
taking the NIR-RIT the patient continues with between 2 to 4 medications with an
effect against the Viral Load, such as Emtricitabine/Tenofovir (Truvada),
Ivermectin, Lithospermum erythrorhizon root (Tollovid or Gromwell), Nitazoxanide,
Niclosamide, IVIG, Ozone in high doses, latest mAbs, Nigella sativa or others
Antivirals.
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, Ticagrelor, Apixaban, Rivaroxaban,
Dabigatran, Warfarin, Amiodarone, Digoxin, Diazepam, Midazolam,
Anticonvulsants, Antineoplastics, Lovastatin, Simvastatin, Atorvastatin, Rifampin,
Domperidone, St. John's Wort, Methadone.
o BLACK SEED OIL, BLACK CUMIN SEED OIL, Habbatus sauda (NIGELLA
SATIVA) (34). Syrup bottle. Capsules of 500, 1000 and 2000 mg.
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.
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.
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It is indicated to distribute the dose of the day in 3 doses, and it is taken during
the 8 days that this regime 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.
The liposomal form of vitamin C or ascorbyl palmitate is recommended.
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 regime is 50 mg every 12 hours for 7 days, which
would be from day 2 to day 8 of the regime.
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 regime that last several months.
It has also been indicated in Rheumatoid Arthritis (78).
It should be taken into account that it is a potassium-sparing diuretic.
o METFORMIN, TB 500 or 850 mg. There is also 1000 mg.
The regular dose is 1 TB of 500 mg or 850 mg once a day, to be taken at the end
of one of the meals.
The use of Metformin increases the risk of lactic acidosis in people who have
some degree of kidney failure, so alcohol and drugs that can also increase lactic
acid should be avoided, such as Tenofovir, NSAIDs and Salbutamol.
If Metformin is to be used for more than 15 days, the patient's renal function
should be evaluated to determine its indication, for which serum creatinine
analysis or estimated glomerular filtration rate (eGFR) is requested. These
analyzes should be indicated above all in those over 50 years of age, patients
with diabetes mellitus, arterial hypertension or some kidney pathology, who have
a higher risk of developing kidney disease.
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
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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 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 Polyphenol from the Flavonol group, also known as quercetin-3-
rutinoside or Sophorin.
It is one of the main components of the Vedicinals-9 nutraceutical.
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 THERACURMIN. Capsules of 30, 60, 90, 100, 120, 180 and 300 mg.
It is one of the most highly absorbed and bioavailable forms of curcumin. This
form has been dispersed with colloidal submicron particles. Its particle size is
considerably smaller than that of conventional curcumin.
The suggested regular dose is between 90 to 120 mg per day, divided into 2
doses.
CURCUMIN-GALACTOMANNOSIDE COMPLEX (CGM or CurQfen).
It has a higher biavailability than Teracurmin, including at the brain level.
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
3000 mg, and from the third day to between 4000 and 4500 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 5000 and 6000 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 4000 mg per day, depending on the
patient's tolerance.
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.
Its main active ingredient is Curcumin, which is a Flavonoid Polyphenol from the
Flavonol group. It has been identified that it has an effect against several viruses,
such as Dengue, Zica, Chikungunya, Herpes Simplex 1, EBV, Cytomegalovirus,
parainfluenza, Hepatitis B and C, Influenza A, HIV and SARS CoV-2 (50).
It also has antibiofilm and anti-inflammatory activity.
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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.
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 PALMITOYLETHANOLAMIDE (PEA). Capsules of 300, 400, 500 and 600 mg.
It has been described that it inhibits the entry of SARS CoV-2 into cells. It also
prevents endothelial damage, reduces the cytokines TNF-alpha and IL-1B and
down-modulates mast cell activation.
The regular dose is 600 mg 2 times a day.
It has been used in Persistent Symptoms of COVID along with Luteolin with
significant improvement in olfactory dysfunction (82). Previous studies have
shown that PEA and Luteolin act synergistically to reduce mast cell activation and
elicit neuroprotection.
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.
It has antiandrogenic and estrogen-like activity, which is why it has been indicated
in the treatment of polycystic ovary syndrome (PCOS) together with
spironolactone therapy (79).
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
12 to 20 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 CABOTEGRAVIR. TB of 30 mg. Extended-release 600 mg/3 ml ampoules, for
monthly use.
Its use for HIV prevention has been studied, showing that it is more effective than
tenofovir disoproxil fumarate/emtricitabine (TDF/FTC).
Its use in Long COVID has not yet been reported, but in view of the usefulness of
Tenofovir, it can be considered as an alternative.
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
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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 LUTEOLINE. Capsules of 50, 100 and 200 mg.
It is a Flavonoid Polyphenol from the Flavone group, to which Apigin also belongs.
It has low absorption, it is noted that less than 10% is absorbed orally, this
improves when taken with fatty foods or with 1 to 2 teaspoons of organic olive oil
or other oil. It is noted that it is also useful for gastrointestinal problems,
mastocytosis and allergic reactions.
The regular dose is 200 mg per day, it can be in 2 doses or in one.
In those who weigh less than 55 kilos the suggested dose is 100 mg a day.
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:
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 OTHER ANTIVIRALS:
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There are other antivirals that can be tested against the SARS CoV-2 virus. In
alphabetical order we will mention: Amantadine, Amenamevir, Aviptadil,
Azvudine, Baloxavir, Bictegravir, Cabotegravir, Elvitegravir, Famciclovir,
Foscarnet, Isoprinosime (Inmunovir), Leronlimab, Lopinavir/Ritonavir (Kaletra),
Maraviroc, Nelfinavir, Oseltamivir (Tamiflu, Procaps), Penciclovir, Simeprevir,
Ribavirin, Rimantadine, Tenofovir Alafenamide Fumarate (TAF) alone or together
with Emtricitabine, 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 Regime 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 (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 (Famvir, others): 500 mg orally 3 times a day for 8 days.
Requires reassessment to continue longer.
- ACYCLOVIR (Zovirax, others): 400 mg orally 5 times a day for 8 to 10 days.
Requires reassessment to continue longer.
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 Regime 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.
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o OTHER ALTERNATIVES AGAINST CMV:
Other alternatives for the treatment of MVC infections in immunosuppressed
patients are FOSCARNET (90 mg/kg), MARIBAVIR (Itencity), CIDOFOVIR
(Vistide, 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.
o CISTUS INCANUS. Its most frequent presentation is as Tea. It is rich in
polyphenols.
o COLLOIDAL SILVER.
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 LOW DOSE NALTREXONA (LDN).
o MINT (Mint piperita).
o MONTELUKAST.
o NICOTINE, PATCHES. In smokers hospitalized with acute COVID, the
indication of Nicotine in patches, lozenges or gum was associated with a
reduction in mortality.
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 regime
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
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symptoms), the presence of persistent clots and biofilms should be considered, so it is
suggested to opt for a regime 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) Dietary supplements with an effect on blood circulation or Anticoagulants.
In the 3-3-3 Treatment Regime, if 1 Antiplatelet Agent, 2 Fibrinolytics and 1 Supplement
with an effect on the circulation are included, they can all be taken together during the 8
days, unless a risk of bleeding has been identified.
But if instead of a supplement with favorable effects on blood circulation, an
anticoagulant such as Apixaban is taken, we suggest that the following sequence be
followed:
- The Antiplatelet is indicated during the first 3 days of the Regime.
- The 2 Fibrinolytics are indicated during the 8 days of the Regime.
- The Anticoagulant is indicated from the 3rd day of the Regime.
It is indicated in this way to reduce the risk of bleeding, since it is recommended not to
give the 3 drugs that reduce coagulation for several days at a time.
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
regime 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 regime.
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 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 Regime.
ASSESSMENT OF THE RISK OF BLEEDING.
It is emphasized that the use of Antiplatelets and Anticoagulants requires medical
indication. To apply this regime, 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:
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- History of gastrointestinal ulcer, gastrointestinal 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 when brushing teeth.
- History of prolonged bleeding 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. These cases must be evaluated by a doctor, and in
them Liposomal Glutathione or Lysine could be indicated.
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 indicate
Ginger, Lysine, Lumbrokinase, Serrapeptase or Nattokinase, which generate a lower risk
of bleeding compared to Antiplatelet Agents 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 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 regime, 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 Regime to follow.
In cases where the patient was already using ASA or an anticoagulant, consideration
should be given to incorporating it into the Treatment Regime 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
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"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, Adiro, Bayaspirin, Ecotrin, Egalic), 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 regime
lasts. If the patient is over 55 years old, the Antiplatelet can be given during the first
6 days of the regime.
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.
Enteric-coated presentations should be sought out as this reduces the incidence of
gastrointestinal bleeding.
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): Aspégic comes in
sachets of 100, 250, 500, 900 and 1000 mg, under this name it is sold in France,
Belgium and other European countries.
It has been identified that it has a greater antiplatelet effect than ASA.
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
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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.
o MAGNESIUM SALICYLATE (Doan's), TB of 580 mg.
It is stated that 580 mg of magnesium salicylate tetrahydrate is equivalent to 467 mg
of anhydrous magnesium salicylate.
The recommended dose is 1 tablet after breakfast, lunch and dinner. Apparently it is
more tolerable than Aspirin.
o OTHER SALICYLATES OR DERIVATIVES OF ACETYL SALICYLIC ACID.
They can be chosen as an alternative to ASA, but since they are the same as
salicylates and NSAIDs, they generate a risk of bleeding.
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.
It is a P2Y12 Receptor Inhibitor. The suggested dose is 1 TB of 75 mg per day for
the first 3 days of this regime.
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 regime, take
1 TB per day.
o OTHER P2Y12 RECEPTOR INHIBITORS: Other antiplatelet agents in this class
include TICAGRELOR (Brilinta, regular dose: 90 mg twice daily), PRASUGREL,
TICLOPIDINE, and CANGRELOR.
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:
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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 Regime.
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 or capsules 500, 1000, 1200, 1500, 2000, 2400,
3000, 5000, 10000 and 15000mg.
The recommended dose is 6,000 mg or 6 grams per day (2 g at breakfast, lunch,
and dinner).
For patients weighing 76 to 95 kilograms, a dose of 8,000 mg or 8 g per day (3 g at
breakfast, 2 g at lunch, and 3 g at dinner) is suggested.
In patients weighing more than 95 kilos, a dose of 10000 mg or 10 g per day is
suggested, it would be 5 g at breakfast and dinner, or 3 g at breakfast and lunch and
4 g at dinner.
If the patient weighs between 42 and 55 kilos, 5000 mg or 5 g per day is
recommended (2 g at breakfast, 1 g at lunch and 2 g at dinner).
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.
ALLICIN or Garlic with Allicin. TB 5000 mcg.
It is the active component in garlic. The recommended dose is 5,000 mcg per day.
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 Polyphenol, 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.
It has been reported to have activity against cerebral amyloid deposits.
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.
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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 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 It is a Flavonoid Polyphenol 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 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.
o MYRICETIN. 100 mg capsules.
It is a Flavonoid Polyphenol. 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.
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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).
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 DULOXETINE (Cymbalta, Duceten, Dulpicap, Ideliver, Xeristar):
Is a serotonin and norepinephrine reuptake inhibitor antidepressant. It can help
relieve pain and fatigue associated with fibromyalgia. It is also useful for chronic
neuropathic pain and has been used for Cramps-Fasciculation Syndrome.
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:
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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.
- 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.
- 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
Nattokinase. By acting specifically by degrading fibrin, the risk that bleeding may
occur due to its use is reduced. 2 or 3 oral fibrinolytics 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 content of fibrin amyloid, will
improve the penetration of drugs and supplements that act against the viral and
microbial load that infect the cells that are covered by the fibrin amyloid 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).
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The best known brands that are enteric coated, but combine Serraptase and
Nattokinase, are: Solaray's Nattokinase 3000FU +Serrapeptase 60,000FU,
Doctor's Best Natto-Serra (Nattokinase 2000FU +Serrapeptase 40,000SPU).
We consider it the fibrinolytic of choice, because it does not generate an increase
in histamine, which can be produced by Nattokinase.
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 11am, 4pm and 10.30pm, 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 11am, 4pm and 10.30pm
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 11am and 10pm, and from the
3rd day it increases to 120 mg or 240,000 SU per day. It would be 40 mg at
11am, 4pm and 10.30pm.
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, 11am, 4pm and 10.30pm,
and if there is good tolerance from the 3rd day, the dose is increased to 220 mg
or 440,000 SU, to take it in 3 doses a day, it would be 60 mg at 11am, and 80 mg
at 4 and 10:30pm.
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 11am and 10pm. If there is good tolerance,
the dose is increased from the 3rd day to 100 mg or 200,000 SU per day, in 3
doses. That would be 20mg or 40,000 SU at 11am, and 40mg at 4pm and
10:30pm.
In patients who present severe symptoms associated with hypoperfusion, the
mentioned doses can be increased by 33 to 50% for a few days.
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 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 and mg
variable according to the company that produces it (from 15 to 30 FU for each
mg). Typically, 100 mg equals 2,000 FU.
Enteric-coated brands: Solaray's Nattokinase 1250FU, Solaray's Nattokinase
3000FU +Serrapeptase 60,000FU, Doctor's Best Natto-Serra (Nattokinase
2000FU +Serrapeptase 40,000SPU), Redfood's Nattokinase 2000FU, Naturally
Vitamins Nattokinase 750 FU.
The regular dose for adults is between 6 to 9 mg per kilo of weight per day.
In patients weighing between 56 and 75 kilos, a dose of 100 mg or 2,000 FU at 11
am and 10 pm is recommended for the first 2 days, that is, 200 mg per day, which
is generally equivalent to 4,000 FU. From the 3rd day the dose is increased to
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500 mg or 10,000 FU per day. In this case, 300 mg at 11 am and 200 mg at 10
pm would be indicated.
In those who weigh between 76 and 95 kilos, the recommended dose during the
first 2 days is equal to 200 mg at 11 am and 10 pm, that is, 400 mg or 8,000 FU
per day. And from the 3rd day the dose is increased to 600 mg or 12,000 FU per
day, it would be 300 mg at 11 am and 10 pm.
In patients weighing more than 95 kilos, it is also recommended to start with a
dose of 200 mg or 4,000 FU at 11 am and 10 pm, that is, 400 mg or 8,000 FU per
day. If there is good tolerance, it is suggested to increase the dose from the 3rd
day to 700 mg or 14,000 FU per day, it would be 400 mg at 11 am and 300 mg at
10 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 FU per day. From the
3rd day the dose is increased to 400 mg or 8000 FU per day, it would be 200 mg
at 11 am 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. Inactivates
plasminogen activator inhibitor-1, increases fibrinolysis, and decreases plasma
levels of fibrinogen, factor VII, and factor VIII.
Natto is the food in which the highest content of menaquinone-7, which is a
subtype of vitamin K2, has been found.
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, or in any case its tolerance must be evaluated.
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 11am, 4pm and 10.30pm
for the first 2 days (60 mg per day), and from the third day take 40 mg o 600,000
UI at 11am, 4pm and 10.30pm (120 mg per day) until completing the 8 days of the
Treatment Regime 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
the dose from the third day to 60 mg or 900,000 IU at 11am, 4 pm and 10.30pm
(180 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 11am and 4pm, and 60 mg at 10.30 pm (220 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
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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 L-LYSINE (L-lysine hydrochloride or L-Lysine HCL), 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 10.30 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 10.30pm.
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 10.30 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 10.30 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 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 10.30
pm).
If the patient weighs more than 95 kilos, a dose of 500 mg is recommended at
11am, 4pm and 10.30pm (1500 mg per day) from the first day and for 8 days.
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 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 THROMBOLYTICS FOR INDOVENOUS USE:
The most frequently used are
3rd Generation Thrombolytics:
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- 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.
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.
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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 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 CHYMOTRYPSIN.
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. SUPPLEMENT WITH EFFECT ON CIRCULATION OR ANTICOAGULANT:
Since 1 Antiplatelet Agent is being indicated plus between 2 to 3 Fibrinolytics
(depending on the severity of the symptoms), in practice as the 3rd medication of this
2nd Line of Therapeutic Action, we are more frequently indicating a supplement with
favorable effects on blood circulation.
But if the presence of hypercoagulability and thrombophilia is very evident, with the
presence of moderate or severe symptoms, if there is no indication to avoid the use of
anticoagulants and the treating physician believes it appropriate to indicate it, one can
choose to include one of the alternatives. of anticoagulants that are described later in
the paragraphs, instead of the supplement.
SUPPLEMENT WITH EFFECT ON BLOOD CIRCULATION:
Sub-Acute and Chronic COVID: Therapeutic Plan for patients with Post Acute COVID Syndrome (PACS) or Long
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The dietary supplements that we recommend as the 3rd medication of this 2nd
Therapeutic Line are:
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 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 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 Flavonoid Polyphenols 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