Ivermectin for COVID-19: What’s the Dose?

Photo by Anna Shvets on Pexels.com

Critics of the use of ivermectin for prevention or treatment for COVID-19 point out potential flaws in the supportive scientific studies. A few of these critiques are:

  • small size of experimental and control groups
  • lack of a reasonable control group; e.g., if everybody in the U.S. is vaccinated for COVID-19, we won’t have a control group to help us determine true long-term consequences of vaccination or lack thereof
  • not accounting for changes concurrent with the experiment; e.g., lockdowns, mask-wearing compliance, natural waxing/waning of viral surges
  • excessively complicated study design; e.g., using doxycycline or azithromycin or a steroid along with the ivermectin
  • the chosen doses of ivermectin are all over the map

The non-standard doses of ivermectin are maddening, but understandable. We’re trying to re-purpose a drug that’s already FDA-approved for several indications. Physicians already prescribe numerous drugs where the dose depends on age, weight, renal function, liver function, etc. Big Pharma spends millions of dollars per drug to figure this out when a drug is patent-able. But who’s going to pay for that when the drug is off-patent, like ivermectin? It’d be nice if the CDC or FDA did. We’re already a 18 months into this pandemic.

If ivermectin works at all for COVID-19, the dose for prevention may be different than for treatment. The following are some oral doses I’ve run across, mostly from positive clinical studies. “Kg” means body weight in kilograms. “Mg” means milligrams. If you can’t convert between milligrams and micrograms in your head, do it here. Many ivermectin proponents recommend starting treatment early, especially if there are co-morbidities.

Prevention of COVID-19

  • at least 150 microgram/kg per week
  • 12 mg (~150 microgram/kg) monthly or every 42 days

Treatment of COVID-19 Whether or Not Hospitalized

  • 200 to 1200 microgram/kg daily for three to seven days
  • 0.2 mg/kg (200 microgram/kg) on Day 1 and Day 3 (plus Days 6 and 8 “if not recovered”)
  • 400 microgram/kg (max of 24 mg) on Days 1 through 4 (Caution: study by Elgazzar et al is under investigation for misconduct)
  • 18 to 36 mg daily or every other day for between 1 and 5 doses (Drs Orient and Vliet with help from McCullough)
  • 0.4-0.6 mg/kg daily for five days or until recovered (I-MASK+ and MATH+)

Treatment of COVID-19 in Hospitalized Patients

  • 200 microgram/kg on Day 1 (plus 200 microgram/kg on Day 7 at physician’s discretion) (Broward Health hospitals study)
  • single dose of 0.15 to 0.4 mg/kg
  • 200 microgram/kg single dose
  • 400 microgram/kg (max of 24 mg) on Days 1 through 4 (Caution: study by Elgazzar et al is under investigation for misconduct)

See, doses vary wildly. And don’t ask me if dose should be based on ideal rather than actual body weight.

You probably know that you can often get ivermectin without a prescription. Many countries have decided it’s safe enough to sell over-the-counter.

I’m not recommending ivermectin to you or anybody else. I’m not your doctor. Only your personal physician who knows you, your lab results, your physical exam, and your medical history is in a position to recommend drug therapy.

Steve Parker, M.D.

7 responses to “Ivermectin for COVID-19: What’s the Dose?

  1. Pingback: Ivermectin for COVID-19: What’s the Dose? — Advanced Mediterranean Diet – Pynez9ja

  2. “I’m not recommending ivermectin to you or anybody else. I’m not your doctor. Only your personal physician who knows you, your lab results, your physical exam, and your medical history is in a position to recommend drug therapy. ”

    Unfortunately, (s)he probably won’t prescribe any inexpensive early antiviral treatment if you are high risk–only MABs, which are expensive.

    Most doctors are clueless about early antiviral treatment studies, from what I have seen. They think that late treatment studies apply to early treatment, they fail to recognize when studies are underpowered and fail to realize that a lack of significance is not evidence that the treatment doesn’t work, and they fail to understand the importance of focusing early treatment studies on high risk patients.

    They just go along with the mindless herd.

    Pharma has to take a lot of the blame for this. It was obvious to me that pharma was using late treatment studies to poison the well against early treatment with inexpensive antivirals, in order to preserve the EUAs for vaccines.

    • [For those not aware, I think MAB above refers to monoclonal antibodies.}

      • yes, and to further explain the problems with getting early treatment with antivirals, pharmacists are refusing to fill prescriptions even if a doctor wants to treat.

        It’s very confusing and sad. People need a beating for being so stupid. One doctor I know is very ashamed of his profession and thinks that doctors will end up taking the blame for so many premature deaths due to failure-to-treat. Lawyers will have a field day.

      • Dr Peter McCullough in a recent video (at Michigan for Vaccine Choice) also predicted that lawyers will have a field day. I predict that is wrong for two reasons. 1) The CDC is on record saying ivermectin and hydroxychloroquine don’t work (I don’t know if fluvoxamine is on CDC radar screen yet). 2) The defendant’s lawyer will have no trouble finding a medical school professor who will testify that those treatments don’t work.

      • You have laid out the prima facie defense. I think that it will be easy to pick apart.

        The CDC statements can’t be introduced into court except by a witness. Who can be cross-examined. “What is the medical reason for treating covid patients exclusively late with antivirals and withholding treatment early?” Witness stammers “I don’t know.” Plaintiff’s attorney, “So you know of no medical reason for treating covid patients late with antivirals and withholding early treatment?” Witness, “No.” “Did the FDA give justification for treating covid patients late with antivirals?” Witness, “None that I know of.” PA, “In your experience, when ought patients be treated with antivirals?” W, “not late.” PA, “For covid, would it be better before or after three days post symptom onset.” W, “Before.” “Why is that?” W, “Because it is better to stop viral replication early before the virus has a chance to multiply.” PA, “What happens when the virus multiplies?” W, “It damages the body.” PA, “Will more damage occur the longer the virus multiplies?” W, “Yes.” PA, “And that can lead to lung damage and organ failure and heart attacks and pulmonary embolii and strokes?” W, “Yes.” PA, “So these damaging effects can derive directly from failing to treat early?” W, “Yes.” So does the FDA’s directive for late treatment and withholding early treatment make sense from a medical perspective?” W, “No.” PA, “No further questions.”

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s