Ivermectin vs Hydroxychloroquine vs Zinc for COVID-19: What's the Difference?

Ivermectin, hydroxychloroquine and zinc have received various media and social media attention for the past two years. 'No high quality evidence', "can only be used in a clinical trial setting', 'double blinded randomized controlled clinical trial needed', "insufficient data to recommend either for or against the use" are some of the medical and scientific technicalities that you might read in various social media channels. Confused? 

The number of options for the treatment of COVID-19 has increased drastically in recent months, thus making it complicated when it comes to choosing the right combination. In general, there are 3 broad categories of medical interventions:

  1. Prevention or Prophylaxis e.g. vaccine
  2. Early out-patient treatment
  3. Hospital treatment



McCullough et al. Reviews in Cardiovascular Medicine, 2020

All these treatments come with various technical jargons, thus could be overwhelming and confusing for you as a consumer.

Generally, multiple treatments and strategies are used in combination to achieve the best possible outcome.

In this article, we would like to cover 3 popular treatments i.e. Ivermectin, Hydroxychloroquine and Zinc.

Ivermectin and COVID-19

If you still believe that there is little evidence on the effectiveness of ivermectin, please check out this up-to-date overview of all published studies on ivermectin in the treatment and prevention of COVID-19, we recommend visiting c19ivermectin.com; in addition, a meta-analysis of all studies can be found at ivmmeta.com (constantly updated). For adoption and regulatory status of ivermectin globally, check out ivmstatus.com.

Ivermectin is an anti-parasitic medication widely used in low- and middle-income countries to treat parasitic worm infections in adults and children. It’s been used for decades for this purpose by over 3.7 billion people, and is considered safe and effective. It has an increasing list of indications due to its antiviral and anti-inflammatory properties, and is included on the WHO’s Model List of Essential Medicines.

For updated early outpatient protocol (COVID-19 positive), please check out FLCCC I-MASK+ protocol.

Notes: 
  • Ivermectin has a number of potentially serious drug-drug interactions. Please check for potential drug interaction at Ivermectin Drug Interactions - Drugs.com. The most important drug interactions occur with cyclosporin, tacrolimus, anti-retroviral drugs, and certain anti-fungal drugs. 
  • Quercetin and ivermectin interactions? According to Drugs.com: "No interactions were found between ivermectin and Quercetin. This does not necessarily mean no interactions exist. Always consult your healthcare provider."
  • Ivermectin is also lipophilic and therefore, bioavailability is maximised on a full stomach; or best to be taken with meal.

Ivermectin and Legal Updates in US: 

  • Several states gave healthcare providers an immunity guarantee for the use of ivermectin and hydroxychloroquine for COVID. 
  • Kansas: Kansas’ Senate voted to strengthen religious exemptions and give safe harbor to those prescribing ivermectin.
  • New Hampshire: On May 5, 2022, New Hampshire’s Senate adopted a bill that allows licensed providers to create a standing order for pharmacists to dispense ivermectin (for a legitimate medical purpose). The bill also prohibits medical, nursing and pharmacy boards from disciplining licensees based on that standing order.
  • Indiana State: Attorney General opinion: "Physicians and other HCPs with prescription authority licensed in Indiana may prescribe medication off-label for the treatment and prevention of COVID-19 (in.attorneygeneral/Opinion-2022-1.pdf)
  • Nebraska: The State Attorney General of Nebraska issued an opinion the included: " ... available data does not justify filing complaints against physician simply because they prescribe ivermectin or hydroxychloroquine to prevent or treat COVID-19 ..." https://ago.nebraska.gov
  • Oklahoma: Oklahoma State Attorney General stated that no legal basis exists to discipline medical professionals for prescribing ivermectin or hydroxychloroquine to treat COVID-19 (https://www.oag.ok.gov/articles/attorney-general-oconnor)
  • South Carolina: The Attorney General of South Carolina issued an opinon that included: "... doctors have the right to make important medical decisions, as long as they have the informed consent of their patients. In fighting COVID ... ” https://www.scag.gov/covid-19/
  • Tennessee: Tennessee's legislature made ivermectin essentially an over-the-counter drug in April 2022. The state’s Senate overwhelmingly voted 66-20, and the House voted 22-6 in favor of the bill.  
Related: 

Hydroxychloroquine and COVID-19

In January 2022; we saw hydroxychloroquine (HCQ) being added in the FLCCC prevention and early treatment protocol.

The move follows the experience of several frontline doctors who found that hydroxychloroquine is particularly useful to deal with Omicron, in combination with Ivermectin and other agents, as indicated in the protocol.

Credit: covid19criticalcare.com
So, with this move, we will expect less confusion and conflict among frontline doctors regarding the nature of the most appropriate agents to be included in early treatment protocols for COVID-19.

Hydroxychloroquine and Clinical Evidence

As of June 2022, there have been more than 30 studies of Hydroxychloroquine for early treatment with an overall average improvement of 64% as compared to the control groups.

Hydroxychloroquine (HCQ) is not effective when used very late with high dosages over a long period (RECOVERY/SOLIDARITY), effectiveness improves with earlier usage and improved dosing. Early treatment consistently shows positive effects. Negative evaluations typically ignore treatment time, often focusing on a subset of late stage studies.

Here’s a chart from c19early.com that shows that hydroxychloroquine performs better than ivermectin when given as early treatment in terms of risk reduction of dying from COVID-19:


The overall improvement for hydroxychloroquine is better than ivermectin (for early treatment); 72 % vs 43 % in terms of death rate. Importantly, hydroxychloroquine needs to be given 'early'.

The latest FLCCC I-MASK protocol has incorporated hydroxychloroquine as part of both the prevention and treatment protocols:

Specifically, they recommend hydroxychloroquine (preferred for Omicron) and ivermectin as first line anti-viral agents:
  • Ivermectin: 0.4–0.6 mg/kg per dose (take with or after meals) — one dose daily, take for 5 days or until recovered. (Find a Doctor). Use upper dose range if:  1) in regions with more aggressive variants (e.g. Delta); 2) treatment started on or after day 5 of symptoms or in pulmonary phase; or 3) multiple comorbidities/risk factors. (Ref)
  • Hydroxychloroquine (preferred for Omicron): 200mg PO twice daily; take for 5 days or until recovered. (Find a Doctor)

Most of the other component treatments in the I-MASK+ protocol have various mode of actions and may not be affected by the changes in the Omicron variant spike protein.

The evidence tracking on Hydroxychloroquine versus COVID-19 is available at c19hcq.com (constantly updated).

Do you need a prescription for hydroxychloroquine? 
Yes, hydroxychloroquine is a prescription drug and you do need it to be prescribed to you by a doctor. 

Related: 


Zinc and COVID-19

Foods that are high in zinc include oysters, crab, lobster, mussels, red meat, and poultry. Cereals are often fortified with zinc. Most multivitamin and nutritional supplements contain zinc.

Check out the evidence tracker on zinc and COVID-19 from c19zinc.com (constantly updated). 


While much attention is placed on HCQ (hydroxychloroquine), it in and of itself is not the answer. Zinc is. Both HCQ and quercetin are zinc ionophores, meaning they shuttle zinc into the cell, (Medical Hypotheses) and there’s compelling evidence to suggest the primary benefit of the HCQ protocol actually comes from the zinc, which effectively inhibits viral replication.

If given early, zinc along with a zinc ionophore should, at least theoretically, help lower the viral load and prevent the immune system from becoming overloaded. The problem is that zinc does not readily enter cells, which is why a zinc ionophore is needed.

Evidence of this was presented in a September 2020 study in the Journal of Medical Microbiology. In it, they compared outcomes in hospitalized COVID-19 patients treated with one of three regimens: HCQ alone, Azithromycin alone, or a triplet regimen of hydroxychloroquine, azithromycin and zinc.

While the addition of zinc had no impact on the length of hospitalization, ICU duration or duration of ventilation, univariate analyses showed it did:
  • Increase hospital discharge frequency
  • Decrease the need for ventilation
  • Decrease ICU admission rates
  • Decrease the rate of transfer to hospice for patients who were never admitted to the ICU
  • Decrease mortality
Taking zinc long term is typically safe for healthy adults, as long as the daily dose is under the set upper limit of 40 mg of elemental zinc (PubMed).

Be aware that typical daily doses of zinc provided by zinc lozenges generally exceed tolerable upper limits for zinc, and for this reason, they should not be used for longer than about a week. 

Excessive doses may interfere with copper absorption, which could negatively affect your immune system as it can cause copper deficiencies, blood disorders, impair the absorption of antibiotics and potentially permanent nerve damage or loss of smell.

The ideal dose for prevention while the COVID-19 risk is high is 40-100 mg/d, a portion of which comes from zinc lozenges to spread the zinc through the tissues of the nose, mouth and throat. It should be accompanied by at least 1 mg copper from food and supplements for every 15 mg zinc.

Do take note that you should keep the dosage back to within 40 mg/d once the exposure risk is back to normal.

Zinc Sulphate is also part of Dr. Vladimir Zelenko anti-coronavirus experimental protocol. Please take note that the protocol is experimental and has not been 100% proven. Do discuss with your doctor before taking the medication as per the protocol. You can check out his publication in the International Journal of Antimicrobial Agents

Based on the statement released on 2 October (2020) by the then U.S. president’s physician, zinc is also part of the treatment given to the US President. According to the president's physician, "Trump has been taking zinc, vitamin D, famotidine, melatonin and a daily aspirin.”

Editor's note: Hydroxychloroquine is a zinc ionophore. If increased intracellular Zn ion concentration is required to disrupt viral replication, perhaps using multiple zinc ionophores would increase that concentration thus decreasing viral replication further. Other OTC (over the counter) zinc ionophores include quercetin (QCT) and epigallocatechin-gallate (EGCG – green tea extract).


Ivermectin vs Hydroxychloroquine vs Zinc

What works better hydroxychloroquine or ivermectin? Clinical evidence to date has reported promising results (see above) for Ivermectin in prevention, early treatment as well as late treatment for COVID-19. While both Ivermectin and Hydroxychloroquine might be useful for early treatment, Ivermectin has a broader potential benefit i.e. prevention, early treatment as well as late treatment / hospital treatment. An important point to note is that both ivermectin and hydroxychloroquine perform better when given early (within first 3 - 5 days of symptoms) as opposed to late treatment.

Can hydroxychloroquine, zinc and ivermectin be used together? The 3 drugs do not seem to have a between-drug interaction. However, no major studies have been published on the combined effect/s of Hydroxychloroquine, zinc and ivermectin on COVID-19 infection.

Theoretically, hydroxychloroquine (HCQ) would behave as a first-level barrier by inhibiting the entry of the virus into the host cell, while ivermectin could reduce viral replication if the virus did get in, strengthening HCQ antiviral effects. 

That said, the Zelenko protocol recommends that both hydroxychoroquine and ivermectin can be used together, especially for high risk patients. If you have started with only one, the second agent may be added after about 2 days of treatment if obvious recovery has not yet been observed.

The dosages as per Zelenko protocol:
  • Hydroxychloroquine (HCQ) 200mg 2 times a day for 5-7 days 
  • Ivermectin 0.4 mg/kg/day for 5-7 days
The FLCCC I-MASK+ treatment protocol recommends:
  • Ivermectin: 0.4–0.6 mg/kg per dose (take with or after meals) — one dose daily, take for 5 days or until recovered. (Find a Doctor). Use upper dose range if:  1) in regions with more aggressive variants (e.g. Delta); 2) treatment started on or after day 5 of symptoms or in pulmonary phase; or 3) multiple comorbidities/risk factors. (Ref)
  • Hydroxychloroquine (preferred for Omicron): 200mg PO twice daily; take for 5 days or until recovered. (Find a Doctor)
Hydroxychloroquine and Quercetin are both zinc ionophores i.e. they transport zinc into the cells. A study (Frontera, Oct 2020) published in the NIH Preprint database, showed that zinc with hydroxychloroquine was associated with increased rates of discharge home and a 24% reduced risk of in-hospital death rate among COVID-19 patients, while neither zinc alone nor hydroxychloroquine alone reduced death rate.

Note: Due to the possible drug interaction between quercetin and ivermectin (may increase ivermectin levels), these drugs should not be taken simultaneously (i.e. should be staggered morning and night). 

Is ivermectin a zinc ionophore? Although there are many articles stating it is but most articles do not provide scientific references to support the claim. We have found studies that showed that ivermectin has a probable ionophore nature: 
Although ivermectin and hydroxychloroquine are relatively safe drugs, they are still synthetic chemicals that can have side effects. Quercetin and Vitamin D, C and zinc are nutrients that your body require for optimal health. Nutrients are safer alternatives especially if your risk is low e.g. age below 50 and no other chronic illness. Discuss with your doctor on the benefit vs risk for each treatment. If you are on multiple medications, be aware of supplement-drug interactions that might enhance the possibilities of adverse effects.

Ivermectin, Hydroxychloroquine, Zinc and FLCCC I-MASK+ Protocol

For updated prevention and early outpatient protocol  for COVID-19 positive, please check out FLCCC I-MASK+ protocol.


Summary

Nutrients (e.g. quercetin and zinc combination) are safer alternatives especially if your risk is low e.g. age below 50 and no other chronic illness. Discuss with your doctor on the benefit vs risk for each treatment. If you are on multiple medications, be aware of supplement-drug interactions that might enhance the possibilities of adverse effects.

The most important key takeaway is 'early' treatment. That said you should never attempt to self medicate without the guidance of a licensed medical provider. If you are not a medical doctor, you are likely to find the above information overwhelming. The aim of this article is to empower you with a better understanding of the options available and to discuss the options with your medical doctor.

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Z-Stack Supplement

In an effort to make it easier for patients, Dr Zelenko has developed an oral supplement that contains all four key ingredients: vitamin C, quercetin, vitamin D3 and zinc. It’s referred to as 'Z-Stack Supplement'. 

Z Stack Ingredients

Z-Stack Vitamin cocktail provides key ingredients needed in order to help your body fight off this deadly invader. The Z-Stack Vitamins are Kosher certified, GMP certified and made in the USA.

The cost of the Z-STACK vitamin cocktail is $55 per bottle for a one month supply. 

Where to buy Z-Stack: Z-stack is available on Dr Zelenko's website. Here is the link: Z Stack Supplement 

Note: To get 5% OFF, please use this coupon code: DRFRANCIS
 
Disclaimer: Always see your doctor before taking these supplements. 

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