Personal MD protocol for adults: Modified for COVID-19

Always consult with a physician prior to taking any supplement or medication.

Protocols below were created by Nelson X. Simmons, MD

Updated February 2021

Main Source: The American Journal of Medicine: Volume 134, issue 1, page 16-22

 

Prophylaxis and have not had completed a vaccine series for Sars-CoV-2

                Nutraceutical Combination recommended for daily use

  • Vitamin D3 2,000-4,000 IU/day
  • Zinc: Read the note below for the recommended dose
  • Quercetin 500 mg per day. DO NOT TAKE AT THE SAME TIME AS YOUR ZINC
  • Melatonin (tablet): Begin with 1 mg and increase as tolerated to 3 mg taken thirty to sixty minutes before bed. This supplement makes some people groggy in the morning.  If this is the case take the supplement earlier before bed or do not take it.
  • Vitamin C 500 mg: 1 each morning and 1 each evening: Vitamin C is good for prevention only.
  • Flu shot unless contraindicated.

Prophylaxis and have completed a vaccine series for Sars-CoV-2

                Streamlined Nutraceutical Combination

  • Vitamin D3: 2,000-4,0000 IU/day
  • Melatonin (tablet): 1 mg – 3 mg taken thirty to sixty minutes before bed as tolerated.
  • Flu shot unless contraindicated.
  • NOTE: I recommend stopping Zinc, Quercetin, and Vitamin C once you get your vaccine. Speak to your provider about the long-term use of vitamins and minerals.

Post Exposure until tested (optimum time to test is 5-7 days after exposure)

  • Increase Vitamin D3 to 50,000 (fifty thousand) IU/day x 7 days then drop to down to the usual recommend dosing (2,000 – 4,000 IU/day).
  • Zinc Sulfate: 50 mg (as elemental zinc) per day (prescription can be provided).
  • Quercetin 500 mg twice per day x 14 days.
  • Vitamin C 3000 mg per day x 7 days.
  • Continue Melatonin at a max of 3 mg taken thirty to sixty minutes before bed.

Positive for COVID -19 in a patient UNDER the age of 50 and NO comorbid conditions (with no to mild symptoms)

Start/Compete nutraceutical combination.  Make action to check on a patient on day 5 of symptoms.

  • Increase Vitamin D3 to 50,000 (fifty thousand) IU per day x 7 days then drop down to the usual recommend dosing (2,000 – 4,000 IU/day).
  • Zinc Sulfate 50 mg (dose expressed as elemental zinc) per day (prescription can be provided).
  • Quercetin 500 mg twice per day x 14 days.
  • Increase Melatonin 6 mg at night (the optimal dose is unknown).
  • Monitor home pulse oximetry if available (notify your physician if saturations drop below 94%).

 

  • If symptoms worsen or oxygen saturations are sustained under 94% – add an antibiotic regimen and inhaled budesonide.
  • If oxygen saturations drop below 90% on room air for more than 2 hours, emergency room evaluation is recommended.

 

Positive COVID-19 in a patient UNDER the age of 50 with at least 1 comorbid conditions or

Positive COVID-19 in a patient over the age of 50 with NO comorbid conditions

 

Comorbid conditions include BMI over 30, Pulmonary Disease, Diabetes, Coronary Vascular Disease, Chronic Kidney Disease, or Cancer

  • Start/Complete nutraceutical combination above.
  • If feasible: start Monoclonal antibody infusion x 1 (EUA dosing).

If monoclonal antibody infusion is not feasible, start an antibiotic regimen.

  • Add Ivermectin 6 mg every other day x 5 doses (10 tablets of 3 mg) – If allergic to IVM – use Hydroxychloroquine 200 mg bid x 7 days if no history of heart disease. An EKG on file in the past 2 years is recommended.
  • Add Azithromycin 250 mg tablets twice a day x 5 doses (10 tablets).
  • If allergic to Azithromycin, use Doxycycline at 100 mg bid x 7 days (14 tablets).

If respiratory symptoms develop (Shortness of breath at rest or pulse oximeter under 94%)

  • add inhaled budesonide 1 mg/2 mL nebulization’s bid x 7 days.
  • If the patient does not have a nebulizer, substitute Dexamethasone 6 mg IM x 1 or prednisone 1mg/kg x 5 days then taper at 50% q 3 days until you reach 10 mg or under.

If the patient has an underlying serious medical condition, increased risk of venous thromboembolism, or if the patient is suspect for micro or overt thrombosis

  • Add Aspirin 325 mg PO daily or low-molecular-weight heparin or oral substitute.

Positive COVID-19 in a patient over the age of 50 with at least 1 comorbid condition

  • If feasible: Start Monoclonal antibodies x 1 (EUA dosing)
  • Add antibiotic regimen of IVM and AZM or DOXY. Use HCQ if allergic to IVM and no history of heart disease.
  • Provide a prescription for a nebulizer and budesonide nebulizer solution. Can be purchased at McKinney Pharmacy or Allen Family Drug if the patient does not already have one.  If the nebulizer is not feasible, do not add IM or PO steroids unless the patient has pulse ox levels of under 94%.
  • Add Aspirin 325 mg per day x 30 days.

If inhaled steroids were not used and respiratory symptoms develop or pulse oximeter shows a level of under 94%, add Dexamethasone 6 mg IM x 1 or Prednisone as prescribed above.

Pulse oximeter levels of under 90% should be considered high risk and emergency room evaluation should be recommended.

 

INFORMATION ON ZINC

Zinc comes in many forms: For prevention, I recommend taking the doses below.  If exposed or positive, I recommend changing to zinc sulfate at 220 mg (can also be written as 50 mg of elemental zinc). We can provide a prescription for zinc sulfate.

NOTE: Zinc is better absorbed on an empty stomach, however, the most common side effect is nausea.  To minimize nausea, I advise taking it at least 30 minutes after a meal.  Also, note that you should not take Zinc and Quercetin together as they compete for absorption.

  • Zinc Gluconate: 50 mg per day
  • Zinc Sulfate: 10-15 mg per day
  • Zinc Picolinate: 30-50 mg per day
  • Zinc Citrate: 50 mg per day
  • Chelated Zinc: 15-30 mg per day.  Often goes by names like Zinc Acetate and Zinc Orotate.

Sources for nutraceutical combination

Vitamin D3

  1. http://imj.ie/vitamin-d-and-inflammation-potential-implications-for-severity-of-covid-19/
  2. https://www.thelancet.com/journals/landia/article/PIIS2213-8587%2820%2930268-0/fulltext
  3. https://www.bmj.com/content/356/bmj.i6583

 

Zinc

  1. http://www.ajtmh.org/content/journals/10.4269/ajtmh.19-0718;jsessionid=AwGWc1BBVSjvDo5aywsrRwXY.ip-10-241-1-122
  2. https://www.cmaj.ca/content/184/10/E551?ijkey=6625c04161d0271c51447e514dfa0404c08fc289&keytype2=tf_ipsecsha

 

Melatonin

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7024751/
  2. https://www.researchgate.net/publication/341405791_Therapeutic_Algorithm_for_Use_of_Melatonin_in_Patients_With_COVID-19

 

Vitamin C

  1. https://pubmed.ncbi.nlm.nih.gov/29099763/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521194/
  3. https://pubmed.ncbi.nlm.nih.gov/23440782/

 

Aspirin

  1. https://www.covid19treatmentguidelines.nih.gov/adjunctive-therapy/antithrombotic-therapy/