Nitazoxanide: 500 mg, 2 times daily
Nitazoxanide (NTZ), an oral antiparasitic drug, has activity against many protozoa and helminths and – like ivermectin – has been shown to have antiviral, anti-inflammatory, and immune-modulatory effects and broad spectrum antiviral
activity that includes influenza virus, RSV, and SARS-CoV-2.
Ivermectin: 0.4 mg/kg daily for 5 days
In-vitro (test tube) studies suggest that ivermectin has broad antiviral activity against RNA viruses including influenza.
However, there is no (published) clinical data on the use of ivermectin in the treatment of influenza. Therefore, we recommend ivermectin as part of a multi-drug regimen when nitazoxanide is not available. Ivermectin is best taken with a meal. This drug should be avoided in pregnancy and in patients taking calcineurin inhibitors (cyclosporine and Prograf).
Zinc: 50-90 mg daily
Zinc is essential for innate and adaptive immunity, with zinc deficiency being a major risk factor for influenza. Due to
competitive binding with the same gut transporter, prolonged high-dose zinc (> 50mg day) should be avoided, as this is associated with copper deficiency. Commercial zinc supplements contain 7 to 80 mg of elemental zinc and are commonly formulated as zinc oxide or salts with acetate, gluconate, and sulfate.
N-acetylcysteine (NAC): 600-1200 mg orally, 2 times daily
NAC, the precursor of reduced glutathione, penetrates cells where it is deacetylated to yield L-cysteine, thereby
promoting glutathione (GSH) synthesis. NAC has a broad range of antioxidant, anti-inflammatory, and immune- modulating mechanisms.