Fluvoxamine for COVID: what you need to know

I funded the original study, I was featured on 60 Minutes, and have been in touch with the researchers on all the trials that have been done in the US, Brazil, and Croatia.

Here are the key things you should know about fluvoxamine for COVID:

1. It works. As of November 13, fluvoxamine has been proven to work in every trial that has published results, including outpatient and inpatient studies. It was recommended back in January 2021 by a key opinion leader (KOL) panel to be used, but it took a year for the KOL meeting notes to be published because they were rejected by 10 journals. After publication of the recommendation in December 2021, the NIH did absolutely nothing change their recommendation. The drug’s mechanisms of action were explained to the KOL panel which voted 2>1 in favor of fluvoxamine. The NIH did nothing despite the fact the that NIH, FDA, CDC, and academic institutions participated in the panel

   this is NOT about the science. The medical community doesn’t care about saving lives. The NIH never did a risk benefit analysis of this drug. Physicians who use the drug for COVID now swear by it. The Wall Street Journal thinks it should be used (and that the NIH is wrong for waiting for more clinical trials).

2. It is very safe: There is no evidence fluvoxamine is harmful and led to a worse outcome. Zero. There are reports of people who can’t tolerate the drug, but they stop using it and nothing bad happened. Generally, at 50mg BID x 14, it is very tolerable as long as the patient is instructed to lay off the caffeine. I took it myself at that dosage and noticed zero side effects. I couldn’t tell I was on the drug. My experience is very typical. If you do have a side-effect, it is usually mild nausea which goes away when you stop taking the drug. People who report not tolerating the drug are typically prescribed too high a dose. The 50mg BID dose was quite effective, but it has to be started early (as soon as symptoms start). If you start later, doctors use higher dosages and compliance becomes a bigger problem.

3. Proven in clinical use all over the world. Doctors who have used fluvoxamine in the US and other countries swear by it. Added to FLCCC protocols and Fareed-Tyson protocol among others.

4. Dosing. My favorite dosage is 50mg twice a day for 14 days. This was shown to be very tolerable (no side effects in 99% of patients) and extremely effective (no hospitalizations and death if you start it ASAP after first symptoms). This is what the Seftel trial at Golden Gate fields used.

5. Food/drugs to avoid while on fluvoxamine. Completely avoid caffeine, alcohol, tylenol, and benadryl. You can experience serious side effects if you do not pay attention to interactions such as if you are currently on another SSRI of a different type. ALWAYS check with your doctor and report any medications you are taking before or plan to take after you start taking fluvoxamine. For example, tylenol+caffeine+fluvoxamine can lead to serotonin syndrome.

6. Adverse reactions/side effects. If you are experiencing any odd adverse reactions, you’ll need to consult with your doctor ASAP. In some cases, you’d want to taper down the dosage. In other cases, stop cold turkey. Some people report mild nausea while on the drug (stops when stop the drug). Some people are jittery, but usually that is because the doctor either prescribed a dosage higher than 50mg twice a day or didn’t notify the patient to completely avoid the list in the previous paragraph, or the patient is simply sensitive to the drug (50mg twice a day can be too much for some people). Decreasing the dosage or stopping the medication will mitigate symptoms within hours. One user reported dilated pupils and increased heart rate (which could be nerves about the dilated pupils). This looks ominous, but it harmless. The paramedics will think you are on drugs. Stopping the meds will return you to your normal self. So check the side-effects list to be familiar with which side-effects are associated with which drug so if you have a side-effect, you’ll know which drug to reduce or eliminate. Always be self aware when using fluvoxamine. I’ve used it personally at 50mg twice a day and experience no adverse events at all. That’s pretty typical, but your mileage may vary.

7. Long haul. No long haul symptoms if you start the drug ASAP after first symptoms. P-value was 10^-14 on that study (done by Dr. Seftel). It doesn’t get much better than that.

8. The effect size is huge if the drug is given early right after symptoms start. The Lancet paper showed that if you were treated early enough and took the drug as prescribed (it only works if you take it), it was shown to reduce your chance of death by 12X making it far more effective than any other drug for COVID. If the drug is started right after symptoms, we’ve seen 100% prevention in hospitalization. If you start 5 days after symptoms, all bets are off. It could do nothing.

9. The evidence is solid. There are 4 outpatient studies that have been done (2 at WashU (see Phase 2 trial results published in JAMA), one in Berkeley, CA by David Seftel, one in Brazil published in the Lancet, and one in-patient study done in Croatia. Three of the four outpatient trials have been reported out: all were successful. The WashU Phase 3 study hasn’t been disclosed yet, but they had compliance problems with their patients this time around (phase 2 was local so the patients got the drug early and also were very compliant and the placebo group was truly taking nothing). There were no studies reported out so far where fluvoxamine made things worse or neutral. All the supporting observational studies were positive as well.

10. The differences are obvious to untrained eyes. The most stunning study of fluvoxamine ever done was at the Golden Gate Fields racetrack in November 2020, right after the WashU trial was published in JAMA. They were all given the drug soon after symptoms and the placebo group was “pure” in that they were not taking any COVID drugs. Nobody who took the drug got sick at all, most all wanted to return to work within 3 days after starting treatment. The group who declined the drug were very sick with 12.5% requiring hospitalization and one died. The track management was so impressed, they asked for prescriptions. After two weeks (since it was a tight knit community, everyone could see what was happening to the two groups), every track worker who got sick with COVID, demanded the drug. So it was both obvious and convincing the difference between the groups to the workers and the track management.

11. Have the drug on hand. Get your prescription in advance of getting COVID. That way you can start immediately. Timing is everything with respect to outcomes. The sooner you start, the better the outcomes.

12. Avoid caffeine, benadryl, tylenol, and alcohol. If you take fluvoxamine, please avoid caffeine while on the drug. You will be wired for 24 hours if you don’t heed my advice. If you can’t lay off the java, then try fluoxetine (Prozac).

13. Substitutions. You can use fluoxetine as well (aka Prozac). Dosage there is 30mg once a day. Some countries don’t have fluvoxamine so this is the alternative. Also, for people who can’t tolerate fluvoxamine for whatever reason (nausea, jittery, etc), this is the alternative. Other SSRIs work as well, but fluvoxamine activates the Sigma-1 receptor the most of the SSRIs which is why it was chosen. Fluoxetine is just as effective.

14. In-patient use. Fluvoxamine works on hospitalized patients too, but no US hospital will let you use it (sound familiar? just like ivermectin). Reason is the hospital gets release from liability if they follow NIH guidelines. NIH doesn’t want you to get the drug since it would compete with Molnupiravir, so fluvoxamine will never make the NIH guidelines.

15. We’ve known it works since August 24, 2020. That is when the phase 2 results were published. Since FLV is a safe drug, it should have been widely discussed with patients that there is virtually no downside and a huge reduction in hospitalization if the drug is given early. Every earlier study of fluvoxamine (such as observational studies) showed it work and the mechanism had been shown. Once the Phase 2 result came out, it should have been embraced by doctors. The medical community did nothing (with a few exceptions like Dr. Seftel).

16. The infectious disease scientists lied to me. They all promised me when fluvoxamine passed Phase 3 trials, nearly everyone would use it. That was a lie. Pretty much nothing changed when the Phase 3 trial confirmed fluvoxamine worked. . Fluvoxamine was reportedly added to just 2 practice guidelines (Ontario and Johns Hopkins). Medicine isn’t about saving lives anymore. Those days are gone.

17. Why fluvoxamine isn’t used. The reason that it isn’t used is because the medical community ignores evidence-based medicine principles. Doctors wait for government permission (EUA or added to the NIH guidelines) before using a drug. It does not matter how many lives will be saved. Medicine has been transformed to doing whatever the NIH/FDA says, regardless of how many lives will be lost. See this Wall Street Journal op-ed.

18. Doctors who are most familiar with the drug would prescribe it to their patients. I’ve talked to doctors who are extremely familiar with the drug and all the trial results and they would prescribe it to their patients. But they don’t want their names used.

19. Silence from the medical community. Nobody in the medical community is speaking out about how hypocritical the medical community is for ignoring the positive Phase 3 trial results and instead following whatever the NIH or FDA says. So much for “evidence-based” medicine. We pretty much practice “government agency opinion medicine” all over the world now, with just a few exceptions.

20. Government agencies are ignoring the science. NIH and WHO refuse to acknowledge it works since it will cause vaccine hesitancy if it is known that there is a drug that turns COVID into a mild disease. That’s why they didn’t change their recommendation when the Phase 3 trial was published in Lancet. I fully expected both organizations to do absolutely nothing. They knew in advance it was coming and on the day the paper was published they ignored it entirely.

21. Comparison with molnupiravir. Fluvoxamine is way better than Molnupiravir, but the NIH doesn’t approve drugs on effectiveness. It’s whether Merck can make a killing that matters. Think about it … Molnupiravir has a 50% risk reduction whereas fluvxoamine is over 90%. Fluvoxamine has a 40 year safety track record. Molnupiravir followed patients for only 30 days because they know the drug is dangerous. The NIH picks the drug that makes the most money for the drug companies regardless of long-term safety… Molnupiravir!

22. Lack of action. All this was known back in January 2021 when a key opinion leader panel of experts from NIH, CDC, FDA, academia, and journal editors voted by over 2:1 to recommend that fluvoxamine be recommended to physicians to discuss with patients. All the medical journals refused to publish the meeting notes (rejected by 6 journals). We could have saved a lot of lives.

23. Doctors have no excuse for not prescribing. If you ask your doctor for any evidence that fluvoxamine doesn’t work or is harmful (like a DB-RCT which is the only thing they trust), they will show you nothing. But they will refuse to give it to you even after being proven in a Phase 3 trial that was approved by the WHO. It used to be that a Phase 3 study would do it. No more. It’s all about NIH saying it is OK.

24. Medicine today is driven by government opinion, not science. Most doctors won’t use it until NIH greenlights it, no matter what the science says. Medicine today isn’t about saving your life. It is about following orders and making money for the drug companies and protecting the doctor from liability and losing his medical license.

25. If you have trouble getting a prescription, perhaps you have OCD? If you can’t get a prescription for COVID, then perhaps you have OCD? Compulsive hand washing? Compulsive fiddling with your mask? Or just depression about the vaccine mandates? All can merit a fluvoxamine prescription based on traditional diagnoses. So you can address your OCD and if you get COVID, you’ll can up the dose.

26. There are other non-prescription things you should always have on hand. See my article on treatments. Vitamin D, NAC, betadine, aspirin, and Nigella sativa are all super cheap, effective, and available without a prescription. I have all of these on hand and I load up on vitamin D3 every day.

I’m sorry to sound so cynical. I’m just telling you the truth. I learned this the hard way. Fauci wants the vaccine to be the only option, Cliff Lane works for Fauci, and Cliff follows his orders. This is why Cliff doesn’t talk to me.

And he won’t talk to you either if you ask nosy questions like “Cliff, my risk benefit analysis shows you should be rushing to recommend this drug. Can I see your risk-benefit analysis?”

Note: normally I have lots of hyperlinks to all the sources, but I’m pressed for time. My website www.skirsch.io has tons of info on fluvoxamine with all the links.