Hip
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Emetine looks like a potent antiviral for coxsackievirus B, echovirus and cytomegalovirus.
Emetine is one of the main alkaloids found in the roots of the ipecacuanha plant.
Emetine EC50 values for CVB, echovirus and CMV are very low, around the 0.05 μM mark (see table 1 of this study). This is what makes emetine a potent antiviral at low doses.
The emetine EC50 for Zika virus is also around 0.05 μM, and emetine was demonstrated in this study to reduce Zika viral loads in mice by 10 times, which is a major reduction. This was achieved at safe dose levels: the mice were given 1 mg/kg of emetine by injection daily; this is equivalent of a human dose of 0.08 mg/kg, which works out at around 6 mg for an adult human, which is considered safe (see toxicity section below).
So since emetine works for Zika virus in vivo, it should also work for coxsackievirus B, echovirus and cytomegalovirus in vivo, as all these viruses have more or less the same EC50 of around 0.05 μM.
It's not often that you find an antiviral that can target a range of ME/CFS viruses like CVB, echovirus and CMV.
Emetine also has some efficacy against SARS-CoV-2, but it is about 10 times weaker for SARS-CoV-2 compared to CVB, echovirus and CMV, as the SARS-CoV-2 EC50 is 10 times higher at 0.50 μM.
Emetine Sources
Emetine is incredibly cheap, costing about $5 for a kilogram on IndiaMart.
Emetine is found in syrup of ipecac, with 30 ml of the syrup providing emetine 13.8 mg and cephaeline 45 mg.
In India, a safer synthetic analogue of emetine called dehydroemetine is available as an injection called Tilemetin. But it is not known if dehydroemetine has the same antiviral effects as emetine. Ref: 1. It is safe as it has a lower cardiovascular risk.
Tilemetin is cheap, costing about $0.50 for a 60 mg injection. One such injection vial could provide 10 x 6 mg oral doses.
EDIT: one study examining the antiviral effects of emetine and dehydroemetine on SARS-CoV-2 found both have similar antiviral potency, but with dehydroemetine, only one of its four isomers (named the (-)-R,S isomer) worked as an antiviral; the other three isomers of dehydroemetine did not have any antiviral action. So may be best to use emetine, because we don't know which dehydroemetine isomer is present in the Tilemetin injections.
Emetine Administration and Toxicity
High doses of emetine (20 to 60 mg daily) can be toxic to the nerves, the heart, and can also cause nausea. But low doses of 6 mg daily are considered safe and do not create nausea, according to the "Toxicity of Emetine in Clinical Practice" section of this paper.
This paper (full text on SciHub) delves more deeply into the cardiotoxic effects of emetine. I have not yet fully examined this study.
This paper says that when a 30 ml oral dose of ipecac syrup (containing 13.9 mg of emetine) was administered to 10 people, all these people vomited, due to the nausea effect. So if oral doses are taken, these need to be low. Note though that ipecac syrup also contains cephaeline, which is more nausea-producing than emetine.
If any nausea does occur with emetine, it can be treated with 5-HT3 antagonists such as ondansetron. Ref: 1 Lemon essential oil 5 or 10 drops is also a good 5-HT3 antagonist.
Unfortunately when emetine is injected, it causes pain at the injection site which can last hours or days. This pain is experienced in both subcutaneous and intramuscular injections, and for low and high doses of emetine.
So oral dosing may be better. Though one issue with oral dosing is that "emetine absorption from oral ipecac displays considerable inter-patient variation. Some patients may not absorb sufficient emetine or alkaloids to be therapeutically effective". Ref: 1
Emetine Pharmacokinetics
Emetine has a half-life of 35 hours.
In tests in mice, rats and dogs, it was found that emetine concentrations in the tissues were relatively low, but the drug was found at very high concentrations in the tissues. Ref: 1. This may be appropriate for ME/CFS, because in ME/CFS the viral infections are found in the tissues, not so much the blood.
Emetine is one of the main alkaloids found in the roots of the ipecacuanha plant.
Emetine EC50 values for CVB, echovirus and CMV are very low, around the 0.05 μM mark (see table 1 of this study). This is what makes emetine a potent antiviral at low doses.
Source: table 1 of this study.
The emetine EC50 for Zika virus is also around 0.05 μM, and emetine was demonstrated in this study to reduce Zika viral loads in mice by 10 times, which is a major reduction. This was achieved at safe dose levels: the mice were given 1 mg/kg of emetine by injection daily; this is equivalent of a human dose of 0.08 mg/kg, which works out at around 6 mg for an adult human, which is considered safe (see toxicity section below).
So since emetine works for Zika virus in vivo, it should also work for coxsackievirus B, echovirus and cytomegalovirus in vivo, as all these viruses have more or less the same EC50 of around 0.05 μM.
It's not often that you find an antiviral that can target a range of ME/CFS viruses like CVB, echovirus and CMV.
Emetine also has some efficacy against SARS-CoV-2, but it is about 10 times weaker for SARS-CoV-2 compared to CVB, echovirus and CMV, as the SARS-CoV-2 EC50 is 10 times higher at 0.50 μM.
Emetine Sources
Emetine is incredibly cheap, costing about $5 for a kilogram on IndiaMart.
Emetine is found in syrup of ipecac, with 30 ml of the syrup providing emetine 13.8 mg and cephaeline 45 mg.
In India, a safer synthetic analogue of emetine called dehydroemetine is available as an injection called Tilemetin. But it is not known if dehydroemetine has the same antiviral effects as emetine. Ref: 1. It is safe as it has a lower cardiovascular risk.
Tilemetin is cheap, costing about $0.50 for a 60 mg injection. One such injection vial could provide 10 x 6 mg oral doses.
EDIT: one study examining the antiviral effects of emetine and dehydroemetine on SARS-CoV-2 found both have similar antiviral potency, but with dehydroemetine, only one of its four isomers (named the (-)-R,S isomer) worked as an antiviral; the other three isomers of dehydroemetine did not have any antiviral action. So may be best to use emetine, because we don't know which dehydroemetine isomer is present in the Tilemetin injections.
Emetine Administration and Toxicity
High doses of emetine (20 to 60 mg daily) can be toxic to the nerves, the heart, and can also cause nausea. But low doses of 6 mg daily are considered safe and do not create nausea, according to the "Toxicity of Emetine in Clinical Practice" section of this paper.
This paper (full text on SciHub) delves more deeply into the cardiotoxic effects of emetine. I have not yet fully examined this study.
This paper says that when a 30 ml oral dose of ipecac syrup (containing 13.9 mg of emetine) was administered to 10 people, all these people vomited, due to the nausea effect. So if oral doses are taken, these need to be low. Note though that ipecac syrup also contains cephaeline, which is more nausea-producing than emetine.
If any nausea does occur with emetine, it can be treated with 5-HT3 antagonists such as ondansetron. Ref: 1 Lemon essential oil 5 or 10 drops is also a good 5-HT3 antagonist.
Unfortunately when emetine is injected, it causes pain at the injection site which can last hours or days. This pain is experienced in both subcutaneous and intramuscular injections, and for low and high doses of emetine.
So oral dosing may be better. Though one issue with oral dosing is that "emetine absorption from oral ipecac displays considerable inter-patient variation. Some patients may not absorb sufficient emetine or alkaloids to be therapeutically effective". Ref: 1
Emetine Pharmacokinetics
Emetine has a half-life of 35 hours.
In tests in mice, rats and dogs, it was found that emetine concentrations in the tissues were relatively low, but the drug was found at very high concentrations in the tissues. Ref: 1. This may be appropriate for ME/CFS, because in ME/CFS the viral infections are found in the tissues, not so much the blood.
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