Ivermectin Dosage for Cancer in 2026: Marik vs Makis vs Hope — What the Numbers Actually Are
This article is educational. It is not a prescription and not a substitute for care from a licensed clinician. Ivermectin is FDA-approved for selected parasitic infections. Fenbendazole is a veterinary drug and is not approved for human use. Neither agent is approved to treat cancer. Do not self-medicate. Do not replace surgery, radiation, endocrine therapy, targeted therapy, immunotherapy, or chemotherapy that is working. High-dose daily ivermectin can cause neurologic toxicity. Any off-label use requires a physician, baseline labs, and a stop plan.
Why this article exists
Patients keep asking the same question: how many milligrams? The answers now disagree in public.
In September 2024, Baghli, Makis, Marik and colleagues published a hybrid orthomolecular protocol in the Journal of Orthomolecular Medicine that listed ivermectin by cancer grade — including a high-grade row of 1–2 mg/kg/day. That table still circulates as if it were settled. It is not.
In June 2026, Dr Paul Marik — a co-author of that paper — wrote that there is no guideline-endorsed cancer dose, that the working rule is the lowest effective dose, and that circulating high-dose versions are potentially toxic and not recommended. Dr Justus Hope, co-author of the Independent Medical Alliance (IMA) cancer guide with Marik, publishes the same lower band. Dr William Makis answered in July 2026 that Marik’s 12–36 mg/day range is too low for most active cancers.
A 2 September 2026 Substack post (9) on Oncology Truth tried to freeze four names — Marik, Makis, Danny Hill, and Hope — into one “official” map. This article is the September 2026 comparison we actually need.
The 30-second map
| School | Typical daily dose | Practical ceiling | Default partner |
|---|---|---|---|
| Marik (Jun 2026) | Start ~0.3 mg/kg/day; backbone 0.2–0.4 mg/kg | 0.8–1.0 mg/kg/day only if needed | Modest mebendazole inside a multi-drug stack |
| Hope / IMA (Jul 2026) | Limited 0.3; Aggressive 0.6 mg/kg/day | Titrate toward 1.0 mg/kg/day if poor response | Aggressive track: mebendazole 200 mg/day |
| Makis (2025–2026 tiers) | Often 1.0 mg/kg/day for active solid tumors | 1.5–2.0 mg/kg/day high-grade / “turbo” | High mebendazole and/or fenbendazole, sometimes both |
| JOM paper (Sep 2024) | 0.5 or 1.0 mg/kg/day, 3×/week by grade | High-grade row: 1–2 mg/kg/day | Mebendazole 200→1,500 mg/day or fenbendazole 1,000 mg 3×/week |
↔ Swipe the table sideways to see all columns on mobile.
First, the labeled dose — so the tables stay honest
Ivermectin’s approved human use for parasites is about 0.15–0.20 mg/kg, usually as a single dose or a very short course. A 70 kg adult at the labeled dose is roughly one 12 mg tablet, once.
Every number below that line is off-label, weight-based, and taken far longer than the package insert ever contemplated. “Low-dose” in these protocols already means more than a labeled antiparasitic dose, taken daily.
| Dose | 60 kg | 70 kg | 80 kg | 90 kg |
|---|---|---|---|---|
| 0.2 mg/kg (labeled-adjacent) | 12 mg | 14 mg | 16 mg | 18 mg |
| 0.3 mg/kg (Marik start / IMA Limited) | 18 mg | 21 mg | 24 mg | 27 mg |
| 0.6 mg/kg (IMA Aggressive common) | 36 mg | 42 mg | 48 mg | 54 mg |
| 1.0 mg/kg (Makis standard active) | 60 mg | 70 mg | 80 mg | 90 mg |
| 2.0 mg/kg (Makis high-grade tier) | 120 mg | 140 mg | 160 mg | 180 mg |
↔ Swipe the table sideways to see all columns on mobile.
Most human tablets are 3 mg or 12 mg. 70 mg/day is six 12 mg tablets. 140 mg/day is about twelve. That arithmetic is why monitoring is not optional.
1. Dr Paul Marik — lowest effective dose
Dr Paul E. Marik, MD, FCCM, FCCP, is a former critical care physician and co-founder of the FLCCC, now known as the Independent Medical Alliance (IMA). He currently writes about cancer and metabolic therapies through his Substack, Cancer & Metabolic Healing, and contributes to the IMA cancer guide. His June 2026 essay, “The Ivermectin and Mebendazole Dosing Question,” is particularly important when assessing ivermectin dosing claims and should be read before relying on any 2024 dosing table that still bears his name.
What he actually published in June 2026
- There is no established or guideline-endorsed ivermectin dose for cancer. Published experience is case reports, observational series, and extrapolation.
- Continuous backbone inside a multi-drug protocol: 0.2–0.4 mg/kg orally once daily.
- Practical start: about 0.3 mg/kg/day.
- Pulse options for prevention or post-NED: 0.4 mg/kg daily for 5 days every 2–4 weeks; or 0.3–0.6 mg/kg three times weekly.
- Refractory disease only, with supervision: 0.6–1.0 mg/kg/day. He rarely wants to approach 1.0 mg/kg.
- Rule: the smallest dose that controls the disease — not the maximum tolerated dose.
He has said circulating high-dose versions of the 2024 protocol are potentially toxic and that he does not recommend them. That is a co-author walking part of his own earlier table back. Any article that still prints “Marik = 2 mg/kg” without that sentence is out of date.
How he uses it
Ivermectin is one lever in a stack — diet, doxycycline plus oral vitamin C, curcumin, metformin or berberine, melatonin, vitamin D — not a monotherapy hammer. Mebendazole in his current writing stays modest compared with the dual high-dose fenbendazole-plus-mebendazole combinations circulating online. For post-NED maintenance he prefers rotation and pulses so tumors do not adapt to a flat daily cocktail.
Toxicity he wants readers to know
Neurotoxicity is the dose-limiter: dizziness, visual change, tremor, ataxia, confusion. Risk rises with P-glycoprotein inhibitors (verapamil, amiodarone, clarithromycin and others), strong CYP3A4 inhibitors, liver impairment, pre-existing neurologic disease, and veterinary formulations.
He described a colleague’s patient who developed tremor, unstable gait, confusion, impaired memory and manic behavior after nearly 1 mg/kg/day for more than six weeks. Early neurologic symptoms mean reduce the dose or stop and reassess — not “push through.”
2. Dr Justus Hope — Limited vs Aggressive (IMA)
Hope writes the Substack Repurposed Drugs: Powers & Possibilities and co-authored the IMA document Approach to the Use of Repurposed Drugs and Nutraceuticals in Patients with Cancer with Marik. The July 2026 update of that guide is the cleanest public table attached to both names. The guide itself says treatment should be supervised by a qualified integrative clinician and that self-treatment is strongly discouraged.
| Category | Limited | Aggressive |
|---|---|---|
| Who it is for | Earlier or less aggressive disease, or patients already on heavy standard therapy | Advanced disease that needs more intensity |
| Ivermectin | 0.2–0.4 mg/kg/day (commonly 0.3) | 0.4–0.8 mg/kg/day (commonly 0.6). Titrate toward 1.0 mg/kg if response is poor and the drug is tolerated. |
| Mebendazole | Not required on the Limited core list | 200 mg/day (100 mg twice daily) |
| Diet | Low-carbohydrate, low-glycemic; green tea / coffee | Low-glycemic ketogenic; OMAD; periodic 48–72 hour fasts |
| Hard stop | Physician supervision | Take with food. Reduce dose if headache, dizziness, or other neurologic signs appear. |
Hope has also written about a RESET-5 cocktail — mebendazole, ivermectin, sulforaphane, metformin, aged garlic extract — aimed at cancer-stem-cell pathways. That is a combination idea, not a second license to escalate ivermectin to 2 mg/kg. Do not splice Hope’s cocktail onto Makis’s milligram counts and call it one protocol.
3. Dr William Makis — high-exposure escalation
Makis is the high-dose pole of this debate. Trained in nuclear medicine (McGill), he has published widely on repurposed drugs since 2023 through Substack and X. He argues that bioavailability and tumor grade justify daily 1–2 mg/kg, usually with a fatty meal, often 6 days on / 1 day off or continuous, stacked with fenbendazole and/or high-dose mebendazole.
In July 2026 he wrote that Marik’s recommendations fail in most active cancers, that 12–36 mg of ivermectin is too low, and that such doses may only help a small minority of cases (he has cited lymphoma, some bladder and lung cancers with chemo, occasionally prostate). That disagreement is now part of the public record. Readers should see both columns, not a blended “official” number.
Tiers as compiled from his 2025–2026 public posts
| Tier | Ivermectin | Benzimidazole partner | Typical add-ons |
|---|---|---|---|
| Low-grade / maintenance | 0.5 mg/kg, 3×/week | Mebendazole 200 mg/day or fenbendazole ~222 mg | Vitamin D, berberine, curcumin |
| Standard active solid tumors | 1.0 mg/kg/day | Fenbendazole 444–1,000 mg or mebendazole ~1,000 mg | Berberine, CBD in some write-ups |
| High-grade / aggressive / “turbo” | 1.5–2.0 mg/kg/day | Often both: fenbendazole ~1,000 mg plus mebendazole 1,000–1,500 mg | Methylene blue and others in some aggressive stacks |
What belongs next to this table
- Fenbendazole is not approved for humans. Pharmaceutical mebendazole is the licensed benzimidazole analog.
- Visual disturbance and other neurologic effects are repeatedly described at the top of this range.
- Liver enzymes need watching when benzimidazoles run high, especially with dual agents.
- Makis has not held an active Canadian medical licence since 2019. In March 2026 an Alberta court granted a permanent injunction restricting his practice and use of protected titles. Treat his tables as commentary from a prolific writer, not as a board-authorized prescription pad.
Observational combination series continue to circulate in 2026, including a Hulscher et al. report of ivermectin plus mebendazole with a high “clinical benefit” rate in an uncontrolled cohort. Uncontrolled cohorts cannot separate drug effect from selection, concurrent standard care, or natural history. They are a reason to run proper trials — not a reason to skip the oncologist.
4. The 2024 JOM table — keep the citation, date the claim
The September 2024 Journal of Orthomolecular Medicine paper listed:
- Low-grade: 0.5 mg/kg, 3× per week (Guzzo et al., 2002).
- Intermediate-grade: 1 mg/kg, 3× per week (Guzzo et al., 2002).
- High-grade: 1 mg/kg/day (de Castro et al., 2020) to 2 mg/kg/day (Guzzo et al., 2002).
Two facts have to travel with those citations. Guzzo 2002 was a healthy-volunteer safety study, not a cancer trial. de Castro 2020 discussed high-dose safety in a leukemia / COVID setting, not tumor shrinkage. Science Feedback reviewed the efficacy leap in 2024 and called it unsupported. Marik’s 2026 Substack is the co-author update. Keep the paper in the reference list. Stop calling it current consensus.
5. How these drugs are usually taken — the logistics that matter
Food and absorption
Ivermectin is lipophilic. Almost every clinician in this space says take it with a fatty meal if the goal is higher blood levels. Some of Marik’s earlier notes also discuss empty-stomach timing; in practice the IMA aggressive table says take with food. Pick one method with the prescribing clinician and stay consistent so levels are interpretable.
Binders
Binders (modified citrus pectin, charcoal, clay, and similar) are used in this community to mop up die-off debris. They also adsorb drugs. Separate binders from ivermectin and benzimidazoles by several hours or they can cancel the dose you think you took.
Cycling
You will see 6 days on / 1 day off, 3 weeks on / 1 week off, and 3-week switches between fenbendazole and mebendazole. The stated aims are hepatic recovery and slowing adaptive resistance. None of those calendars is validated in a cancer RCT. If liver enzymes climb, the calendar yields to the lab.
Monitoring that should be non-negotiable
- Baseline and interval liver enzymes, CBC, and renal function.
- Full medication review for P-gp and CYP3A4 inhibitors.
- Stop-and-call rules: new visual change, severe headache, ataxia, confusion, jaundice, rash, collapse.
- Human pharmaceutical-grade tablets only. No veterinary paste.
- Do not use in pregnancy.
6. What the evidence is — and is not
Laboratory work on ivermectin and benzimidazoles is not imaginary. Multiple groups have published effects on WNT, Hedgehog, Notch, PAK1, microtubules, and cancer-stem-cell models. That is why these agents keep showing up in repurposing papers.
Human cancer evidence is still the thin layer: case reports, uncontrolled observational cohorts, and very small early combinations with immunotherapy that have not produced a standard of care.
A City of Hope–linked Phase I/II ivermectin plus checkpoint-inhibitor effort in metastatic triple-negative breast cancer presented limited early numbers and did not establish benefit. ASCO told oncologists in 2026 to ask patients about these drugs and not to recommend them outside trials. NCI has said it is looking at preclinical properties; that is research interest, not approval. A Phase II ivermectin plus checkpoint-inhibitor concept (ICONIC) has been described with a 2026 start window.
7. How to use this page with your clinician
Bring the comparison table, not a screenshot of a single influencer chart.
- If the plan is Marik / IMA Limited: you are talking about ~0.3 mg/kg/day as one piece of a stack.
- If the plan is IMA Aggressive: ~0.6 mg/kg/day, ceiling near 1.0, mebendazole 200 mg/day, cut dose for neurologic symptoms.
- If the plan is a Makis-style high-grade stack: you are talking about 1–2 mg/kg/day plus high-dose benzimidazoles, which is the highest-risk column and needs the tightest monitoring.
- Ask who is watching LFTs, what the stop rules are, and how this interacts with whatever standard therapy is already in motion.
Cancer care is a team effort with the patient at the centre. Talk to the treating oncologist and, if you use these agents, an integrative clinician who will actually order the bloodwork.
Bottom line
There is no official ivermectin cancer dose. There is a 2026 split.
Marik and Hope now operate around 0.3 mg/kg/day on the Limited track and 0.6 mg/kg/day on the Aggressive track, with 1.0 mg/kg as a supervised ceiling. Makis still publishes 1–2 mg/kg/day for active high-grade disease. The 2024 JOM high-grade row sits in the archive as the table that started the argument.
Anyone using these agents needs a licensed clinician, labs, pharmaceutical-grade product, and a plan that does not replace proven therapy.
Sources
- Baghli I, Martinez P, Marik PE, Makis W, et al. Targeting the Mitochondrial-Stem Cell Connection in Cancer Treatment: A Hybrid Orthomolecular Protocol. Journal of Orthomolecular Medicine. 2024;39(3).
- Marik PE. The Ivermectin and Mebendazole Dosing Question. Substack. 21 June 2026.
- Marik PE, Hope JR. Approach to the Use of Repurposed Drugs and Nutraceuticals in Patients with Cancer. Independent Medical Alliance. July 2026 update.
- ASCO Clinical Notice: Recommending Against Ivermectin and Fenbendazole for Cancer Treatment, Outside of Clinical Trials. May 2026.
- Science Feedback. Lack of evidence for cancer treatment protocol that recommends antiparasitic drugs ivermectin and mebendazole. 25 October 2024.
- Guzzo CA et al. Safety, tolerability, and pharmacokinetics of escalating high doses of ivermectin. 2002.
- de Castro CG et al. High-dose ivermectin comment in a leukemia / COVID context. 2020.
- Makis public protocol notes compiled from Substack and X, 2025–2026 (secondary compilations, including prior OneDayMD protocol pages).
- Oncology Truth / Repurposed Oncology. Official Ivermectin Dosage Protocols According to Paul Marik, William Makis, Danny Hill and Justus Hope. 2 September 2026.
- OneDayMD. Best Ivermectin Dosage for Humans with Cancer or Different Cancer Types. 2026.
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