What Drugs Are Used for COVID Long Haulers?

A promising development comes from Yale researchers who have found initial evidence that a combination of two existing medications, guanfacine and N-acetylcysteine (NAC), can mitigate or even help alleviate brain fog in Long COVID patients.

Guanfacine, developed in the lab of Amy Arnsten, and NAC, an antioxidant also used to support recovery in traumatic brain injury (TBI), were combined by Dr. Arman Fesharaki-Zadeh, who has been treating Long COVID patients with this regimen. The combined therapy was successful in helping to relieve brain fog for a small cohort of patients.

While larger, placebo-controlled clinical trials are needed to establish these drugs as a definitive treatment for post-COVID-19 neurocognitive deficits, the researchers suggest that patients can obtain these drugs now, as they are FDA-approved, affordable, and widely available.

One of the most promising treatments for Long COVID is antiviral medication. Pfizer’s PAXLOVID, initially developed to treat active COVID-19 cases, was being studied for its potential benefits for long haulers through Stanford, though the study was stopped early and we await more information. The drug works by inhibiting the virus from replicating inside the body, and researchers are hopeful that it could help alleviate persistent symptoms like fatigue, weakness, and brain fog.

On July 31, 2023, the National Institutes of Health announced the launch of a phase 2 clinical trial through the RECOVER Initiative called RECOVER-VITAL that focuses on PAXLOVID for the treatment of Long COVID. They report that the first trial sites are activated and they are currently enrolling participants.

Inflammation is a key player in Long COVID, with many patients experiencing a persistent inflammatory response. Drugs like colchicine, an anti-inflammatory medication traditionally used for gout, are being explored for their potential to reduce inflammation and alleviate symptoms in Long COVID patients. By targeting the body's overactive immune pathways, these medications may help calm the systemic inflammation that drives ongoing fatigue, joint pain, and other debilitating symptoms. Researchers continue to study various anti-inflammatory protocols to determine the most effective dosages and combinations.

Interestingly, some antihistamines, such as famotidine (Pepcid) and diphenhydramine (Benadryl), have shown promise in supporting Long COVID patients. While these drugs are typically used for allergies and heartburn, they may also help reduce inflammation and other symptoms associated with Long COVID. Because histamine release can trigger widespread inflammation and mast cell activation, blocking these receptors might help stabilize the immune system. Many patients report improvements in gastrointestinal issues, skin rashes, and brain fog when incorporating targeted antihistamine therapies under medical supervision.

Another intriguing approach is the stimulation of the vagus nerve, a key component of the body’s parasympathetic nervous system. Devices that stimulate this nerve have been granted Emergency Use Authorization by the FDA for use in COVID-19 patients, and there’s hope that this approach could help manage the cytokine storm often seen in Long COVID. Non-invasive vagus nerve stimulation (VNS) may help regulate autonomic nervous system dysfunction, commonly known as dysautonomia, which frequently affects long haulers. By promoting a 'rest and digest' state, VNS offers a drug-free option to support recovery.

While the fight against Long COVID continues, these treatments offer a glimmer of hope for those grappling with persistent symptoms. It’s important to remember that what works for one patient may not work for another, and treatment often involves a degree of trial and error. As research progresses, RTHM clinicians can hope for more effective and targeted therapies for Long COVID in the near future. Always consult with a healthcare provider before starting any new medication, supplement, or treatment regimen.