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4 months ago Uncategorized

Ivabradine for long COVID

IVABRADINE

What is Ivabradine?

Ivabradine is a medication used to treat heart conditions.

 

What does Amantading do in the body?

Ivabradine slows the electrical conduction in the heart which subsequently slows the heart rate.

 

How can Ivabradine help alleviate certain long COVID symptoms and pathophysiology?

The use of ivabradine in long COVID (post-acute sequelae of SARS-CoV-2 infection, PASC) is based on limited but emerging scientific evidence. According to the 2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 by the American College of Cardiology, ivabradine has been used in patients with severe fatigue exacerbated by beta-blockers and calcium-channel blockers.

This recommendation is based on a small trial involving 22 patients with postural orthostatic tachycardia syndrome (POTS). The trial found that ivabradine improved heart rate and quality of life over one month[1]. Additionally, a perspective article suggests that ivabradine may be helpful in managing COVID-19-related cardiovascular complications due to its heart rate-lowering effects and various additional benefits, such as anti-inflammatory and anti-oxidant actions[2]. However, these findings are preliminary and derived from small-scale studies or theoretical benefits rather than large, randomized controlled trials specifically targeting long COVID. While there is some evidence supporting the use of ivabradine for managing cardiovascular symptoms in long COVID, it is primarily based on small studies and expert opinion. More extensive clinical trials are needed.

 

 

1.Gluckman TJ, Bhave NM, Allen LA, et al. 2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and other Myocardial involvement, Post-Acute Sequelae of SARS-COV-2 Infection, And return to play. Journal of the American College of Cardiology. 2022;79(17):1717-1756. doi:10.1016/j.jacc.2022.02.003

2.Baka T, Repova K, Luptak I, Simko F. Ivabradine in the Management of COVID-19-related Cardiovascular Complications: A perspective. Current Pharmaceutical Design. 2022;28(19):1581-1588. doi:10.2174/1381612828666220328114236

4 months ago Uncategorized

Amantadine for long COVID

AMANTADINE

 

What is Amantadine?

Amantadine is a medication used to treat abnormal movements in conditions such as Parkinson’s disease.

 

What does Amantadine do in the body?

Amantadine has mild effects on dopamine neurons, but we’re not sure exactly how it works for Parkinson’s. It also seems to stop a virus from infecting cells, but we don’t fully understand how it works.  While Amantadine has some antiviral properties, it is no longer recommended as an antiviral in clinical practice. [1]

 

How can Amantadine help alleviate certain long COVID symptoms and pathophysiology?

When it comes to long COVID, especially post-COVID-19 fatigue, there’s limited but hopeful evidence for using amantadine. One study found that patients who took amantadine for two weeks had less fatigue compared to those who didn’t, as measured by the Visual Analog Fatigue Scale (VAFS) and Fatigue Severity Scale (FSS). [2] However, other studies looked at different aspects of COVID-19 and how amantadine is used to treat it.

For example, one study found no significant improvements in fatigue among unvaccinated patients with early, mild to moderate COVID-19. [3] Another study emphasized the need for more standardized and robust studies on long COVID.[4]. The treatment has also been considered for fatigue in other conditions, such as Multiple Sclerosis. A Cochrane Database of Systematic Reviews found that amantadine is generally well-tolerated. However, the evidence supporting its effectiveness in reducing MS-related fatigue is still limited and inconsistent [5].  While Amantadine has the potential to reduce post-COVID-19 fatigue, but we need more large-scale, well-controlled studies to confirm its effectiveness and safety in this context.

 

1.Uyeki TM, Bernstein HH, Bradley JS, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal InfluenzaaClinical Infectious Diseases. 2018;68(6):e1-e47. doi:10.1093/cid/ciy866

2.Harandi AA, Pakdaman H, Medghalchi A, et al. A randomized open-label clinical trial on the effect of Amantadine on post Covid 19 fatigue. Scientific Reports. 2024;14(1). doi:10.1038/s41598-024-51904-z

3Rejdak K, Fiedor P, Bonek R, et al. Amantadine in unvaccinated patients with early, mild to moderate COVID‐19: A randomized, placebo‐controlled, double‐blind trial. European Journal of Neurology. 2023;31(1). doi:10.1111/ene.16045

4.Chee YJ, Fan BE, Young BE, Dalan R, Lye DC. Clinical trials on the pharmacological treatment of long COVID: A systematic review. Journal of Medical Virology. 2022;95(1). doi:10.1002/jmv.28289

 

6 months ago Uncategorized

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6 months ago Uncategorized

Glutathione for long COVID

GLUTATHIONE

 

What is glutathione?

Glutathione is a tripeptide of glutamate, glycine, and cysteine [[1]]. It has been called a “mighty little molecule” because of its antioxidant, immune response, antiviral defense, and other functions [[1]].

 

What does glutathione do in the body?

Glutathione is an antioxidant made in our bodies and found in our cells. It is the most abundant of the endogenous antioxidants found in our cells. Its high concentration reflects its important functions in detoxifying the body’s tissues, folding proteins, defending the body against viruses, and regulating the immune response [[2]].

 

Glutathione can neutralize reactive oxygen species, molecules involved in chronic inflammatory disorders. Many enzymes, including regulators of blood vessel function, also use glutathione as a co-factor for chemical processes. Glutathione also helps generate nitric oxide, stimulate blood flow, and promote brain and vascular health [[3]].

 

How can glutathione help alleviate certain Long COVID symptoms and pathophysiology? 

COVID-19 creates a severe inflammatory response that leads to the overactivity of immune cells called cytokines in the lungs. This so-called “cytokine storm” can be dangerous and, if not lethal, may linger after the acute infection phase [[3]]. Glutathione has a protective response against this inflammatory response.

 

Risk factors for severe COVID, such as advanced age, diabetes, and being immunocompromised, are linked to glutathione deficiency as well as increased oxidative stress [[2]].

 

A study found that hospitalized COVID-19 patients have a glutathione deficiency and increased oxidative stress. Oxidative damage was worse in older people but also present in younger adults, in whom it typically does not happen [[4]]. Given that Long COVID involves oxidative damage, glutathione’s antioxidant effects could potentially help reduce the serious manifestations of post-COVID syndrome.

 

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