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
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 Influenzaa. Clinical 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
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Omega-3 Fats for long COVID
OMEGA-3 FATS, SUCH AS DHA AND EPA
What are omega-3 fats?
Omega-3 fats are polyunsaturated fatty acids found in foods like fish and flaxseed. They can also be obtained from supplements, such as fish oil capsules [[1]]. Omega-3s can also be found in some plant sources, such as flaxseed [[2]].
Two types of omega-3 fats that have beneficial properties for Long COVID are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) [[3]]. Because they have anti-inflammatory properties, they might be relevant to immune dysfunction and inflammation inherent in Long COVID.
What do omega-3 fats do in the body?
Omega-3s have anti-platelet effects and can lower the levels of fibrinogen, thrombin, and factor V, proteins involved in clotting [[4]].
Omega-3s are also well-known for being anti-inflammatory, especially those from EPA and DHA. They also have anti-clotting properties [[5]]. The omega-3s in fish oil have been found to reduce disease activity in inflammatory and autoimmune conditions and reduce the need for anti-inflammatory drugs [[3]].
Omega-3 fats, especially EPA, have shown promise in treating mood disorders by reducing pro-inflammatory cytokine activity, acting on the HPA axis, and regulating neurotransmitters [[7]].
How can omega-3 fats help alleviate certain Long COVID symptoms and pathophysiology?
Omega-3 fats’ anti-clotting properties can be useful for Long COVID patients, who are at greater risk of clotting events due to cellular death and debris, which lead to thickening of blood and “brain fog” [[8]]. Omega-3’s anti-inflammatory properties can also help reduce inflammation in Long COVID patients.
Omega-3s can improve Long-Term COVID by treating brain damage and inflammation (including brain inflammation), reducing long-term central nervous system damage, and repairing oxidative stress due to cytokine storms and blood clotting.
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