Vitamin C
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https://arkenea.atlassian.net/browse/COM-140
mRNA COVID-19 vaccination for long COVID
mRNA COVID-19 Vaccine (Pfizer, Moderna)
How can the COVID-19 vaccine prevent long-COVID?
The COVID-19 vaccine was developed to protect against an active COVID-19 infection. Although active infections are generally acute, long-COVID can last weeks to months. Patients with long-COVID are theorized to be living in a state of inflammation. COVID-19 sets off a cytokine storm, an immune system overresponse. Although the active infection is now gone, patients are still shedding the virus, resulting in symptoms of “brain fog,” exercise intolerance, and shortness of breath.
Researchers have begun to look at the connection between the COVID-19 vaccine and long-COVID to lessen this symptom burden. For instance, one study’s analysis found that people who got a single dose of the COVID-19 vaccine before testing positive for COVID had a 35% lower risk of developing long COVID compared with unvaccinated people who got COVID. They found that unvaccinated people who recovered from COVID and then got a vaccine lowered their long-COVID risk by 27% [1].
Can the COVID-19 vaccine treat long-COVID?
For those already diagnosed with long-COVID, several studies have aimed to find if the use of the COVID-19 vaccine can treat already existing long-COVID. One observational study revealed that COVID vaccination, after long COVID was tied to fewer symptoms, increased well-being, and less inflammation [2]. A second study out of the Mayo Clinic looked at 477 patients looking for treatment from long-COVID. The study found that vaccinated patients were less likely to report symptoms, including loss of smell, chest pain, dizziness, numbness, shortness of breath, tremors, and weakness. There was no significant difference between vaccinated and unvaccinated patients in reports of fatigue, muscle pain, tachycardia, or irregular heartbeat.
Additionally, at least one dose post-vaccination, several articles showed an improvement in long-COVID symptoms after at least one dose. At the same time, four studies reported no change or worsening in long-COVID symptoms after vaccination [3].
Overall, there is substantial evidence that the COVID-19 vaccine may be helpful in preventing and treating long-term COVID. Although the vaccine is not currently indicated for this purpose, additional research may help solidify its use for this condition.
References:
1https://www.health.harvard.edu/diseases-and-conditions/vaccination-may-protect-against-long-covid
3https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00354-6/fulltext
Zileuton for long COVID
ZILEUTON
What is zileuton (Zyflo)?
Zileuton is part of a class of medications known as leukotriene receptor antagonists. Leukotrienes, specifically LTC4, LTD4, and LTE4, are pro-inflammatory mediators heavily involved in the mechanisms behind asthma. When provoked, leukotrienes constrict the airways, making breathing harder. Zileuton blocks leukotrienes from closing the airways, effectively making breathing easier.
What is the relationship between zileuton and long-COVID?
For patients suffering from inflammatory respiratory symptoms of long-COVID such as wheezing, cough, exercise intolerance, and trouble breathing, zileuton may play a role in mitigating these symptoms [1]. Patients with COVID-19 have been found to have high levels of LTE4, a member of the leukotriene family, in the lung space. Zileuton could help decrease these levels. Studies have only been conducted on montelukast, a medication in the same class as zileuton. One of these studies found that adding montelukast decreased cough severity, decreased cough paroxysms per day, and a shorter duration of cough [2]. Although no formal recommendations for zileuton to treat long-COVID have been made, there is some potential for zileuton to aid in pulmonary symptoms associated with long-COVID.
1https://www.frontiersin.org/articles/10.3389/fphar.2022.784214/full
2https://doi.org/10.1186/s43168-022-00154-6
Treatment Article
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Naltrexone for long COVID
NALTREXONE
What is naltrexone (Vivitrol)?
Naltrexone is an opioid antagonist, a medication that blocks opioid receptors in the brain. Opioids are a class of drugs that derive from or mimic natural substances found in the opium poppy plant [1]. When taken, they can decrease pain and provide a sense of euphoria. Opioids can be very addictive due to their euphoric effects. Naltrexone is prescribed to combat this problem by preventing a person from getting “high.” Naltrexone blocks where the opioids bind at the opioid receptors. In addition to opioid use disorder, naltrexone can also be used for alcohol use disorder.
How can naltrexone be used in long-COVID?
There has been some evidence that naltrexone may be helpful for patients dealing with symptoms of long-COVID. In long-COVID, the body is theorized to be under constant inflammation. Although a person is no longer actively infected with COVID-19, the body is still shedding the virus. Since the virus is a foreign material, the immune response is invoked and causes inflammation [2]. Using naltrexone at doses much lower than for alcohol or opioid disorder emphasizes its anti-inflammatory properties to help the body recover quicker [3].
Current published studies have looked at the use of low-dose naltrexone and symptom relief. One study of 52 patients showed improvement in activities of daily living, energy levels, pain levels, concentration levels, and sleep disturbance with the use of low-dose naltrexone [4]. A second study found that low-dose naltrexone increased sleep patterns, headache, brain fog, fatigue, fewer symptoms, and overall better functional status [5].
Current studies are being conducted to help solidify naltrexone’s use as a treatment option for long-COVID, however, it is still in the beginning phases [6]. However, with the limited research conducted, naltrexone does show promise in treating the long-COVID disease state to help restore patients to their pre-COVID baselines.
References:
1https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/opioids
2https://www.covidcaregroup.org/blog/low-dose-naltrexone-for-post-covid-inflammation
4https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9250701/
5https://doi.org/10.1101/2023.06.08.23291102
6https://classic.clinicaltrials.gov/ct2/show/NCT05430152
Search for: Long COVID, naltrexone | Card Results | ClinicalTrials.gov
Acetaminophen for long COVID
ACETAMINOPHEN
What is acetaminophen?
Acetaminophen, or paracetamol or Tylenol, helps reduce fevers, headaches, and muscle or body aches. It is found in many over-the-counter products, and patients can take 325 to 650 mg every 4-6 hours or 1 g every six hours as needed. Unlike other pain relievers like NSAIDs (nonsteroidal anti-inflammatory drugs like ibuprofen), acetaminophen does not have anti-inflammatory properties and is, thus, not beneficial in treating inflammatory conditions.
How can acetaminophen help alleviate certain long COVID symptoms?
The prevalence of post-COVID pain is estimated to be up to 63.3%, and patients with chronic pain can have exacerbated symptoms after COVID.1 There are multiple possible mechanisms behind post-COVID pain. Post-COVID pain may be caused by the virus entering and attacking musculoskeletal and nervous systems, including the brain.
Acetaminophen can be used to relieve arthralgias, myalgias, and headaches that persist after COVID; however, it does not help with inflammation and should not be used to treat COVID or to reduce the duration of COVID symptoms. Acetaminophen is often preferred for pain relief in older adults due to the potential side effects of NSAIDs.
What evidence supports acetaminophen’s use for long COVID?
There needs to be more studies that have looked at acetaminophen for long COVID symptoms. A survey of 696 COVID patients in Italy reported that acetaminophen was the most commonly used in the post-acute phase of COVID for pain and had a temporary reduction in pain severity.2 Because of its established use today, acetaminophen is a reasonable option to use for fevers, muscle pain, or body aches after COVID.3
What are some things to watch out for with acetaminophen?
Many OTC products contain acetaminophen, so it is important to follow dosage information and stay within recommended dosages when taking a combination of these products. The recommended maximum daily dose is 4,000 mg to prevent liver damage, but it is best not to exceed 3,000 mg daily, especially in older adults. Acetaminophen may cause nausea, vomiting, and stomach pain and is not recommended in people with liver disease. If you take Tylenol for headaches, you should not take it more than 10-15 days out of the month.
References:
3) Landon E. Which over-the-counter medications are best for COVID-19 symptoms? October 19, 2023. Accessed November 13, 2023. https://www.uchicagomedicine.org/forefront/coronavirus-disease-covid-19/which-otc-medications-are-best-for-coronavirus-symptoms#:~:text=Acetaminophen%2C%20also%20called%20paracetamol%20or,the%20duration%20of%20your%20illness.
Fexofenadine (Allegra)
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Hydroxyzine for long COVID
HYDROXYZINE
What is hydroxyzine?
Hydroxyzine is an antihistamine that helps block H1 receptors, which stops histamine from being released in the body. It’s commonly prescribed to relieve allergy symptoms like itching and can also help with anxiety or make it easier to fall asleep. There are some over-the-counter antihistamines, like fexofenadine and loratadine, that tend to be less sedating.
What does hydroxyzine do in the body?
Histamine is crucial in how our immune system reacts, especially during allergic responses. It causes blood vessels to become more permeable (“leaky”), leading to swelling and redness. Antihistamines block these effects at the H1 receptors, which helps reduce allergy symptoms.
First-generation antihistamines, including hydroxyzine, can easily cross into the brain and affect central nervous system receptors. This leads to different effects compared to second-generation antihistamines, which primarily target receptors outside the brain.
How can hydroxyzine help in long-COVID?
For people dealing with long COVID, hydroxyzine might be helpful. After COVID-19, some patients experience an overwhelming immune response, often called a cytokine storm. This can also involve alterations in histamine levels as well [1]. Hydroxyzine helps manage this immune reaction, potentially leading to improvements such as reduced wheezing and better exercise tolerance [2]. Some reports suggest that using hydroxyzine for an extended period could help improve long COVID symptoms like exercise intolerance, chest pain, fatigue, and brain fog. While we need more research, early findings are promising [3].
There’s alson encouraging but limited evidence that antihistamines might help with other long COVID symptoms. For instance, a study by Glynne et al. showed that 72% of long COVID patients who took a combination of H1 and H2 blockers for at least four weeks noticed some improvement in various symptoms, although not in dysautonomia [4]. It also mentioned ongoing T cell issues in these patients, suggesting that antihistamines may play a role in modulating the immune response. However, since this study was observational, we can’t assume a direct cause-and-effect relationship.
Another study by Samimi et al. looked at people with COVID-19 who were using antihistamines and found no significant difference in their symptoms compared to those who didn’t use them for four weeks[5]. While this didn’t specifically focus on long COVID, it gives some background on how antihistamines treat COVID.
Overall, early evidence is that antihistamines may help with long COVID, but more clinical trials are needed to confirm this and establish treatment recommendations.
References:
1Eldanasory OA, Eljaaly K, Memish ZA, Al-Tawfiq JA. Histamine release theory and roles of antihistamine in the treatment of cytokines storm of COVID-19. Travel Medicine and Infectious Disease. 2020;37:101874. doi:10.1016/j.tmaid.2020.101874
2Mashauri HL. Covid‐19 Histamine theory: Why antihistamines should be incorporated as the basic component in Covid‐19 management? Health Science Reports. 2023;6(2). doi:10.1002/hsr2.1109
3Pinto MD, Lambert N, Downs CA, et al. Antihistamines for postacute sequelae of SARS-COV-2 infection. The Journal for Nurse Practitioners. 2022;18(3):335-338. doi:10.1016/j.nurpra.2021.12.016
4Glynne P, Tahmasebi N, Gant V, Gupta R. Long COVID following Mild SARS-CoV-2 Infection: Characteristic T Cell Alterations and Response to Antihistamines. Journal of Investigative Medicine. 2021;70(1):61-67. doi:10.1136/jim-2021-002051
5Samimi S, Nimrouzi M, Sousani M, Vazani Y. EXPRESS: Antihistamine and COVID-19 outcomes in outpatients. Journal of Investigative Medicine. Published online August 1, 2024. doi:10.1177/10815589241270449
Clinical Trials
Search for: Long COVID, Other terms: Histamine H1 Antagonists | Card Results | ClinicalTrials.gov
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