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Lisdexamfetamine for long COVID
LISDEXAMFETAMINE
What is lisdexamfetamine, and how does it work?
Lisdexamfetamine is a stimulant medication that belongs to the drug class amphetamines. This medication acts on the central nervous system (CNS) by increasing levels of two chemicals, dopamine and norepinephrine, in the brain. Norepinephrine is thought to play a role in the body’s stress response and helps to regulate sleep, alertness, and blood pressure. Dopamine plays a crucial role in movement and affects motivation, perception of reality, and the ability to experience pleasure [1]. By increasing these levels of chemicals, it leads to an increase in focus and attention. Lisdexamfetamine is a controlled substance and does have the potential for abuse if used in a manner inconsistent with how it is prescribed.
How can lisdexamfetamine be used in long-COVID?
Sufferers of long-COVID often deal with “brain fog,” a persistent cognitive defect resulting in memory problems, poor focus, and decreased ability to concentrate. Although the reasoning is still unclear, researchers think COVID-19 may linger in the brain for months afterward. Even though it does not cause an active infection, it is a foreign substance in the body. This leads to constant attack by the immune system, causing inflammation. Over time, the continuous inflammation manifests as “brain fog” symptoms [2].
Stimulants, such as lisdexamfetamine, can improve focus, attention span, and even fatigue. A case study completed in 2022 showed benefits when using lisdexamfetamine, along with other agents, to help reduce “brain fog” [3]. Although there have been no formal studies conducted on using lisdexamfetamine for “brain fog,” one provider stated he has been using it, in conjunction with behavioral exercises, as a treatment option. He saw improved memory, attention, fatigue, and concentration difficulties [4].
Although current recommendations do not advocate for the use of stimulants to treat long-COVID or symptoms of long-COVID, for those suffering from “brain fog” or fatigue, it may be an attractive option to those looking for symptom management.
References:
1https://americanaddictioncenters.org/antidepressants-guide/ndris#
3https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10102822/
4https://www.ohsu.edu/sites/default/files/2023-02/PCR23-Mon-18-AndersonWM.pdf
Prednisone for long COVID
PREDNISONE
What is prednisone (Deltasone)?
Corticosteroids, often called steroids, are a class of medication used to decrease inflammation. Steroids, like prednisone, reduce the production of chemicals that cause inflammation [1]. They are used in a variety of disease states when inflammation is abundant. Steroids should be used for the shortest duration and lowest dose possible and should not be stopped abruptly. Doing so could lead to withdrawal symptoms or a flare-up if used for an autoimmune condition such as rheumatoid arthritis.
Can prednisone treat long-COVID?
Patients dealing with symptoms of long-COVID may see some beneficial results with the use of prednisone. In long-COVID, it is theorized that the body is under constant inflammation via a cytokine storm, an overresponse of the immune system. Although a person is not actively infected with COVID-19, the body still sheds the virus. Since COVID-19 is a foreign material, the immune response is invoked, resulting in inflammation [2]. Since prednisone decreases inflammation, it could alleviate some of the symptoms of long-COVID, such as “brain fog, chronic fatigue, and exercise intolerance.
Although there have been few studies testing prednisone’s effectiveness in treating long-COVID, the limited results show promise. In one study on 14 patients, researchers looked at the immune response before and after treatment with prednisone for four days. Results showed the immune response decreased and was maintained for at least four months following therapy [2]. A second study found that treatment with tapering steroids improved breathing, increased oxygen levels, and decreased inflammation on chest X-rays [3].
Prednisone may offer symptom improvement for patients suffering from side effects of long-COVID, however, there has been no evidence it treats the disease state itself. It may be an attractive option to patients as it is relatively affordable and for a short duration, may help with lung capacity and oxygen levels. A conversation with a healthcare provider can offer additional insight as to whether prednisone would be a potential therapy option for long-COVID.
References:
1https://my.clevelandclinic.org/health/drugs/4812-corticosteroids
3https://pubmed.ncbi.nlm.nih.gov/34730322/
Lumosity for long COVID
BRAIN TRAINING PROGRAMS: Lumosity
What are brain training programs like Lumosity?
Lumosity provides research-based brain training games to improve memory, processing speed, and problem-solving for people of all ages and skill levels.1 Users can choose from more than 50 games in the following categories: speed, memory, attention, flexibility, problem-solving, word, and math. The games are intended to be adaptive and have personalized difficulty. Each game is also derived from a clinically-based assessment that could be done in a research lab.
How can brain training programs like Lumosity help alleviate certain long COVID symptoms?
Cognitive symptoms of long COVID include brain fog (trouble thinking clearly or remembering) and difficulty focusing on tasks. The SARS-CoV-2 virus can directly infect the central nervous system and damage brain tissue, which is hypothesized to lead to cognitive impairment. In addition, the virus possesses a spike protein that studies have associated with memory loss after COVID.2 This spike protein can activate neuroinflammation and ultimately lead to memory impairment.
Programs like Lumosity may help with cognitive symptoms of long COVID by training the brain over multiple sessions to improve memory and processing time. As users improve their ability to complete the cognitive tasks for each game, these tasks boost memory and attention in daily activities.
What evidence supports using brain training programs like Lumosity for long COVID?
The founder of Lumosity conducted a randomized study of 4,715 participants who either completed the brain training program for 15 minutes a day for five days per week or online crossword puzzles. After ten weeks, they found that those who used Lumosity improved more on assessments of working memory, short-term memory, processing speed, problem-solving, fluid reasoning, and overall cognitive function.3
Another study conducted in Saudi Arabia had 51 healthy participants randomized to use either Lumosity for 15 minutes a day, at least seven days per week, for three weeks or no brain training as a control. The study found a statistically significant difference in attention-switching tasks and motor speed between the Lumosity and control groups.4
However, some argue that brain training programs such as Lumosity only improve a user’s ability to complete specific tasks assessed in the games with little transferability to overall cognitive performance. One study found no evidence of improvement in decision-making behavior, brain response, or cognitive task performance using Lumosity versus playing online video games.5
Thus, the evidence for Lumosity is controversial and may not be as effective in improving overall cognitive function. Lumosity has also been used anecdotally by long-term COVID patients, but it has not yet been formally studied in this patient population.
References:
1) Discover what your mind can do. Lumosity. 2023. Accessed November 9, 2023. https://www.lumosity.com/en/
Active Clinical Trials: Long COVID, brain training | Card Results | ClinicalTrials.gov
Health Insurance for Individuals
Hi
Lovastatin for long COVID
LOVASTATIN
What is lovastatin (Mevacor, Altoprev)?
Lovastatin is part of a class of drugs commonly referred to as statins. Its role is to reduce the amount of cholesterol the liver makes. Cholesterol comprises HDL, the “good” cholesterol, and LDL, the “bad” cholesterol. The body uses cholesterol to make various hormones and other substances. However, if a person has too much LDL, it can cause a buildup in the arteries, leading to stroke, heart attack, or other health problems.
How does lovastatin relate to long-COVID?
Lovastatin possesses anti-inflammatory and modifying effects on the immune system (1). A recent study conducted in vitro (in test tubes) showed that simvastatin reduced levels of pro-inflammatory proteins and inhibited human cells from being infected with COVID-19 (2). However, statins can also upregulate or increase an enzyme called ACE2. ACE2 is how COVID-19 makes its way into the cells, leading to an influx of disease ( 3).
For those who suffer from long-COVID, the effects of statins may prolong illness even further. Highlights of long-COVID include chronic fatigue, exercise intolerance, and muscle weakness. Muscle weakness or muscle pain (myalgia) is also a primary side effect associated with the use of statins. Therefore, many believe that statins are exaggerating long-COVID in patients. Additionally, statins can decrease the amount of CoQ10 available for use by the body. CoQ10 is an antioxidant that has a role in the cells’ energy production (4). For those suffering from long-COVID and already with a decreased energy reserve, statin use could only exacerbate this problem further.
Although currently, there is no definitive answer regarding the role of lovastatin use in patients with long-COVID, the consensus is to aid on the side of caution. A benefit versus risk scenario for every patient should be warranted for providers to assess whether the cardio-protective use of statins outweighs the prolonged effects of long-COVID in patients.
References:
1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9520195/
2https://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1011050
3https://jamanetwork.com/journals/jama/fullarticle/2780872
4 https://www.mdpi.com/2077-0383/12/14/4659
Pregabalin for long COVID
PREGABALIN
What is pregabalin?
Pregabalin is a medication that mimics gamma-aminobutyric acid (GABA) in the body. GABA is responsible for inhibiting neurons that produce an excitatory signal. In pain or seizures, neurons constantly fire, inducing an excitatory response. GABA works to calm these neurons and return them to normalcy. Pregabalin is commonly used for neuropathy (nerve pain) and those affected with partial seizures [1]. It is a controlled substance (C-V) and does have the potential for abuse if taken differently than prescribed.
Can pregabalin help with long-COVID?
Patients with long-COVID can display a variety of symptoms such as tremors or neuropathy in the fingers or toes. Although the mechanism behind this is still unclear, some theories point to damage of the nerve cells by COVID-19, causing an imbalance in excitatory versus inhibitory neurons [2]. Several providers have turned to therapies, such as pregabalin, to control these symptoms. In a guide created for primary care physicians regarding long-COVID, the use of pregabalin is warranted for neuropathic pain [2]. Additionally, a review study published in 2022 found that in patients with neuropathy from long-COVID, 61% were prescribed agents such as pregabalin for symptom management [3].
Pregabalin may be a helpful therapy for those suffering from neurological pain associated with long-COVID. It may offer symptom management and help restore a patient to pre-COVID baseline function.
References:
2https://www.jabfm.org/content/jabfp/34/6/1229.full.pdf
3https://onlinelibrary.wiley.com/doi/10.1002/acn3.51570
Active Clinical Trials: Long COVID, pregabalin | Card Results | ClinicalTrials.gov
EndeavorRx for long COVID
BRAIN TRAINING PROGRAMS: EndeavorRx
What are brain training programs like EndeavorRx?
EndeavorRx is an FDA-authorized video game to improve attention function in children ages 8-12 with ADHD. The program can be considered part of a treatment plan combined with provider-directed therapy, medication, and educational programs. EndeavorRx is prescribed by a provider and is currently priced at $99 for a 30-day prescription and FSA/HSA eligible.1
Like EndeavorRx, EndeavorOTC is a similar video game app clinically designed to improve adult ADHD symptoms. The game tests your ability to see a target and navigate a course to avoid obstacles. It is recommended to be played for six weeks intervals followed by a one-week break.2
How can brain training programs like EndeavorRx help alleviate certain long COVID symptoms?
Cognitive symptoms of long COVID include brain fog (trouble thinking clearly or remembering) and difficulty focusing on tasks. The SARS-CoV-2 virus can directly infect the central nervous system and damage brain tissue, which is hypothesized to lead to cognitive impairment. In addition, the virus possesses a spike protein that studies have associated with memory loss after COVID.3 EndeavorRx and EndeavorOTC can improve attention in long COVID patients.
What evidence supports using brain training programs like EndeavorRx for long COVID?
EndeavorRx is supported by five clinical studies that included more than 600 children with ADHD. The company’s randomized controlled trial found that the program improved objective attention in children when played for about 25 minutes a day, five days per week, for four weeks, with added benefits in a second month of treatment.4
EndeavorOTC was studied in adults with ADHD, with 73% of participants reporting quality of life improvements. This study found that 60% were better able to complete projects on time, and 53% were better able to manage multiple tasks at once.5
EndeavorRx and EndeavorOTC are currently being studied at Cornell New York Presbyterian and Vanderbilt for use in long COVID patients with cognitive impairment.6
What are some things to watch out for with brain training programs like EndeavorRx?
No serious adverse events have been reported. About 9% of participants reported a treatment-related adverse event such as frustration, headache, dizziness, emotional reaction, nausea, and aggression. All adverse events were transient, and only three led to discontinuation of the program.1
References:
1) The only doctor prescribed video game treatment for kids with ADHD. EndeavorRx. April 2022. Accessed November 8, 2023. https://www.endeavorrx.com
2) Improve your focus, game changing results. EndeavorOTC. 2023. Accessed November 8, 2023. https://www.endeavorotc.com
4) The Research. EndeavorRx. June 2022. Accessed November 8, 2023. https://www.endeavorrx.com/the-research/
6) Aguilar M. Akili’s therapeutic video game will be tested as a treatment for Covid ‘brain fog.’ STAT. April 7, 2021. https://www.statnews.com/2021/04/07/akili-endeavorrx-covid19-brain-fog/
Active Clinical Trials: Long COVID, brain training | Card Results | ClinicalTrials.gov
Pepcid2
CompendiRx:
Empowering the long COVID Community
Who We Are
Welcome to CompendiRx, an innovative online platform dedicated to transforming the journey of individuals grappling with the often-overlooked condition known as COVID. Born from a genuine commitment to addressing the unique challenges faced by this community, CompendiRx stands as a beacon of hope, understanding, and invaluable support.
Our mission is simple yet profound: to offer an empowering registry of treatment ratings and reviews, complemented by concise summaries of the latest research findings relevant to long COVID.
We envision a world where individuals impacted by this condition feel informed, supported, and optimistic about their path to recovery.
Our Core Values
At the heart of CompendiRx is a set of guiding principles that inform every aspect of our operations and interactions with the long COVID community:
Integrity and Trust: Upholding the highest standards of honesty and transparency, we are committed to providing reliable, evidence-based information. Your safety and privacy are paramount to us.
Empowerment through Knowledge: We believe in the power of informed decisions. Access to the latest, scientifically-backed treatment insights can significantly impact recovery outcomes.
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