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Molnupiravir for long COVID
MOLNUPIRAVIR
What is molnupiravir (Lagevrio)?
Molnupiravir, a medication authorized by the FDA in 2021 for Emergency Use, is used to treat COVID-19 infections [1]. It is an antiviral that changes the genetic makeup of COVID-19, so it cannot replicate. For the best outcome, molnupiravir should be used within five days of symptom onset.
How can molnupiravir help with long-COVID?
Currently, there is some evidence supporting the use of molnupiravir to decrease the risk of long-COVID. In a clinical study completed in 2021, patients treated with molnupiravir had faster tissue oxygen saturation times and a reduced demand for respiratory aid [2]. Long-COVID is often characterized by symptoms such as fatigue, shortness of breath, and exercise intolerance; these findings indicate molnupiravir decreases respiratory symptoms, allowing patients to return to pre-COVID baselines quicker [3]. A second study completed by the Veterans Affairs (VA) found that those who received molnupiravir within five days of having symptoms had a reduced risk of adverse outcomes after six months. It did not matter if a person was unvaccinated, partially vaccinated, or unvaccinated; the outcomes were positive regardless of vaccination status [4].
Molnupiravir as a treatment for COVID-19 has been established; however, for prevention of long-COVID, the status remains unknown. It shows promise in decreasing symptoms early on in COVID-19. However, further research can help to solidify its use for patients with long-COVID.
References:
2https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10029330/
4https://www.bmj.com/content/381/bmj-2022-074572
Venlafaxine for long COVID
VENLAFAXINE
What is venlafaxine (Effexor)?
Most used for anxiety and depression, venlafaxine belongs to a class of medication called serotonin-norepinephrine reuptake inhibitors (SNRIs). Serotonin is a molecule in the body that aids in mood, sexual desire, sleep, digestion, wound healing, bone health, and blood clotting [1]. It is often referred to in psychology as the “happy” chemical. Norepinephrine is thought to play a role in the body’s stress response and helps to regulate sleep, alertness, and blood pressure [2]. In conditions like depression and anxiety, the brain is dealing with an imbalance of chemicals such as serotonin and norepinephrine. SNRIs, like venlafaxine, keep serotonin and norepinephrine in a space where they can readily be used for bodily processes.
How can venlafaxine help with long-COVID?
In those diagnosed with long-COVID, many suffer from “brain fog”; decreased cognitive acuity, memory deficits, poor focus, reduced ability to multitask, and reduced concentration [2]. The proposed reason is that during a COVID-19 infection, the body’s immune response becomes activated, causing heavy amounts of inflammation. This inflammation affects the central nervous system (CNS), brain, and spinal cord. To combat this problem, researchers have turned to already existing medication therapies in the hopes they may be able to help decrease “brain fog” symptoms. Although studies have been completed in humans regarding venlafaxine’s effect in long-COVID, lab data has shown promise.
Serotonin and norepinephrine have been shown to have an effect against viral inflammation by blocking certain viruses (like HIV-1) into the cells. In addition, they can decrease cytokine production, promoting the immune response [3]. Since serotonin and norepinephrine possess anti-inflammatory properties and may inhibit viral activity, venlafaxine could be an option for treating long-COVID. Venlafaxine keeps these chemicals around longer in the body to perform their functions; therefore, if they are active longer, the immune response and symptoms of depression may decrease.
Further research needs to be conducted in clinical trials to assess the effectiveness of venlafaxine for treating long-COVID; however, for symptom management of depression, venlafaxine may be an option for patients.
References
1https://my.clevelandclinic.org/health/articles/22572-serotonin
2https://americanaddictioncenters.org/antidepressants-guide/ndris
Naltrexone
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Montelukast for long COVID
MONTELUKAST
What is montelukast (Singulair)?
Montelukast 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. Montelukast works by blocking leukotrienes from closing the airways, making breathing easier.
What is the relationship between montelukast and long-COVID?
For patients suffering from inflammatory respiratory symptoms of long-COVID such as wheezing, cough, exercise intolerance, and trouble breathing, montelukast 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. Montelukast could help decrease these levels. A pilot study conducted in long-COVID patients with cough lasting more than eight weeks found that adding montelukast decreased cough severity, decreased cough paroxysms per day, and a shorter duration of cough [2]. Although no formal recommendations for montelukast to treat long-COVID have been made, a more thorough clinical study is currently being conducted in Spain to examine the relationship between montelukast and cough in long-COVID patients [3].
References:
1https://www.frontiersin.org/articles/10.3389/fphar.2022.784214/full
2https://doi.org/10.1186/s43168-022-00154-6
3https://classic.clinicaltrials.gov/ct2/show/NCT04695704
Active Clinical Trials: Long COVID, montelukast | Card Results | ClinicalTrials.gov
Zafirlukast for long COVID
ZAFIRLUKAST
What is Zafirlukast (Accolate)?
Zafirlukast 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. Zafirlukast blocks leukotrienes from closing the airways, effectively making breathing easier.
What is the relationship between Zafirlukast and long-COVID?
For patients suffering from inflammatory respiratory symptoms of long-COVID such as wheezing, cough, exercise intolerance, and trouble breathing, zafirlukast 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. Zafirlukast could help decrease these levels. A study conducted on patients with COVID-19 showed that zafirlukast made no difference in the outcomes of patients; however, this study was done in hospitalized patients, not long-COVID patients residing at home [2]. Although formal recommendations for zafirlukast to treat long-COVID have yet to be made, additional studies could help close the gap and provide guidance regarding its use.
References:
1https://www.frontiersin.org/articles/10.3389/fphar.2022.784214/full
2https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9673052/
Vitamin C
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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
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