Anakinra for long COVID
ANAKINRA
What is anakinra?
Anakinra is an IL-1 receptor antagonist that reduces IL-1 in the body. IL-1 belongs to a group of substances called cytokines, which induce inflammation and provoke the immune response. Anakinra works by blocking this immune response from occurring, thus decreasing inflammation in the body. Anakinra treats rheumatoid arthritis in those over 18 years of age.
How can anakinra be used in long COVID?
Patients diagnosed with long COVID are thought to be in a constant state of inflammation. This inflammation manifests in symptoms such as fatigue, “brain fog,” exercise intolerance, wheezing, and trouble breathing. The current working theory is that by decreasing the inflammatory response using anakinra, the inflammation in the body will decrease and bring patients back to their pre-COVID baselines.
Research thus far has been mixed. A systematic review conducted by researchers in Germany found anakinra had no positive or negative effect on hospitalized patients dealing with COVID-19 symptoms [1]. However, in a review of all available evidence of anakinra, researchers think it may benefit patients with severe respiratory problems that may progress to respiratory failure [2]. As of November 2022, the FDA granted anakinra Emergency Use Authorization for certain hospitalized patients requiring supplemental oxygen [3]. Whether that authorization gets extended to use outside of hospitals remains.
References:
1https://doi.org/10.1186/s40001-023-01072-z
2https://doi.org/10.1016/j.intimp.2022.109075
Active Clinical Trials: Long COVID, Anakinra | Card Results | ClinicalTrials.gov
Fluvoxamine for long COVID
FLUVOXAMINE
What is fluvoxamine (Luvox)?
Most used for anxiety and depression, fluvoxamine belongs to a class of medication called selective serotonin reuptake inhibitors (SSRIs). 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. In conditions like depression and anxiety, the brain is dealing with an imbalance of chemicals such as serotonin. SSRIs, like fluvoxamine, work by keeping serotonin in the space where it can readily be available for bodily processes.
What is the connection between fluvoxamine and 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. To date, researchers have found some evidence that fluvoxamine may help mitigate symptoms.
Serotonin has also been shown to have an effect against viral inflammation by blocking certain viruses (like HIV-1) into the cells. In addition, it can decrease cytokine production, promoting the immune response [2]. A trial conducted on 60 patients showed a decrease in depression when treated with an SSRI [2]. More research needs to be conducted as there is currently limited evidence to support the use of SSRIs for inflammation-related long-COVID; however, for symptoms of depression associated with long-COVID, fluvoxamine may be a viable option [3].
References:
1 https://my.clevelandclinic.org/health/articles/22572-serotonin
3https://link.springer.com/article/10.1007/s40267-022-00975-x
Active Clinical Trials: Long COVID, SSRI | Card Results | ClinicalTrials.gov
Armodafinil for long COVID
ARMODAFINIL
What is armodafinil (Nuvigil) used for?
Armodafinil is commonly prescribed for narcolepsy and shift-work sleep disorder. It is a central nervous system (CNS) stimulant that impacts the brain and spinal cord; however, it has a low potential for abuse, unlike Adderall or Vyvanse, due to its pharmacokinetic properties [1].
How can armodafinil help patients dealing with long COVID?
Some researchers theorize that neural pathways in the brain become distorted in long COVID. The initial infection caused by COVID-19 increases inflammation in the brain, which may leave cells vulnerable to other organisms or substances that may also cause inflammation. Continuation of this cycle can damage the signaling pathways between the cells in the brain. Over time, this results in the death of brain cells, leading to cognitive symptoms such as “brain fog.” Armodafinil may assist in rebuilding the destroyed pathways, leading to increased concentration and memory [1].
Additionally, as armodafinil is a CNS stimulant, it can promote wakefulness and decrease fatigue, something long COVID sufferers are all too familiar with [2]. Although more research needs to be completed regarding using armodafinil for long COVID, it does show promise in helping patients struggling with concentration, memory, and fatigue problems.
References:
1https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp-rj.2022.170402
2https://journals.sagepub.com/doi/pdf/10.1177/10398562211003598
Gabapentin for long COVID
GABAPENTIN
What is gabapentin?
Gabapentin 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. Gabapentin is commonly used for neuropathy (nerve pain) and those affected with partial seizures. [1].
Can gabapentin 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 gabapentin, to control these symptoms. In a guide created for primary care physicians regarding long-COVID, the use of gabapentin 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 gabapentin for symptom management [3].
An additional theory for COVID-19 involves its proposed effect on the nerve cells responsible for smell. Since damaged nerve cells are thought to be involved, researchers turned to gabapentin to mitigate this loss of olfactory neurons. A study found that the use of gabapentin did not significantly improve the sense of smell compared to placebo [4].
Gabapentin 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:
1https://medlineplus.gov/druginfo/meds/a694007.html
2https://www.jabfm.org/content/jabfp/34/6/1229.full.pdf
3https://onlinelibrary.wiley.com/doi/10.1002/acn3.51570
4https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2809346#:~:text=Conclusion%20and%20Relevance%20In%20this,COVID%2D19–induced%20OD.
Atomoxetine for long COVID
ATOMOXETINE
What is atomoxetine (Strattera)?
Atomoxetine is a medication used to treat attention/deficit hyperactivity disorder (ADHD). Atomoxetine belongs to a class of 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 ADHD, the brain is dealing with an imbalance of chemicals such as serotonin and norepinephrine. SNRIs, like atomoxetine, work by keeping serotonin and norepinephrine in a state that can readily help with attention and concentration issues. Atomoxetine, unlike other medications used to treat ADHD, is not a stimulant. It is not a controlled substance and does not have a potential for abuse.
How can atomoxetine affect those 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), or the 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.
Currently, there has been one study in which a singular patient was given atomoxetine to combat their “brain fog.” The patient did respond, creating a potential avenue to combat fatigue and maintain wakefulness in patients with COVID-19 [3]. More research needs to be conducted to evaluate the actual effect atomoxetine has on patients with long COVID; however, there is potential that it may help in relieving “brain fog” in a subset of patients.
References:
1https://my.clevelandclinic.org/health/articles/22572-serotonin
2https://americanaddictioncenters.org/antidepressants-guide/ndris
3https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8405712/
Gemfibrozil for long COVID
GEMFIBROZIL
What is gemfibrozil?
Gemfibrozil is part of a class of medications known as fibric acid derivates. Their primary function is to lower triglyceride levels and increase HDL cholesterol levels in patients.
How does gemfibrozil work?
Cholesterol in the body comprises two parts: low-density lipoprotein (LDL) and high-density lipoprotein (HDL). LDL is often referred to as the “bad” cholesterol, as an abundance of this type can lead to heart attacks, stroke, and other health problems. HDL, on the other hand, is the “good” cholesterol; it clears other circulating cholesterol in the body to prevent buildup [1]. Gemfibrozil affects HDL and triglycerides, another potentially harmful fat circulating in the blood. Gemfibrozil works to increase the amount of HDL and break down unwanted triglycerides so they can be removed from the body.
How can gemfibrozil affect those with long-COVID?
Gemfibrozil also possesses anti-inflammatory, antioxidant, and anti-thrombotic properties [2]. These properties help reduce symptoms for those suffering from long-COVID. Additionally, gemfibrozil has activity against an enzyme called ACE2, the same enzyme that COVID-19 uses to enter the cells. By blocking this entryway, gemfibrozil stops COVID-19, thereby halting its access into the body [2].
Although more research needs to be conducted in humans to solidify gemfibrozil’s role in long-COVID, it does show promise based on its properties. One study showed that viral infectivity may be reduced by up to 70% [3]. In persons with long-COVID, the current theory is that although patients are not actively infected, they still shed the virus in their bodies [3]. Through gemfibrozil’s ability to block COVID-19’s access into the cells, COVID-19 is now halted, decreasing symptoms and eventual recovery.
References:
2https://link.springer.com/article/10.1007/s00011-022-01615-w
3https://www.jacc.org/doi/10.1016/j.jacc.2021.08.021
Atorvastatin for long COVID
Atorvastatin (Lipitor)
What is atorvastatin (Lipitor)?
Atorvastatin is part of a class of drugs commonly referred to as statins. Its role is to reduce the amount of cholesterol made by the liver. Cholesterol is comprised of 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. The regular use of statins can reduce the risk of such cardiovascular disease.
Can atorvastatin help in long COVID?
Atorvastatin possesses anti-inflammatory and modifying effects on the immune system [1]. A recent study conducted in vitro (in test tubes) showed that atorvastatin reduced levels of pro-inflammatory proteins and inhibited human cells from being infected with COVID-19. Additionally, atorvastatin was one of the statins that showed the most promise in restoring a COVID-19 state to a healthy state [2]. Further, an observational study suggested that patients who regularly used statins were less likely to die and more likely to have better outcomes when hospitalized for an acute COVID-19 infection [3].
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 [4]. For those who suffer from long-COVID, the effects of statins may theoretically prolong illness. Hallmarks of long COVID include chronic fatigue, exercise intolerance, muscle weakness, and muscle pain (myalgia). Muscle weakness or muscle pain are also potential side effects associated with the use of statins. If such a side effect occurs, the use of statins may exacerbate long COVID symptoms. 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 [5]. For those suffering from long COVID and already with a decreased energy reserve, statin use could further exacerbate this problem.
Additional research is needed to better understand the role of statins in long COVID. In the meantime, a benefit versus risk assessment for every patient should be considered to assess whether the cardio-protection of statins outweighs potential prolonged negative effects on long COVID symptoms.
References:
1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9520195/
2https://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1011050
3https://pubmed.ncbi.nlm.nih.gov/36753725
4https://jamanetwork.com/journals/jama/fullarticle/2780872
5 https://www.mdpi.com/2077-0383/12/14/4659
Active Clinical Trials: Long COVID, statin | Card Results | ClinicalTrials.gov
Azithromycin for long COVID
AZITHROMYCIN
What is azithromycin (Zithromax)?
Azithromycin is an antibiotic used to treat bacterial infections such as pneumonia, sinusitis, and sexually transmitted diseases. It works by preventing bacteria from making proteins. Without proteins, bacteria cannot survive and die. Azithromycin is commonly prescribed in the outpatient setting under the name “Z-pack.”
Can azithromycin help with long-COVID?
At the beginning of the COVID-19 pandemic, azithromycin had gained some headway as a potential treatment option for COVID-19 due to its antiviral properties and modifying effects on the immune system. Lab research on azithromycin found that it may prevent COVID-19 from entering the cells while decreasing the likelihood of an overresponse of the immune system [1]. Unfortunately, when tested in clinical studies, azithromycin did not produce positive results in active COVID-19 infections. For instance, one study found that azithromycin did not reduce the time to sustained clinical improvement or discharge in hospitalized patients, rendering it insignificant [2].
Although azithromycin may not be helpful in active COVID-19 infections, a minimal amount of data points to its use as a potential agent in long-COVID. In a case study, an older woman who suffered severe lung inflammation post-COVID was given azithromycin three times weekly for an extended period. After treatment, a follow-up chest X-ray showed almost complete resolution of lung disease [3]. The mechanism as to how this worked needs to be clarified. However, more clinical studies and data could shed light on the use of azithromycin as a potential therapy for patients dealing with long COVID.
References:
1https://bmjopenrespres.bmj.com/content/8/1/e000806#
3https://scholars.direct/Articles/microbiology/amr-5-022.pdf
Bupropion for long COVID
BUPROPION
What is bupropion?
Bupropion is a medication that is commonly used to treat depression, seasonal affective disorder (SAD), and smoking cessation. It is an atypical antidepressant in that it is not in the selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) class. Bupropion works by inhibiting the reuptake of norepinephrine and dopamine in the brain. These chemicals are used in reward- and emotion-related behavior [1]. In depression, there is an imbalance of these chemicals in the brain. By inhibiting the reuptake of norepinephrine and dopamine, bupropion makes them more available for the brain to use, thus restoring the chemical balance.
How can bupropion help with long-COVID?
In those diagnosed with long-COVID, many suffer from “brain fog” memory problems, difficulty concentrating, and forgetfulness. The proposed reason for “brain fog” is that during a COVID-19 infection, the body’s immune response becomes activated, causing heavy amounts of inflammation, including in the central nervous system (CNS). Additionally, those with long-COVID can often exhibit symptoms of depression, as it may take months or years for long-COVID to resolve, if at all. To combat this, researchers have turned to already existing medication therapies in the hopes they may be able to help decrease “brain fog” and resolve depression in patients. To date, researchers have found some evidence that bupropion may help mitigate symptoms.
A small case series found that dosing patients with bupropion increases mood, energy, and focus [2]. Although the exact mechanism of how bupropion works in “brain fog” is still unclear, it is proposed to block the loss of brain cells and decrease part of the inflammation response in the brain [2]. More research needs to be explicitly conducted for “brain fog” patients. However, bupropion does play a role in decreasing depressive symptoms that some long-COVID patients may exhibit due to the loss of their baseline activity.
References:
Famotidine
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.
Community-Centric Approach: We listen, we care, and we adapt. Understanding the evolving needs of the long COVID community is central to our mission.
Collaborative Expertise: Our team is our strength. Drawing upon the diverse knowledge of medical doctors, pharmacists, scientific writers, and HealthIT Web developers, we strive to offer a comprehensive resource for all affected by long COVID.
Serving the Long COVID Community: Our Founders Pledge to You
“To the many patients I’ve personally supported during their long COVID journeys, and to every individual currently navigating the complexities of long COVID, CompendiRx pledges to be your trusted ally. In a landscape where research is rapidly unfolding, and new treatments are continually emerging, staying informed can be overwhelming. We are here to simplify this journey by offering a user-friendly platform where you can find not just information but hope” – Founder, CompendiRx.
Join us in shaping a future where the long COVID community is no longer overlooked but empowered with the knowledge and support needed to embark on a path toward recovery. Whether you’re seeking insights into potential treatments, looking to share your experiences, or simply searching for understanding, CompendiRx is here for you. Together, let’s turn the page towards a brighter, healthier tomorrow. Welcome to CompendiRx – where your journey to empowerment begins.”
Connect with us
We’re eager to hear from you. Whether you have questions, wish to share your story, or simply need someone to talk to, our doors are open. Together, we’re stronger.
Welcome to CompendiRx.
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