Doxycycline for long COVID
DOXYCYCLINE
What is doxycycline (Vibramycin)?
Doxycycline is an antibiotic used to treat infections such as pneumonia, urinary tract infections, and sexually transmitted diseases. It works by binding to the region of bacteria that creates proteins, inhibiting new protein synthesis. The lack of proteins for the bacteria causes bacterial death.
What is the connection between doxycycline and COVID-19?
Historically, doxycycline has been used for bacterial infections; however, researchers have found some evidence that it may also be helpful in the case of COVID-19 viral infection. It contains anti-inflammatory and immune response-modulating properties [1]. In several case reports of patients with COVID-19, the administration of doxycycline reduced the need for ICU admission [2].
Currently, doxycycline research is focused on preventing long-COVID and decreasing the severity of the disease. How doxycycline fares in helping with long-COVID remains unknown. There is no evidence supporting its use for long-COVID in symptom management or treatment. Further research needs to be conducted to establish doxycycline’s role in COVID-19. However, for preventing escalation into long-COVID, doxycycline does show promise in the few case reports available.
References:
1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8464303/
2https://www.medrxiv.org/content/10.1101/2022.01.30.22269685v1
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right form makes all the difference. Go from busywork to less work with powerful forms that use conditional logic, accept payments, generate reports, and automate workflows.
right form makes all the difference. Go from busywork to less work with powerful forms that use conditional logic, accept payments, generate reports, and automate workflows.
right form makes all the difference. Go from busywork to less work with powerful forms that use conditional logic, accept payments, generate reports, and automate workflows.
right form makes all the difference. Go from busywork to less work with powerful forms that use conditional logic, accept payments, generate reports, and automate workflows.
Duloxetine for long COVID
DULOXETINE
What is duloxetine (Cymbalta, Yentreve)?
Most used for anxiety and depression, duloxetine 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 duloxetine, work by keeping serotonin and norepinephrine in the space where they can readily be available for bodily processes.
How can duloxetine help with long-COVID?
Many people diagnosed with long-COVID suffer from “brain fog,” which includes decreased cognitive acuity, memory deficits, poor focus, reduced ability to multitask, and reduced concentration [2]. The proposed reason for this 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), the brain, and the spinal cord.
Serotonin and norepinephrine have been shown to have an effect against this 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, duloxetine could be an option for treating long-COVID. Duloxetine keeps these chemicals around longer in the body so they can perform their functions. Therefore, the longer they are active, the more immune response, and symptoms of depression have a higher chance of decreasing.
Aside from depression, duloxetine can also be used to treat peripheral neuropathy (numbness/tingling in the extremities). Some patients with long-COVID experience neuropathy as a side effect, and duloxetine has shown effectiveness as a treatment. In a webinar sponsored by the Centers for Disease Control (CDC), duloxetine was listed as an option for small fiber neuropathy caused by long-COVID [4].
Further research needs to be conducted in clinical trials to assess the effectiveness of duloxetine for treating long-COVID; however, for symptom management of depression and neuropathy, duloxetine may be an option for patients. As its effects are multifold, duloxetine may hold more value over other SNRIs and help to decrease pill burden while also assisting patients in returning to their pre-COVID baselines.
References
1https://my.clevelandclinic.org/health/articles/22572-serotonin
2https://americanaddictioncenters.org/antidepressants-guide/ndris
4https://emergency.cdc.gov/coca/ppt/2021/012821_slide.pdf
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Fenofibrate for long COVID
FENOFIBRATE
What is fenofibrate?
Fenofibrate 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 fenofibrate work?
Cholesterol in the body is made up of 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 works to clear other circulating cholesterol in the body to prevent buildup [1]. Fenofibrate exerts its effects on HDL and triglycerides, another type of potentially harmful fat circulating in the blood. Fenofibrate works to increase the amount of HDL and break down unwanted triglycerides so they can be removed from the body.
How can fenofibrate affect those with long-COVID?
Fenofibrate also possesses anti-inflammatory, antioxidant, and anti-thrombotic properties [2]. These properties may help reduce symptoms for those suffering from long-term COVID. Additionally, fenofibrate has activity against an enzyme called ACE2, the same enzyme that COVID-19 uses to enter the cells. By blocking this entryway, fenofibrate stops COVID-19, halting body access [2].
Although more research needs to be conducted in humans to solidify fenofibrate’s role in long-COVID, it does show promise in the lab-based studies performed [3]. One study showed that viral infectivity may be reduced by up to 70% [4]. In persons with long-COVID, the current theory is that although patients are not actively infected, they still shed the virus in their bodies [4]. Through fenofibrate’s ability to block COVID-19’s access into the cells, COVID-19 is now halted, leading to a decrease in symptoms and eventual recovery.
References:
2https://link.springer.com/article/10.1007/s00011-022-01615-w
3https://www.goodrx.com/fenofibrate/fenofibrate-covid
4https://www.jacc.org/doi/10.1016/j.jacc.2021.08.021
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Fluoxetine for long COVID
Fluoxetine (Prozac)
What is fluoxetine (Prozac)?
Most used for depression, fluoxetine 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, the brain is dealing with an imbalance of chemicals such as serotonin. SSRIs, like fluoxetine, work by keeping serotonin in the space where it can readily be available for bodily processes.
What is the connection between fluoxetine 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.
Additionally, serotonin has been shown to have an effect against viral inflammation by blocking certain viruses (like HIV-1) from entering the cells. It can decrease the production of cytokines, which promotes the immune response. A trial conducted on 60 patients showed a decrease in depression when treated with an SSR like fluoxetine [2]. It was also observed that treatment with fluoxetine decreased COVID-19 levels, specifically in men, after a minimum of 10 days [3].
Researchers have begun clinical trials to test fluoxetine and its effect on serotonin and COVID-19 [4]. Results will not be available for quite some time; therefore, evidence is currently limited to support the use of SSRIs for inflammation-related long-COVID. However, for symptoms of depression associated with long-COVID, fluoxetine may be a viable option [5].
References:
1 https://my.clevelandclinic.org/health/articles/22572-serotonin
3https://www.frontiersin.org/articles/10.3389/fphar.2022.1036093/full#h7
4https://www.nytimes.com/2023/10/16/health/long-covid-serotonin.html
5https://link.springer.com/article/10.1007/s40267-022-00975-x
Amitriptyline for long COVID
AMITRIPTYLINE
What is amitriptyline (Elavil, Vanatrip)?
Amitriptyline belongs to the class of medications called tricyclic antidepressants. Mostly used for depression, it is normally prescribed as an alternative when other depression medications are not effective. Amitriptyline works by inhibiting the reuptake of the neurotransmitters norepinephrine and serotonin. By preventing the breakdown of norepinephrine and serotonin, it aids in restoring the imbalance of these chemicals caused by depression.
What is the link between amitriptyline and long COVID?
Many patients diagnosed with long COVID are plagued by moderate to severe, frequent headaches. The cause is thought to be massive inflammation accompanied by a cytokine storm (overexaggeration of the immune system) [1]. These headaches can worsen a preexisting primary headache or, more specifically, present as a new (intermittent or daily) headache starting during the acute infection or after a delay [1].
To treat these headaches, providers have turned to amitriptyline as a potential treatment option. One observational study looked at post-COVID patients treated with amitriptyline and found that using amitriptyline reduced the number of headache days per month by 9.6 [2]. Additional case reports found amitriptyline was helpful in patients with long-lasting COVID headache and chronic migraines post-COVID. However, the patients in these case reports did not use amitriptyline as a single agent; it was combined with Botox injections [3].
Although amitriptyline will not cure long COVID, it may offer symptom management in headache sufferers. Additional research may help to solidify amitriptyline’s use in long-COVID treatment.
References:
1https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-022-01450-8
Fluticasone propionate/salmeterol for long COVID
FLUTICASONE PROPIONATE/SALMETEROL
What is fluticasone/salmeterol (Advair)?
Fluticasone/salmeterol is a class of medications used to treat inflammatory respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD). It contains a corticosteroid, fluticasone, which reduces inflammation, and a long-acting bronchodilator, salmeterol, which opens the airways.
How can fluticasone/salmeterol be used to treat long-COVID?
Patients with long-COVID have symptoms such as chronic fatigue, shortness of breath, and exercise intolerance. Due to fluticasone/salmeterol’s mechanism of action in opening the airways, those suffering from breathing issues from long-COVID may be positively impacted. Although no formal studies have been conducted to determine how effective this treatment is, patients have reported positive results [1]. Fluticasone/salmeterol is not indicated for the treatment of long-COVID but could provide symptom management by increasing lung capacity, increasing exercise intolerance, and decreasing inflammation in the lungs.
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