Post-COVID Syndrome and Medications

Sep 3, 2021 | Dr. Ravindra Ganesh | @rganesh2603 | Comments (24)

Naturally there is significant interest in medications to treat Post COVID Syndrome. Data about the safety and benefit of medications and supplements is currently insufficient and more research is needed.  Here, I will go through the common medications suggested for treatment, the evidence behind them, and our perspective here at Mayo Clinic.

 

  1. Ivermectin – There is no evidence that ivermectin is helpful in either acute COVID or post COVID syndrome. Additionally, the FDA has advised against its use in COVID. There is also significant toxicity which has led to serious side effects and hospital admission in many cases.
  2. Fluvoxamine – There have been some studies suggesting benefit of fluvoxamine in acute COVID for decreasing progression to severe COVID. The benefit in post COVID syndrome is unknown. Fluvoxamine is generally safe and may have beneficial effects on mood changes that are frequently present along with symptoms of post COVID syndrome.
  3. Prednisone – This has not been studied in post COVID syndrome. The studies on steroids (prednisone is a type of steroid) in acute COVID suggest benefit only once someone has low oxygen levels.  If given in other settings, prednisone may cause harm and could lead to other infections as it suppresses the immune system, and can have detrimental effects on the gut, muscles, adrenal glands, and bones.
  4. Vitamin C – There is no evidence that Vitamin C has a role in the treatment of acute COVID or post COVID syndrome. There is some data that Vitamin C can help with fatigue and recovery from other viruses. Vitamin C is generally considered safe, but in high quantities can cause gastrointestinal symptoms or kidney stones.
  5. Omega-3 fatty acids – There is some evidence that omega-3 fatty acids do have anti-inflammatory effects. They are generally considered safe and do have significant health benefits. They may be beneficial in post COVID syndrome.
  6. Atorvastatin – There is no current evidence that this works for post COVID syndrome. Statins do have a potent anti-inflammatory effect, so may be of benefit. We recommend you discuss the risks and benefits with your primary care provider.
  7. Melatonin – generally considered safe, may help with sleep and recovery in post COVID syndrome.
  8. Vitamin D – There is no current evidence that this works for post COVID syndrome. Vitamin D is generally safe, but can cause toxicity with very high serum levels. We recommend keeping Vitamin D levels within goal range, so may be best to coordinate with your primary care physician and check serum levels of Vitamin D.
  9. Diagnosis and treatment of Mast Cell Activation Syndrome (MCAS) should be performed by an allergist/immunologist, as this syndrome is overdiagnosed due to broad diagnostic criteria and treatments for it can be costly and may have side effects that may be problematic.

Medications/Supplements which may have some benefit and are low toxicity:

  • Fluvoxamine
  • Vitamin C
  • Omega-3 fatty acids
  • Melatonin
  • Atorvastatin

Medications/Supplements which are probably not beneficial but have low toxicity:

  • Vitamin D

Components which are probably not beneficial and may be harmful:

  • Ivermectin
  • Prednisone

To discuss the latest on Post-COVID Syndrome, head over to the Post-COVID Recovery discussion group.

Interested in more newsfeed posts like this? Go to the Post-COVID Recovery blog.

The similarities between long-haul Covid and post ICU syndrome are remarkable and not likely coincidental. I have had PICU for over a year with only slight improvement. I'm discouraged.
Any thoughts.
Thanks,
Charles

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Thank you for the information. It is very confusing for me with ,all the hype going around. It s good to hear the facts.

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@crmerwar

The similarities between long-haul Covid and post ICU syndrome are remarkable and not likely coincidental. I have had PICU for over a year with only slight improvement. I'm discouraged.
Any thoughts.
Thanks,
Charles

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Hi Charles, interesting about the parallels between post-ICU syndrome and long-haul COVID. I hope you'll share your PICS experiences and support in the ICU group here:
– Intensive Care (ICU) https://connect.mayoclinic.org/group/intensive-care-icu/

Were you in ICU because of COVID or another reason (if I may ask)? Are you a COVID longhauler?

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@colleenyoung

Hi Charles, interesting about the parallels between post-ICU syndrome and long-haul COVID. I hope you'll share your PICS experiences and support in the ICU group here:
– Intensive Care (ICU) https://connect.mayoclinic.org/group/intensive-care-icu/

Were you in ICU because of COVID or another reason (if I may ask)? Are you a COVID longhauler?

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I was hospitalized because of intestinal obstruction Terrible experience. Will follow up with more detains.
Charles

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@colleenyoung

Hi Charles, interesting about the parallels between post-ICU syndrome and long-haul COVID. I hope you'll share your PICS experiences and support in the ICU group here:
– Intensive Care (ICU) https://connect.mayoclinic.org/group/intensive-care-icu/

Were you in ICU because of COVID or another reason (if I may ask)? Are you a COVID longhauler?

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I am just learning to navigate your website, so I will reply to you.
I was in the hospital for 10 days in Jan 2020, 7 in the ICU following abdominal surgery for intestinal obstruction caused by adhesions. I was under general anesthesia for 3 1/2 hours because laparoscopic surgery was unsuccessful and belly opening was necessary. I had the full-blow ICU syndrome with confusion, agitation. and hallucinations. All disappeared as soon as I returned home.
Now, however, 20 months later I am still bothered by weakness, loss of stamina, breathlessness and impaired balance. My sleep cycle is confused, and I never awaken feeling refreshed despite 8-10 hours in bed. My memory is single track. At no time did I have any symptoms suggesting Covid infection. My symptoms are typical for PICUS. Other causes have been competingly investigated.
I am a retired Internist 91 years of age. I know that I have common age-related problems, but I cannot account for all of my lingering symptoms by that alone. I feel too bad.
In the recent past, I have tried regular PT and thought I was improving until I hit a wall and regressed. I keep my mind active, but my physical activity level is low because I am most comfortable when inactive.
When I came home post hospitalization 18 months ago, I resumed my role as primary care-giver for my wife who was under Hospice care. She died last Jan.
A few years ago this would have been unbelievable but now is not. All our 3 children and 2 grandchildren have illnesses that are clearly autoimmune in origin. My wife had pericarditis and myocarditis of undetermined origin in 2001 and died of cardiac cachexia. I had serum sickness as a kid albeit secondary to an injection of horse serum.
I anguish over what the virus and its treatment might do to our children. I'm discouraged for myself. Although all receive good medical care, no one seems interested in a link between autoimmune disease, side effects of vaccination( a daughter developed pemphigus several weeks after the second Pfizer dose), and the connection between long-haul Covid infection and PICUS.
If my history is helpful to others I will be pleased. Is it unrealistic at this point in time to expect more?
Thank you for taking the time to read this.
Charles

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@crmerwar

The similarities between long-haul Covid and post ICU syndrome are remarkable and not likely coincidental. I have had PICU for over a year with only slight improvement. I'm discouraged.
Any thoughts.
Thanks,
Charles

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As a doctor, Charles, would you agree that the best available preventative for long-haul Covid is prevention of covid-19 infection itself and the best currently available help against that infection is the shots now recommended? Or are there better preventative treatments available? It is tricky to base judgements on a personal experience because, unavoidably, one thing will always follow another.

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Can you comment on Zinc – is it helpful?

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@pinkpam

Can you comment on Zinc – is it helpful?

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Hi Pam,
The National Institues of Health has a great website describing various COVID treatments under investigation or in use. This is the guidance they offer on zinc and COVID

Zinc: https://www.covid19treatmentguidelines.nih.gov/therapies/supplements/zinc/

Several clinical trials are currently investigating the use of zinc supplementation alone or in combination with hydroxychloroquine for the prevention and treatment of COVID-19. Until these studies are complete, the current recommendations are:

– There is not enough evidence for the COVID-19 Treatment Guidelines Panel (the Panel) to recommend either for or against the use of zinc for the treatment of COVID-19.
– The Panel recommends against using zinc supplementation above the recommended dietary allowance for the prevention of COVID-19, except in a clinical trial.

Pam, be sure to discuss further with your doctor. Long-term zinc supplementation can cause copper deficiency, which can cause other problems.

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@mavolyn

As a doctor, Charles, would you agree that the best available preventative for long-haul Covid is prevention of covid-19 infection itself and the best currently available help against that infection is the shots now recommended? Or are there better preventative treatments available? It is tricky to base judgements on a personal experience because, unavoidably, one thing will always follow another.

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Nothing proven is better at prevention than vaccination. Statistically,benefits far outweigh side effects,

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After I received my covid vaccines I developed vitiligo. Is this possibly connected to the vaccine? It has progressed from one hand to the other. I am a 75 year old female with no previous history of this.

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@nananan

After I received my covid vaccines I developed vitiligo. Is this possibly connected to the vaccine? It has progressed from one hand to the other. I am a 75 year old female with no previous history of this.

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Vitiligo is an autoimmune disease. Our daughter developed pemphigus, also an autoimmune disease of the skin and mucus membranes, several weeks following her second Pfizer vaccination. Hard to believe this is coincidental..

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No definitive answer as yet. Should be the object of much study.

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