Treatments

The contents of this website are intended solely for information and inspiration, and in no way constitute medical advice or recommendations for action.

 

Every theory and medication should be discussed in detail and in person with a specialist and/or Long-Covid center. Under no circumstances should you attempt to self-medicate.

 

No liability is assumed for the content of this website. There is no guarantee for the accuracy or completeness of the information provided.

Close Notice

Most Post-Covid patients will have heard one opinion repeated dozens of times: Unfortunately, the Post-Covid-Syndrome is not yet curable.

However, what is frequently being overlooked, is that the various symptoms are often treatable.

 

There are many so-called "Off-Label Therapies", where existing medications are used on an experimental basis to treat Post-Covid symptoms. Such therapies are frequently reported as being very successful, e.g. in the areas of inflammation, fatigue or brain fog.

 

Unfortunately, there are only very few Post-Covid clinics that know about these therapies, let alone prescribe them. 

Legend:

Benefit
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Side effects
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Overview

Immune System, Inflammation

Cause-Oriented

One of the possible causes of Post-COVID: Overreaction of the immune system. Autoantibodies. Inflammation throughout the body. Crashes after exercise. Treatments often help very well here, as they focus on factors early in the causal chain. However, experimental and strong side effects. Points of contact are GPs, pulmonologist, Post-COVID clinics.

Low-Dose Naltrexone

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Low-Dose Aripiprazole

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Cortisone Therapy

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Monoclonal Antibodies

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Antihistamines

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Viral Residues or Reactivations

Cause-Oriented

One of the possible causes of Post-COVID: Remaining COVID-19 virus in the body or reactivation of other viruses (e.g. Herpes). This causes an overreaction of the immune system. Theory has not yet been confirmed, but partially
supported by success stories from those affected. However, experimental and strong side effects.
Points of contact are GPs and Post-COVID clinics.

Nicotine Patches

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Valaciclovir

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Monoclonal Antibodies

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Antiviral Agents

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Vessels, Blood Circulation & Oxygen Supply

Cause-Oriented

One of the possible causes of Post-COVID: The endothelia in the vessels are weakened, or microclots are formed. In both cases, there is an insufficient supply of oxygen to the mitochondria, cells and organs, which would explain many symptoms. The treatments listed here attempt to solve this casual chain of problems at different points. Contact persons are mostly GPs.

Wim-Hof Method

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Cryotherapy

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IHHT

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Anticoagulation Therapy

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Oxygen Concentrator

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HBOT

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Ozone Therapy

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Lungs & Breathing

Symptom-Oriented

Coughing, sputum, burning sensation in lungs, quickly out of breath, chaotic breathing pattern.
Point of contact: Pulmonologist.

Respiratory Therapy

Benefit
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Asthma Sprays

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Breathing Trainers

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Fatigue & PEM

Symptom-Oriented

Feeling constantly ill, "empty battery", lack of drive, crashes after exertion.
Points of contact are GPs and Post-COVID clinics.

N-Acetylcysteine (NAC)

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Metformin

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Side effects
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Venlafaxine

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Side effects
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Melatonin

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Heart Palpitations & POTS

Symptom-Oriented

Heart rate skyrockets even during small activities, tasks have to be interrupted due to heart rate.
Points of contact are GPs, cardiologist.

Compression Stockings

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Salt & Potassium

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Beta-Blockers

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Ivabradine

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Mestinon

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Alternative medicine

Symptom-Oriented
Certainly not the perfect solution for all problems. However, there are many reports that attribute at least a supportive effect to methods from the field of naturopathy. Points of contact are GPs, osteopaths or physiotherapists.

Vagus Nerve Stimulation

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Electro-Therapy

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Osteopathy

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Meditation

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Ultima Ratio: Expensive options

Cause-Oriented

Highly controversial among doctors and patients. Costs of around $15,000 to be expected. There are reports of complete successes, but also reports of completely ineffective treatments or relapses.
Studies are underway. It is currently difficult to assess the benefits of these therapies.

Blood Washing

Benefit
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Side effects
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* The contents of this website are intended for information and inspiration only and are in no way medical advice or recommendations for action. Any theory and medication should be discussed in detail and in person with a medical specialist and/or Long-Covid center. No liability is accepted for the content of this website. There is no guarantee that the information provided is correct, complete or up-to-date. The following applies to everything on this website: The information should only be used as a starting point for your own research and discussions with your own doctor. Under no circumstances should you attempt to self-medicate.

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Blood Washing

Theory

Blood Washing is one of the most controversial topics in the Post-Covid community. There are reports of complete cures, and reports of financially ruined patients who have received no benefit whatsoever from these very expensive treatments.

I would therefore never consider blood washing as a first treatment approach. However, if patients have been suffering from the symptoms for several months (or even years) and have already tried many other options, a blood washing attempt may make sense as a last resort.

There are basically three types of blood washing techniques that can be considered for Long-Covid patients:


1) H.E.L.P. apheresis


2) Immunoadsorption

  • Based on the theory that "Long-Covid is triggered by autoantibodies that attack the body"
  • Filters out autoantibodies (and all antibodies of size IgM and IgG)
  • Initial studies indicate a chance of success of 70%. Informal surveys indicate a chance of success of 50%
  • 5 applications are common
  • Cost: $2400 - $2600, depending on the filter
  • Filter: The "Fresenius Globaffin" or the "Miltenyi TheraSorb" are usually being recommended by doctors
  • Established providers in Germany:
    • DHZ Cologne
    • DialysisCenter Bayreuth
    • MVZ Kempten

3) Double Filtration Plasmapheresis / InuSpheresis / ToxoSpheresis

  • Some doctors offer their patients this special type of blood washing. It should be noted that the data is particularly sparse in this area! The "successes" of Long-Covid treatment reported in the media were always achieved with H.E.L.P. apheresis or Immunoadsorption.
 

Both H.E.L.P. apheresis and Immunoadsorption appear to have a chance of success around 50%. This supports the hypothesis that there are several different Causes / Puzzle Pieces in Long-Covid. There are many different types of treatments for Long-Covid, and not every treatment is suitable for every patient. 

After all, H.E.L.P. and IA also target completely different goals for blood washing (filtering microclots vs. filtering autoantibodies).

Which of the three forms is the right one for a particular patient? Hard to say. 

If the presence of microclots was detected by dark-field microscopy or the presence of autoantibodies is confirmed by lab tests, this can be helpful as an indication inc hoosing H.E.L.P. or IA, but is by no means a guarantee of effectiveness.

Some centers (e.g. MVZ Kempten, DialyseCentrum Bayreuth) also offer a combination of both therapies. In this case, 2-3 H.E.L.P. apheresis treatments are carried out first, followed by 5 Immunoadsorptions. This addresses both possible problem areas (microclots and AAK).

Usual dosage

H.E.L.P. Apheresis: 5-8 therapies

Immunoadsorption: 5 therapies

Costs

Not covered by statutory or private health insurance.

 

Sources

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9592739/

https://www.medrxiv.org/content/10.1101/2023.08.31.23294813v1

Immunoadsorption

Theory

Long-Covid patients often appear to have microclots in their blood, which impair the supply of oxygen to the organs.

These microclots could be dissolved with the use of blood thinners.

However, this theory, and in particular the use of blood thinners, is controversial amongst doctors due to the severe side effects and bleeding risks.

Usual dosage

There are 3 types of blood thinners that are often used in long-Covid patients:

 

1) Nattokinase and Serapeptase

Over-the-counter food supplements. 

2,000 FU nattokinase, 120,000 FU serrapeptase (recommendation: Doctor's Best Serrapeptase capsules) per day

Can be supplemented with bromelain and curcumin.

2) Aspirin

Available over the counter in pharmacies. "Aspirin 100", one pill per day

3) Triple anticoagulation therapy

Combination of Aspirin, Eliquis, and Clopidrogel. High side effects. High risk of bleeding.

Contact person

Long-Covid Centers.

Costs

Can be prescribed and covered by certain insurances. 

However, as usually only private doctors are prepared to prescribe blood thinners for Long-Covid, the costs are around $200-$800.

Sources

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10663976/

https://assets.researchsquare.com/files/rs-2697680/v1/127550c9-53fa-43f4-bad0-3dce9505eeea.pdf?c=1679495993

Meditation

Theory

In Long-Covid patients, the nervous system often appears to be under "permanent stress", which means that no real recovery is possible. The consequences include exhaustion, trembling muscles and restless sleep.

 

Meditation is certainly not the solution to all Long-Covid complaints, but it can help you to deal with them better and give your body a little more rest and relaxation.

Recommended shapes

There are various different types of meditation and mindfulness trainings.

It is advisable to try out several forms in order to find the one that suits you best.

 

A few examples are listed below:

On-site classes

Meditation classes are also often offered in rehabilitation facilities, fitness studios and yoga centers.

Osteopathy

Theory

Osteopathy attempts to examine and influence the human organism as a whole.

Some patients report that their Long-Covid complaints have been improved by osteopathy.

An osteopath can often relieve cramps, particularly in case of problems with the diaphragm or the spine.

Osteopaths also often offer other forms of therapy such as vagus nerve stimulation, which has also been beneficial for many Long-Covid patients.

 

It is advisable to find an osteopath from the fields of "myofascial osteopathy", "craniosacral therapy" or "vagus nerve therapy".

 

You can find lists and databbases with accredited therapists online. .

Costs

Approx. $150 per session. 5-10 sessions recommended.

Private insurance companies usually cover the costs.

.

Electro-Therapy

Theory

In Long-Covid patients, the nervous system often appears to be under "permanent stress", which means that no real recovery is possible. The consequences include exhaustion, trembling muscles and restless sleep.

It is also possible that Long-Covid patients often suffer from such severe fatigue that the autonomic nervous system needs an external "stimuli" to become more active again.

One possible treatment option here is so-called electrotherapy with water, and in particular the "Stanger bath" and the "4-cell bath".

A constant current flow is used to either calm the autonomic nervous system (recommended for sleep problems) or to stimulate it (recommended for exhaustion).

Contact person

Stanger baths or 4-cell baths are often offered in rehabilitation facilities or by physiotherapists.

Can be prescribed by your family doctor.

Costs

Can be prescribed and covered by certain insurances. 

Vagus nerve stimulation

Theory

The vagus nerve is responsible for various autonomic functions in the human body, including breathing and regulation of the heartbeat.

Studies have shown that the vagus nerve is damaged or at least impaired in Post-Covid patients.

 

Vagus nerve stimulation can help here. There are two possible applications, both of which can be used at home:

  1. With a "Z-Vibe" vibration pen. Hold in your ear for 2-3 minutes per ear every day at the point shown below
  1. With a TENS unit (e.g. the "Stim-Pro T-100"), matching ear clips and electrode gel

Contact person

Osteopath

Costs

Approx. $50 - $100 for the equipment.

Approx. $200 for the consultation with an osteopath.

Sources

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10412500/

https://www.scientificamerican.com/article/zapping-the-vagus-nerve-could-relieve-some-long-covid-symptoms/

Mestinon

Theory

The drug Mestinon is usually prescribed in combination with Low-Dose Naltrexone for Long-Covid patients.

 

Initial case studies show that Mestinon improves the communication of the nervous system with the muscles, reduces POTS, activates the parasympathetic nervous system (leading to calming and recovery of the nervous system), and increases the hormone levels of dopamine (giving patients more drive).

Usual dosage

10mg - 40mg per day.

Contact person

General practitioner. Cardiologist. Long-Covid Centers.

Costs

Can be prescribed and covered by certain insurances. 

However, as usually only private doctors are prepared to prescribe Mestinon for Long-Covid, the cost is around $50.

Sources

https://www.healthrising.org/treating-chronic-fatigue-syndrome/drugs/mestinon-for-chronic-fatigue-syndrome-me-cfs-fibromyalgia-pots-and-long-covid/

https://meassociation.org.uk/medical-matters/items/treatments-mestinon-pyridostigmine-me-cfs/

Ivabradine

Theory

Long-Covid patients often suffer from an increased resting heart rate, palpitations during light exertion, or POTS (postural tachycardia syndrome).

The cause of these symptoms is not yet clear. However, two types of medication are available as symptomatic treatment for palpitations: Beta Blockers and If-channel Blockers.

 

If-channel blockers such as "Ivabradin" are often the better choice for patients with asthma or lung problems.

Compared to Beta-Blockers, If-Channel Blockers like Ivabradine usually calm the heartbeat without strongly affecting other receptors or organs.

Usual dosage

Ivabradine is usually only effective for 12 hours.

 

A good intake schedule is therefore e.g. 2.5 mg in the morning and 2.5 mg in the evening.

Contact person

General practitioner. Cardiologist.

Costs

Can be prescribed and covered by certain insurances. 

Beta blockers

Theory

Long-Covid patients often suffer from an increased resting heart rate, palpitations during light exertion, or POTS (postural tachycardia syndrome).

The cause of these symptoms is not yet clear. However, two types of medication are available as symptomatic treatment for palpitations: Beta Blockers and If-channel Blockers.

 

Beta Blockers are widely used and are considered standard therapy for increased heart rate and palpitations.

In addition, they may provide Long-Covid patients with the added benefit of calming the nervous system (or making the sympathetic nervous system less active) and thus also reducing the "permanent stress" that Long-Covid patients' bodies are often under.

 

Note: Beta-Blockers are not suitable for asthmatics or patients with lung problems! Since even beta-1-selective beta blockers also affect the beta-2 receptors, all Beta Blockers have the risk of triggering cramps in the lungs. If-channel blockers (e.g. Ivabradine) are more suitable for such patients.

Usual dosage

A frequently prescribed beta-blocker is "Bisoprolol".

E.g. 5mg daily.

 

Contact person

General practitioner. Cardiologist.

Costs

Can be prescribed and covered by certain insurances. 

Salt & Potassium

Theory

Long-Covid patients often seem to suffer from palpitations or POTS.

 

Taking in additional salt might be beneficial in these cases (even if it is otherwise considered unhealthy).

Electrolytes might also help (e.g. purchased from a pharmacy).

Potassium is also said to have a calming effect on the heartbeat.

 

Usual dosage

Salt: Up to 10g per day (tip: there are also salt tablets and sweets)

Electrolytes: 1 sachet per day

Potassium: Approx. 400mg per day.

Compression stockings

Theory

Long-Covid patients often seem to suffer from palpitations or POTS.

One possible explanation for this might be: Due to vascular weakness, too much blood is allowed to drop into the legs. The hearth then has to beat harder in order to transport the blood upwards again.

 

Compression stockings compress the blood vessels in the legs, which automatically causes less blood to sink downwards, and relieves the heart. As a result, compression stockings help many Post-Covid patients to at least reduce their phases of palpitations.

Compression stockings that go up the knees are usually sufficient, most patients do not require full-leg stockings.

Usual dosage

To be worn during the day, taken off at night.

Contact person

General practitioner. Cardiologist.

Costs

Can be prescribed and covered by certain insurances. 

Also available over the counter for approx. $20 per pair.

Metformin

Theory

Long-Covid patients often suffer from fatigue or CFS.

A fairly new, and untested, theory assumes that Metformin could help here.

 

Metformin was originally developed as a drug for diabetes.

Studies have already shown that Metformin slows the spread of the virus in acute Covid-19 infections and reduces the risk of acquiring Long-Covid.

 

Since Metformin might have an effect on the spike protein, it is currently being considered as a treatment option for Post-Covid patients with fatigue.

However, before discussing this option with your GP, you should have a detailed check-up with an endocrinologist (hormones, diabetes, ...).

 

It is also advisable to use a blood glucose sensor (e.g. Abbot Libre 3) to monitor your blood glucose level one week before Metformin and one week during Metformin.

Usual dosage

E.g. 250mg in the morning, 250mg in the evening.

Contact person

General Practitioner. Endocrinologist. Long-Covid Centers.

Costs

Can be prescribed and covered by certain insurances. 

However, as usually only private doctors or online pharmacies are willing to prescribe Metformin for Long-Covid, the costs are around $20-$30.

Sources

https://classic.clinicaltrials.gov/ct2/show/NCT06147050

Oxygen Concentrator

Theory

Long-Covid patients often display an impaired oxygen supply to the organs.

 

One possible treatment (in addition to blood thinners, HBOT and Ozone Therapy) to increase the oxygen supply in the body is to purchase an oxygen concentrator for use at home. Compared to the other options mentioned, this is relatively cheap (approx. $300) and has few side effects, but is not as effective.

Usual dosage

The usual recommendation is to breathe through the concentrator for 30 minutes once a day.

Costs

Can be purchased on Amazon, for example.

Approx. $300-$350.

Melatonin

Theory

Long-Covid patients often suffer from sleep problems.

Laboratory tests also often show lower levels of the hormone melatonin in Long-Covid patients.

A simple solution for this: Commercially available melatonin sprays or pills from the pharmacy, to use before going to bed.

Usual dosage

1mg in the evening

Contact person

Pharmacy.

Costs

Approx. $20 for one spray, sufficient for approx. 1 month.

Sources

https://www.news-medical.net/news/20221109/Melatonin-could-be-a-potential-therapy-for-long-COVID-symptoms.aspx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9687267/

Venlafaxine

Theory

First and foremost: Long-Covid is not a depression.

Unfortunately, Long-Covid patients are often wrongly diagnosed with depression, as the usual depression surveys ask about categories such as "exhaustion", in which long-Covid patients naturally score badly due to their illness. Nevertheless, countless studies have now shown that the Post-Covid Syndrome is associated with a physical cause, not pure psychosomatic reasons or a depression.

 

Knowing this, why is an antidepressant such as Venlafaxine still listed here? There is some evidence from studies that Long-Covid patients have serotonin antibodies, reduced serotonin levels, or reduced tryptophan (a precursor of serotonin). An antidepressant would make sense in such cases to increase serotonin levels. In addition, venlafaxine also increases patients' energy and drive to a small extent, due to its noradrenergic effect.

To summarize: Antidepressants should probably not be considered as a first attempt at treatment. There are better alternatives, such as Low-Dose Aripiprazole. However, if the blood tests reveal serotonin antibodies or reduced serotonin levels, Venlafaxine could be worth a try.

Usual dosage

Venlafaxine: 7 days of 37.5mg per day. Then 75mg per day.

Caution: It is very important to phase out antidepressants in a controlled manner. Do not discontinue spontaneously without consulting a doctor!

Contact person

Psychiatrists. Long-Covid Centers with a neurological focus.

Costs

Can be prescribed and covered by certain insurances.

Sources

https://www-aerzteblatt-de.translate.goog/nachrichten/146714/Serotoninmangel-koennte-an-der-Pathogenese-von-Long-COVID-beteiligt-sein?_x_tr_sl=auto&_x_tr_tl=en&_x_tr_hl=de&_x_tr_pto=wapp

https://www.nature.com/articles/s41577-023-00966-7

 

ACC

Theory

ACC 600 is an over-the-counter mucus loosener for coughs containing the active ingredient acetylcysteine.

Interestingly, this active ingredient also has several positive side effects. One of these side effects is the reduction of lactate in the muscles.

In Long-Covid patients, increased muscle lactate is a possible explanation for the symptoms of fatigue and tiredness.

Some patients therefore experience a reduction of their muscle fatiique by trying out a therapy with ACC 600 for 2-3 weeks.

 

Usual dosage

1 tab dissolved in water per day.

Can be increased to 2 tabs if required.

Contact person

Your can get your muscle lactate tested through a so-called blood gas analysis at your pulmonologists office.

Costs

Approx. $20 for 40 Acc600 tabs.

Sources

https://www-gesundheits--lexikon-com.translate.goog/Labormedizin-Labordiagnostik/Sonstiges/Lactat.html?_x_tr_sch=http&_x_tr_sl=auto&_x_tr_tl=en&_x_tr_hl=de&_x_tr_pto=wapp

Breathing Trainers

Theory

Long-Covid patients often have breathing problems at rest or during exertion, pain when breathing or difficulties with too much mucus in the lungs. In addition, pulmonary function tests have shown weakness of the respiratory muscles (especially the diaphragm) and decreased respiratory strength in many Long-Covid patients.

 

Breathing trainers can help in various ways by:

 

.

.

 

.

Contact person

Pulmonologist. General practitioner.

Costs

$40 - $350, depending on the model you choose

Asthma Sprays

Theory

Asthma sprays have been used for decades to counteract breathing problems caused by inflammation, irritation or hyperreactivity of the lungs.

 

There are basically 3 types of sprays:

  1. Long-term sprays with cortisone have an anti-inflammatory effect.
    • e.g. Novopulmon.
  2. Emergency sprays with bronchial relaxant effect.
    • e.g. Salbutamol
  3. Combination sprays that contain both cortisone and 1-2 active ingredients that relax the lungs.
    • e.g. Trimbow

 

Which asthma spray to use depends on the individual situation. .

Ideally, a pulmonologist will carry out a lung function test including a provocation test in order to recommend the optimal asthma spray.

Contact person

Pulmonologist.

Costs

Can be prescribed and covered by certain insurances. 

Respiratory Therapy

Theory

A frequently observed phenomenon in Long-Covid patients: At rest, and especially under stress, a "chaotic breathing pattern" develops, as if the patients have "unlearned" how to breathe to a certain extent.

This could be due to autoantibodies that affect the brain, or it could be a symptom of dysautonomia.

In any case, respiratory therapy with a physiotherapist can help to "relearn" correct breathing patterns, and better breathing under stress.

Example videos

It is advisable to make individual appointments with a respiratory physiotherapist.

The following videos, for example, are suitable for practicing at home:

 

https://www.youtube.com/watch?v=bF_1ZiFta-E

https://player.vimeo.com/video/651484658

https://www.youtube.com/watch?v=ly5gYe04GuA

Contact person

General practitioner. Pulmonologist.

Costs

Covered by some health insurers.

Ozone Therapy

Theory

Long-Covid patients often display an impaired oxygen supply to the organs.

 

One possible treatment (in addition to blood thinners, HBOT, and home oxygen concentrators) to increase the oxygen supply in the body is the so-called Ozone Blood Therapy.

 

Here, a small amount of blood is taken from the patient, mixed with ozone (highly concentrated oxygen) and then injected back into the body. With most providers, this is followed by an infusion of vitamins (e.g. vitamin C or B12).

 

Ozone Therapy has a short-term (energy-boosting) and a long-term (anti-inflammatory) effect.

Usual dosage

10-15 treatments, 2 treatments per week.

Contact person

Often offered by private doctors or alternative practitioners.

Costs

Not covered by health insurance. Costs approx. $90 - $120 per treatment, depending on the provider.

HBOT

Theory

Long-Covid patients often display an impaired oxygen supply to the organs.

 

One possible treatment (in addition to blood thinners, ozone therapy, and oxygen concentrators) to increase the oxygen supply in the body is the so-called Hyperbaric Oxygen Therapy (HBOT).

 

Originally developed for the treatment of diving illnesses, HBOT is now used for a number of medical conditions where an increased oxygen supply and an anti-inflammatory effect are desired.

The patient is placed in a pressurized chamber and breathes in concentrated oxygen. This significantly increases the oxygen concentration in the blood and tissue.

 

There are two types of HBOT therapies:

  • The traditional, medical, HBOT: Only offered in clinics. Professional multi-person pressure chambers made of metal. Pressure is approx. 3 bar. Costs approx. $250 per treatment. Very effective.
  • The so-called "mild" HBOT: Offered in fitness centers and spas. Usually an one-person chamber made of soft fabric. Pressure is approx. 1.3 bar. Costs approx. $60 - $100 per treatment. Correspondingly less effective.

 

Usual dosage

The usual recommendation is 30-40 HBOT treatments.

Costs

Not covered by health insurance.

Sources

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8806311/

Anticoagulation Therapy

Theory

Long-Covid patients often appear to have microclots in their blood, which impair the supply of oxygen to the organs.

These microclots could be dissolved with the use of blood thinners.

However, this theory, and in particular the use of blood thinners, is controversial amongst doctors due to the severe side effects and bleeding risks.

Usual dosage

There are 3 types of blood thinners that are often used in long-Covid patients:

 

1) Nattokinase and Serapeptase

Over-the-counter food supplements. 

2,000 FU nattokinase, 120,000 FU serrapeptase (recommendation: Doctor's Best Serrapeptase capsules) per day

Can be supplemented with bromelain and curcumin.

2) Aspirin

Available over the counter in pharmacies. "Aspirin 100", one pill per day

3) Triple anticoagulation therapy

Combination of Aspirin, Eliquis, and Clopidrogel. High side effects. High risk of bleeding.

Contact person

Long-Covid Centers.

Costs

Can be prescribed and covered by certain insurances. 

However, as usually only private doctors are prepared to prescribe blood thinners for Long-Covid, the costs are around $200-$800.

Sources

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10663976/

https://assets.researchsquare.com/files/rs-2697680/v1/127550c9-53fa-43f4-bad0-3dce9505eeea.pdf?c=1679495993

IHHT

Theory

Several studies have shown that Long-Covid patients often have weakened mitochondria.

As these are the power plants of our cells, symptoms such as lack of energy, exhaustion and POTS might reasonably follow.

 

In "Interval Hypoxia-Hyperoxia Therapy" (IHHT), you wear a mask for approx. 60 minutes and are supplied with oxygen-rich and oxygen-poor air alternating every 5 minutes. As a result, old mitochondria are broken down and new, fresh, mitochondria are formed by your body.

Usual dosage

2 sessions per week, 10-15 sessions in total.

Contact person

Private doctors or commercial providers.

Costs

Paid privately. Costs approx. $150 per session.

Sources

https://armin--hassdenteufel-de.translate.goog/ihht-bei-long-covid/?_x_tr_sl=auto&_x_tr_tl=en&_x_tr_hl=de&_x_tr_pto=wapp

Cryotherapy

Theory

Several studies have shown that the blood vessels of Long-Covid patients are severely weakened.

It is therefore advisable to train the blood vessels, circulation and immune system.

One method that many Long-Covid patients find very helpful is cryotherapy.

Here you visit an ice chamber in your underwear for 3-5 minutes, which causes your blood vessels to contract quickly and stimulates the circulation.

Search terms such as "cryotherapy", "ice box", "cold chamber" are suitable for finding a provider near you.

A good provider should cost a maximum of $50 per session and allow you to choose the length of the session (2-5 minutes).

Usual dosage

2 times a week.

Start with 2-3 minutes and increase to 5 minutes.

Costs

Must be paid privately.

Approx. $ 50 per session.

Discounts can often be found via Groupon.

Wim Hof method

Theory

The Wim-Hof Method is a well-established method amongst athletes for boosting energy and training the immune system.

It combines two methods: On the one hand you actively expose yourself to cold (cold showers, ice bowls, ice baths), on the other hand you use a certain breathing technique to train the body with fluctuating oxygen saturations. This trains your vessels (cold) and your mitochondria (breathing, fluctuating oxygen saturation).

The Wim-Hof method is therefore a good "home version" of cryotherapy and IHHT therapy.

 

Usual dosage

1 time per day

Costs

Free training material available online.

I personally use the app https://www.wimhofmethod.com/wim-hof-method-mobile-appwhich costs around €4 per month.

Sources

https://www.wimhofmethod.com/free-mini-class

 

 

Antiviral Agents

Theory

One possible cause of Post-Covid syndrome migght be residues of the Covid-19 spike protein in the body.

Several studies are therefore currently underway to investigate whether the administration of antiviral agents can eliminate the virus residues and thus resolve the symptoms.

There are 3 main approaches currently being considered:

 

1) Paxlovid

Paxlovid is an antiviral agent specifically developed against Covid-19 during an acute infection. Studies are currently investigating whether a 15-day treatment with Paxlovid can help with Long-Covid. Unfortunately, the results are not yet available. Also, most doctors do not even prescribe Paxlovid during an acute infection (due to the many negative interactions with other medications), which is why it might be impossible to get Paxlovid as a 15-day treatment (three packs instead of one) at the moment.

 

2) Lithium Orotate

There are initial reports that treatment with Low-Dose Lithium might help with Long-Covid symptoms, presumably because lithium breaks down remnants of the spike protein.

Since Low-Dose Lithium, in the form of lithium orotate, has been used for a long time for various usecases, some private doctors have experience with it and prescribe it to their patients. 

.

 

.3) Tictures and Natural Remedies

Not confirmed by studies. However, in naturopathy, for example, artemisia tincture, cardoon tincture and cat's claw tincture as well as lysine are used to aim for an antiviral effect.

.

Usual dosage

Paxlovid: 15 days, morning and evening

Lithium: 5 weeks, 230mg lithium orotate (equivalent to 10mg Lithium), in the morning

Tinctures: Add 5 drops of each tincture to hot water and drink. 6 weeks.

Costs

Paxlovid: Can be prescribed and covered by certain insurances.

Lithium: Paid privately. Approx. 70€ for 5-week capsules.

Tinctures: Paid privately. Approx. 100€

Sources

Paxlovid:

https://pubmed.ncbi.nlm.nih.gov/37731377/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10543503/

 

Lithium:

https://www.clinicaltrials.gov/study/NCT05618587
https://ichgcp.net/de/clinical-trials-registry/NCT05618587

https://michael--nehls-de.translate.goog/infos/lithium/?_x_tr_sl=auto&_x_tr_tl=en&_x_tr_hl=de&_x_tr_pto=wapp

Valaciclovir

Theory

One possible explanation for the Post-Covid Syndrome might be that the Covid-19 infection has reactivated other latent viruses in the body (e.g. EBV or CMV).

Even if the PCR tests for such viruses turn out negative, some patients nevertheless tried antiviral agents such as Alaciclovir / Valaciclovir / Valtrex (agents against herpes viruses) and reported an improvement in their symptoms. 

 

This treatment should only be carried out after extensive testing for various reactivations and a discussion with your doctor.

Under no circumstances should dubious online pharmacies be used to obtain the medication without a prescription.

Usual dosage

In the morning and evening 1000mg for 1-2 weeks.

Contact person

General practitioner / GP

Costs

Can be prescribed and covered by certain insurances.

Sources

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10205150/

Nicotine Patches

Theory

Several studies have shown that the spike glycoprotein (SGP) related to SARS-CoV-2 not only binds to ACE-2 receptors, but also has DNA segments that are highly affine to nicotinic acetylcholine receptors (nAChR). The nAChR is the main structure of cholinergic neuromodulation and is responsible for the coordinated interaction of neuronal networks. Nicotine shows up to 30 times higher affinity for nACHRs than acetylcholine (ACh). It is therefore possible that nicotine can displace the virus from nAChR bindings and pave the way for undisturbed signal transmission.

Nicotine therefore frees receptors that may have been "closed" during the Covid-19 infection.

Usual dosage

Nictoin patches with 7 or 14mg, one patch per day.

Wear for 7-14 days.

Side effects

A relatively large number of side effects are possible. Above all, increased heart rate, dizziness, irritability.

Costs

Must be purchased privately without a prescription at a pharmacy or online.

Sources

https://www-dasgelbeforum-net.translate.goog/index.php?id=635950&_x_tr_sl=auto&_x_tr_tl=en&_x_tr_hl=de&_x_tr_pto=wapp

https://assets.researchsquare.com/files/rs-2063399/v1/6d98a8c5-14cf-440f-951f-05586dde15ee.pdf?c=1669259151

https://altea-network.com/blog/158-nicotine-patches

Antihistamines

Theory

Long-Covid could be caused by an overreaction of the immune system.

Antihistamines might help to calm down immune system overreactiions and allergic reactions.

In addition, many Long-Covid patients seem to struggle with Mast Cell Activation Syndrome (MCAS). Antihistamines often help here too.

 

There are two classes of antihistamines, which can be tried individually or combined: H1 and H2 antihistamines.

 

Among the H1 antihistamines, one could try "Ebastine" (older products such as "Cetirizine" often cause severe drowsiness as a side effect).

If Mast Cell Activation Syndrome is suspected, the H1 blocker "Ketotifen", which has a mast cell-stabilizing effect, might also be favorable.

Regarding H2 antihistamines, poeple usually try "Famotidine".

 

Usual dosage

Ebastine 20mg, 1 in the evening.

Ketotifen 1mg, 1 in the evening.

Famotidine 20mg, 1 in the morning, 1 in the evening.

Contact person

Allergist, ENT specialist, family doctor.

Costs

Usually covered by health insurers.

Monoclonal Antibodies

Theory

Monoclonal antibodies are a new class of drugs that have, so far, been used successfully for rheumatism and severe asthma.

Studies are already underway to investigate the effect of these very expensive medications on the Post-Covid-Syndrome.

There are 3 dominant approaches:

 

1) Monoclonal antibodies against Covid-19 viral residues

E.g. "Ronapreve".

These antibodies were used at the beginning of the pandemic to combat the virus in severe acute Covid-19 cases. Now, the same antibodies might be used retrospectively for Long-Covid patients to eliminate viral residues. However, it will bbe extremely difficult to find a doctor willing to test this out.

 

2) Biologics for interrupting inflammatory chains

E.g. "Tezepelumab" and "Omalizumab".

Injected monthly, these antibodies interrupt the inflammatory chains of the body. This could also be beneficial for Long-Covid, as many of the symptoms can be explained by inflammatory reactions.

Biologics are not yet being prescribed as an Off-Label therapy for Long-Covid.

Realistically, therefore, only patients with pre-existing rheumatism or asthma have a chance of receiving biologics. For this, it must be argued that the Covid infection has significantly worsened the pre-existing condition. This is done in coordination with the relevant specialist.

 

3) Monoclonal antibodies to reduce autoantibodies

E.g. "Rituximab".

Many Long-Covid patients have various autoantibodies in their blood that are directed against the body's own tissue and organs. The administration of external antibodies could help to reduce these harmful autoantibodies. Studies are underway.

Usual dosage

Depending on the specific antibody.

Usually about once a month.

Costs

Biologics are extremely expensive (approx. 1500-3000€ per injection). Specialist must submit a separate application to the health insurance company.

Sources

https://flexikon.doccheck.com/de/Biologikum

https://www.sciencedirect.com/science/article/pii/S073567572300534X

https://twitter.com/L_Habets/status/1714908341980319766

Low-Dose Aripiprazole

Theory

Low-Dose Aripiprazole is the low-dose version of the drug Abilify.

LDA is already being used for diseases such as ME/CFS, and is particularly suitable for cognitive impairments caused by Long Covid.

LDA does this by briefly increasing the production of dopamine.

Compared to LDN (Low-Dose Naltrexone): LDA seems to be more suitable for cognitive symptoms, LDN more for physical symptoms.

Usual dosage

People ususally start with 1 drop daily. They then usually increase by 1 drop every 5 days until the effect sets in.

Maximum 2.5 ml / day.

Contact person

Neurologist

Costs

Can be prescribed and covered by certain insurances.

Sources

https://www-schmerztherapie--hochrhein-de.translate.goog/schmerzpraxis/komplementaere-verfahren/low-dose-abilify-aripiprazol/?_x_tr_sl=auto&_x_tr_tl=en&_x_tr_hl=de&_x_tr_pto=wapp

https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-021-02721-9

Low-Dose Naltrexone

Theory

Long-Covid could be caused by an overreaction of the immune system, i.e. a type of auto-immunity.

Low-Dose Naltrexone is the low-dose version of the drug Naltrexone.

LDN is already used for diseases such as ME/CFS and appears to downregulate auto-immunity.

LDN does this by briefly increasing the production of endorphins, which in turn have a calming effect on the immune system.

Many patients report that with LDN, they experience fewer "crashes" after activities and can therefore train more often.

Compared to LDA (Low-Dose Aripiprazole): LDA seems more suitable for cognitive symptoms, LDN more for physical symptoms.

Usual dosage

0.5mg - 4.5mg

People ususally start with 0.5mg, and increase weekly by 0.5mg until an effective dose is reached.

Side effects

According to current reports, few side effects.

Gastrointestinal complaints seem to occur most frequently.

Contact person

General practitioners (unfortunately, most of them have no experience with LDN).

Private doctors (some already work with LDN for other diseases).

 

The capsules can then be manually produced by a pharmacy.

Costs

Usually not covered by insurance.

Appointment with private doctor approx. $200.

100 LDN capsules approx. $70.

Sources

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10200333/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962576/

https://www.nationalgeographic.com/premium/article/drug-overdose-low-dose-naltrexone-long-covid

Cortisone Therapy

Theory

The immune system overreacts to Long-Covid and causes inflammation throughout the body. 

A "shock therapy" with cortisone could combat the inflammation and "reset" the immune system.

Usual dosage

40mg prednisolone daily for 4 weeks.

Then tapering off by reducing 10mg each week.

 

Important: Before starting therapy and after therapy, have cortisol and ACTH levels tested in your blood (in the morning, on an empty stomach).

Side effects

High risk of side effects, as prednisolone suppresses the immune system. Increased susceptibility to infections during therapy.

In addition: By exceeding the Cushing's threshold with cortisone: Weight gain, hearth palpitations, circulatory problems, ...

Contact person

Pulmonary specialist, family doctor.

Costs

Usually covered by health insurers.

Sources

Common therapy for asthma and rheumatism.

Studies on Long-Covid are ongoing.

https://www-medizin-uni--tuebingen-de.translate.goog/de/das-klinikum/pressemeldungen/556?_x_tr_sl=auto&_x_tr_tl=en&_x_tr_hl=de&_x_tr_pto=wapp

https://www.ukw.de/fileadmin/uk/PreVitaCOV-Studie/2023-01-03_PreVitaCOV_Study_Protocoll_Shortend.pdf