ABCDEFGHIJKLMNOPQRSTUVWXY
1
Some treatments not mentioned here (e.g. pacing, fluids, immunoglobulins) and for symptom-specific targeting:
↓↓↓		Discussion:
reddit.com/r/cfs
reddit.com/r/covidlonghaulers
forums.phoenixrising.me		Study results & comments →
2
CFS treatments (survey 2024) (vid)
CFS/LC research (2023)
CS = Case Series
LC = Long Covid, CFS=Chronic Fatigue Syndrome, FM=Fibromyalgia
3
Treatment recs (clinical coalition 2021)LC treatments (2022)
RS = Retrospective Study, DBDT = Double Blind Discontinuation Trial, OS = Observational Study, RCT = Randomized Controlled Trial, CT = Controlled Trial
4
ClassDrugCostWhy?
Year
Study type
n
Study (group + link)Dosage & test period
Result (P/N)
Exact resultNotesPro (anecdotal)Contra (anecdotal)
5
antihistamineantihistamines (H1 & H2 blockers)mast cell activation (MCA) symptoms widely present in LC [1]2023RS (controlled)27LC(fexofenadine 180mg, famotidine 40mg) 20dP29%: all symptoms disappeared, significant improvement in rest; responder %: {fatigue↓: 64%, brain fog↓: 27%, increased HR↓: 56%, abdominal disorders: 48%} A study criteria: "no registered benefits from previous treatment for long-COVID"top voted in Long Covid Care group re:brain fog; re: MCAS, success stories, 2; for many 1 didn't work, other did
6
antihistamines (H1 & H2 blockers)2021OS (controlled)49LC2 x (loratadine 10mg or fexofenadine 180 mg)/d and 1 x (famotidine 40 mg or nizatidine 300 mg)/d 30d (6-89d)Psymptom severity: 26%↓ (disappeared in: {fatigue: 29%, PEM: 0%, neurologic: 52%, dysautonomia: 0%, chest pain: 37%, ...})Gen1 anti-H1-s cross brain-blood barrier, but have more side effects
7
nattokinasemicroclot breakdown [1], COVID-19 virus' spike protein breakdown [2]2024surveyCFS/LC8k FUs needed to take effect; if possible use enteric coating (some say it works fine without)Pimprovement in 60% (brain fog, fatigue, PEM)1 [LC brain fog]; also good for Alzheimer managementworsening fatigue [1 LC, herxing?]; if side effects don't go away (4 weeks?) try lumbrokinase instead (not fermented, no histamine)
8
immunomodulatorlow dose naltrexone (LDN)anti-inflammatory 2019OS218CFS(3 - 4.5mg on evenings) 1.7y (if insomnia, in mornings)P51%: improved vigilance, 24%: physical performance↑, 21%: cognitive dysfunction diminishedLC: helped [brain fog], CFS: 2 [side effect: "poisoned"], many positive benefits [e.g. 20% impr. brain fog, PEM improvement] side effects: stomach](CFS: made depression worse to psychosis)
9
immunomodulatorlow dose naltrexone (LDN)2014reviewchronic pain & inflammatoryP
10
antipsychoticlow dose aripiprazoleD2 receptor: mediate neuroinflammation, microglial activation, and cell death [1]2021RS101CFS1.1mg (0.2-2mg) (titrated up by 0.25mg) 8m (1m-17m)P74%: [45%↓ severity in fatigue, brain fog & unrefreshing sleep; imrovement in PEM crashes]1 [long covid brain fog]
11
nAChRs agonistnicotinestimulant2023CS4LC7-15mg 6-7d [if too large put tape under x% of it, or cut it]Presolved fatigue, concentration issues, ...articleeffects short duration? (tolerance); possibly fake energy, giving you PEM
12
alpha-2a agonistguanfacine$40/mstrengthens prefrontal connectivity [1]; POTS relief [2]2023CS12LC: w/ NAC1mg guanfacine (XR) for 1 month @bedtime, then 2mg
(NAC: 600mg)		Preduction in brain fog (if guanfacine tolerated)clonidine is a same group drug, but more sedating.
also recommended for POTS		helped some [bad recall & word finding; improved aft. 2w, significantly aft. 7.5M; ], 2 [with 5-10 sec memory; con: for him NAC helped too], 3 [elo ratings improved; didn't help with fatigue?], others: helped with PEM (after 6M), with flight&fight adrenaline shots; 4 [brainfog stimuli related], fatigue (for at least 1-2 weeks); low BP; usually improves executive function, but sometimes the opposite (paranoia, anger); usually taken for anxiety and sleep? (sometimes alongside stimulants for calming effect); overall the effectiveness rate in r/covidlonghaulers for brain fog was like 50% (weirdly in r/ADHD it was lower!), although many stopped taking due to the initial fatigue; helped more with brain fog than fatigue
13
antioxidantN-acetylcysteine (NAC)protects mitochondria and reduces kynurenic acid blockade of NMDA receptors [1] [2]2023CS12LC: w/ guanfacine600mg NAC
(1mg guanfacine (XR) for 1 month @bedtime, then 2mg)		Preduction in brain fog (if guanfacine tolerated)in r/covidlonghaulers the effectiveness was mild and ~30%; for some it made worse
14
oxaloacetate$330/m @1000mgbrain mitochondrial biogenesis, insulin pathway, hippocampal neurogenesis [1]2022RCT120CFS1000-3000mg 2-(6)w (Anhydrous Enol-Oxaloacetate (AEO))Pphysical fatigue 16-29%↓, mental fatigue 13-26%↓1 [LC]
15
MitoQ/CoQ10mitochondrial oxidative phosphorylation process2024review750FM/CFSQ10: ~300mg 40d-3mP12/13 studies showed improvementCoQ10 (ubiquinone), i.e. the oxidized form
16
MitoQ/CoQ102020OS20middle-aged men(MitoQ: 20mg, Q10: 200mg) 6wNno effect on mitochondria (besides mildly suppressing ROS levels (MitoQ more effective than Q10))
17
NADHATP production↑, dopamine↑ [1]2004RCT31CFS5-10mg 2yP?symptom score 50%↓, but as good as therapy group
18
NADH2021RCT242CFS: w/ CoQ10(Q10: 200mg, NADH: 20mg) 12wNno significant improvement
19
...other NAD+ related: NMN (nicotinamide mononucleotide) & nicotinamide riboside​
20
alpha-lipoic acid (ALA)mitochondrial α-ketoacid dehydrogenases, glutathione levels [1]2022RCT174CFS: w/ CoQ102 x (Q10 100mg + ALA 100mg)/d 8w; 300-2400mg (in diabetic neuropathy / MS patients)PVAS: (fatigue 35%↓, pain 50%↓, sleep 41%↓)
21
(acetyl) L-carnitine (ALCAR)fatty acids transport into mitochondria [1]1997OS14CFS(3 x 1g)/d 4-8w Pdepression↓, anxiety↓, OCD↓, paranoia↓, ...↓
22
(acetyl) L-carnitine (ALCAR)2000RCT50CFS: blood levelsNno lowered L-carnitive levels in CFS patients
23
palmitoylehanolamide (PEA)restores GABA-B neurotransmission and cortical plasticity, olfactory function [1]; MCA down-regulation [2]2024surveyCFS/LCPimprovement in 48% (fatigue & brain fog)
24
beta blockersPOTS relief2024surveyCFS/LCPimprovement in 70% (POTS)
25
amifampridine$650/m @10mgreduces fatigue in multiple sclerosis patients2024DBDT5LC5-20mg, 3d test periodPsleep time↓ 12-17h→8h; Bell score↑10-40→40-100alternative drug: fampridine
26
AChE inhibitorpyridostigmine (Mestinon)POTS relief [1]; dysautonomia relief (gut motility) [2]2024surveyCFS/LCPimprovement in 60% (mostly POTS; also: fatigue, PEM, brain fog)
27
antiviralmaraviroc2024surveyCFS/LCPimprovement in 65%
28
NDRImethylphenidatestimulant2016DBRCT194CFS4wP17%: fatigue >50%↓, 22%: concentration issues >50%↓
(65% had stopped the treatment, they're counted as negative)
29
NDRImethylphenidate2006DBRCT60CFS(2 x 10mg)/dPVAS fatigue: 13%↓
30
31
POTS = postural orthostatic tachycardia syndrome"51%: improved vigilance" means that vigilance improved in 51% cases
"VAS fatigue:13%↓" means fatigue severity dropped 13% more than in control (if controlled study)
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100