From the Guidelines
Amantadine may be considered as a treatment option for post-COVID fatigue, though it is not FDA-approved specifically for this purpose, and its use should be based on individual patient assessment and part of a comprehensive approach. The treatment of post-COVID fatigue is complex and multifaceted, involving various mechanisms and symptoms, as outlined in recent studies 1.
Key Considerations
- Typical dosing of amantadine starts at 100mg once daily, potentially increasing to 100mg twice daily after 1-2 weeks if tolerated, with treatment duration varying but often continuing for 2-3 months with periodic reassessment.
- Amantadine works by enhancing dopamine release and blocking NMDA receptors, which may help improve energy levels and reduce fatigue symptoms.
- Patients should be aware of potential side effects including insomnia, dizziness, and hallucinations, and the medication should be taken earlier in the day to minimize sleep disturbances.
- Those with kidney disease, seizure disorders, or heart conditions should use caution and discuss with their healthcare provider before starting.
Comprehensive Approach
- The use of amantadine should be part of a comprehensive approach that includes gradual physical activity, good sleep hygiene, and proper nutrition, as suggested by recent findings 1.
- Other treatment options, such as pacing, cognitive pacing, and low-dose naltrexone, may also be considered, as outlined in Table 1 of the study 1.
- It is essential to note that the current treatment options are based on small-scale pilot studies in long COVID or what has been effective in other diseases, and several additional trials are in progress 1.
Prioritization of Treatment
- The prioritization of treatment options should be based on individual patient assessment, taking into account the specific constellation of symptoms and biological mechanisms involved, as suggested by the study 1.
- A comprehensive approach that addresses the complex and multifaceted nature of post-COVID fatigue is crucial for improving patient outcomes and reducing morbidity, mortality, and improving quality of life.
From the Research
Post-COVID-19 Fatigue and Amanatadine
- Post-COVID-19 fatigue is a common and debilitating symptom experienced by many COVID-19 survivors, with a significant proportion of individuals reporting fatigue 12 or more weeks after COVID-19 diagnosis 2.
- A systematic review of post-COVID-19 fatigue identified potential risk factors, including old age, female sex, severe clinical status in the acute phase of infection, and a high number of comorbidities 3.
- Several treatment approaches have been tested for post-COVID-19 fatigue, including a Chinese herbal formulation, molecular hydrogen inhalation, hyperbaric oxygen therapy, and enhanced external counterpulsation 3.
- A randomized open-label clinical trial found that Amantadine significantly reduced fatigue levels in patients with post-COVID-19 fatigue, suggesting its potential as an effective treatment for this condition 4.
Mechanism and Efficacy of Amanatadine
- The exact mechanism of Amantadine in reducing post-COVID-19 fatigue is not fully understood, but it may be related to its antiviral and anti-inflammatory properties 4.
- The study found that Amantadine significantly improved fatigue levels, as measured by the Visual Analog Fatigue Scale and Fatigue Severity Scale questionnaires, compared to the control group 4.
- The results of this study suggest that Amantadine may be a useful treatment option for post-COVID-19 fatigue, but further research is needed to confirm its efficacy and safety in larger populations 4.
Comparison with Other Treatments
- Other treatments, such as antidepressants, have also been studied for their potential to reduce post-COVID-19 fatigue and other symptoms 5.
- A scoping review found that antidepressants, particularly fluvoxamine, may have a preventive effect against progression to severe COVID-19 and against the development of Long COVID, including fatigue 5.
- However, the evidence for the use of antidepressants in post-COVID-19 fatigue is still limited, and further research is needed to fully understand their potential benefits and risks 5.