Pharmaceutical Treatment Options for Extended COVID-19
For extended COVID-19 (long COVID), the recommended pharmaceutical approach is symptomatic treatment combined with Traditional Chinese Medicine (TCM) based on syndrome differentiation to reduce potential adverse events and improve outcomes. 1
Disease Severity Assessment
First, determine the severity of the patient's condition:
- Mild: Various symptoms without respiratory distress
- Moderate: Lower respiratory disease with SpO2 ≥94% on room air
- Severe: SpO2 <94% on room air or other specific criteria
- Critical: Requires ICU admission or mechanical ventilation 2
First-Line Pharmaceutical Treatments
Antiviral Therapy
- Remdesivir: Consider for high-risk patients with extended symptoms
- Dosing: 200 mg IV loading dose on day 1, followed by 100 mg IV daily for 5 days (can extend to 10 days if no clinical improvement) 2
- Monitor hepatic laboratory tests before starting and during treatment
- Check prothrombin time before initiation and as clinically appropriate
Immunomodulatory Therapy
- For patients with signs of hyperinflammation:
Thromboprophylaxis
- For hospitalized patients: Standard dose anticoagulant thromboprophylaxis during hospitalization only 1
- Do not extend thromboprophylaxis after hospital discharge unless patient has specific high risk factors and low bleeding risk 1
- Avoid intermediate or full treatment dosing unless specifically indicated 1
Symptom-Specific Treatments
For extended COVID symptoms, use medications with the lowest risk of drug-drug interactions and at minimum effective doses for the shortest duration 1:
- Fatigue, chest distress, shortness of breath: HXZQ capsule/dropping pill combined with LHQW capsule/granule 1
- Digestive symptoms (anorexia, diarrhea, constipation): TCM decoctions based on syndrome differentiation 1
- Abdominal fullness, anorexia, nausea: TCM herbs such as Magnolia Bark (Houpu), Cablin patchouli herb (Huoxiang), and Atractylodes Rhizome (Cangzhu) 1
Special Considerations for High-Risk Patients
Elderly Patients
- Reduce polypharmacy and adjust drug doses according to organ function and drug interactions 1
- For patients over 60-80 years old: Use 3/4-4/5 of the adult dose
- For patients over 80 years old: Use 1/2 of the adult dose 1
- Focus on "strengthening healthy energy and removing blood stasis" based on syndrome differentiation 1
Patients with Comorbidities
- Liver disease: Monitor liver function closely when using experimental COVID-19 treatments 2
- Rheumatic disease: Continue the lowest effective dose of dexamethasone to control underlying disease 2
- Cardiovascular disease: Monitor for thromboembolism and adjust treatment accordingly 1
Monitoring Requirements
- Regularly monitor temperature, respiratory rate, and oxygen saturation 2
- Watch for signs of respiratory distress (shortness of breath at rest, respiratory rate ≥30 breaths/minute, oxygen saturation ≤93%) 2
- Monitor for potential complications such as secondary infection and disseminated intravascular coagulation 1
- For patients on immunomodulatory therapy, monitor liver function tests 2
Treatments to Avoid
- Not recommended based on lack of efficacy and potential harm:
- Hydroxychloroquine
- Azithromycin
- Lopinavir-ritonavir
- Interferon-β
- Colchicine 2
Pitfalls and Caveats
- Avoid polypharmacy, especially in elderly patients, to reduce adverse events and drug interactions 1
- Do not use DOACs in critically ill patients due to hemodynamic instability, drug-drug interactions, and risk of acute kidney injury 1
- Do not routinely perform ultrasound screening for asymptomatic DVT in critically ill COVID-19 patients 1
- Be aware that extended thromboprophylaxis after hospital discharge is not recommended unless specific risk factors are present 1
- TCM medications should be used based on syndrome differentiation to maximize efficacy and safety 1
By following these evidence-based recommendations, clinicians can optimize pharmaceutical management of extended COVID-19 while minimizing adverse events and improving patient outcomes.