From the Guidelines
Nicotine patches are not currently recommended as a standard treatment for Long COVID due to insufficient clinical evidence supporting their routine use. The most recent and highest quality study, published in 2023 in Nature Reviews Microbiology 1, highlights the complexity and heterogeneity of Long COVID, with multiple potential causes and mechanisms, including immune dysregulation, persisting reservoirs of SARS-CoV-2, and autoimmunity. While nicotine may have anti-inflammatory properties and effects on the autonomic nervous system, its potential benefit in Long COVID remains speculative and requires further research.
Key findings from the study include:
- Long COVID encompasses multiple adverse outcomes, including cardiovascular, thrombotic, and cerebrovascular disease, type 2 diabetes, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and dysautonomia
- Symptoms can last for years, and particularly in cases of new-onset ME/CFS and dysautonomia, are expected to be lifelong
- There are currently no validated effective treatments for Long COVID
- Cognitive impairment is a major feature of Long COVID, with debilitating effects on daily living, and may increase over time
Given the lack of evidence supporting the use of nicotine patches in Long COVID, patients experiencing symptoms should consult with healthcare providers to recommend evidence-based treatments tailored to their specific symptoms, which may include:
- Physical therapy
- Cognitive rehabilitation
- Medications targeting specific symptoms like fatigue or pain
- Addressing underlying conditions, such as immune dysregulation or autoimmunity
It is essential to note that self-medication with nicotine patches without medical supervision is not advised, as it may lead to potential side effects, including increased heart rate, blood pressure changes, sleep disturbances, and the risk of nicotine dependence 1.
From the Research
Effect of Nicotine Patches on Long COVID
- There is no direct evidence in the provided studies on the effect of nicotine patches on patients with post-acute coronavirus disease (COVID-19) syndrome, also known as long COVID 2, 3, 4, 5, 6.
- However, some studies suggest that nicotine, through its interaction with the nicotinic cholinergic system, may have potential therapeutic effects in COVID-19, including mood regulation, anti-inflammatory effects, and interference with SARS-CoV-2 entry and/or replication 3, 6.
- A case report suggests that nicotine replacement therapy may have contributed to a patient's recovery from COVID-19 without the need for respiratory support, possibly by boosting the cholinergic anti-inflammatory pathway and hindering the overproduction of pro-inflammatory cytokines 6.
- Long COVID management guidelines recommend a comprehensive evaluation of patients, including medical history, physical examination, blood tests, imaging studies, and functional tests, as well as treatment of underlying medical conditions and supportive care 2, 4, 5.
- The use of nicotine patches or other nicotinic agonists in the treatment of long COVID is not mentioned in the provided studies, and further research is needed to determine their potential effectiveness in this context.