Nicotine Patches for Chronic Fatigue Syndrome in Long COVID
There is insufficient evidence to recommend nicotine patches for treating chronic fatigue syndrome in patients with long COVID. 1
Current Evidence on Nicotine and Long COVID
- While nicotine has demonstrated anti-inflammatory properties in animal studies by activating the cholinergic anti-inflammatory pathway through α7 nicotinic acetylcholine receptors, there is no clinical evidence supporting its use specifically for chronic fatigue in long COVID patients 1
- Nicotine has several adverse cardiopulmonary effects and is highly addictive, so recreational use of nicotine products should be strongly discouraged 1
- Current guidelines from the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) state that evidence is insufficient to provide recommendations for or against any specific intervention for managing fatigue in long COVID 1
Understanding Long COVID and Chronic Fatigue
- Long COVID encompasses multiple adverse outcomes, including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), with fatigue reported in approximately 45.2% of long COVID patients 1, 2
- Post-exertional malaise (PEM) is reported in 79.4% of long COVID patients with chronic fatigue, making activity management critical 3, 4
- Clinical overlap exists between long COVID and post-viral fatigue syndromes/ME/CFS, with similar symptom profiles and treatment responses 1, 5
Current Recommended Management Approaches
- Pacing is recommended as a primary management strategy for patients with post-exertional malaise, which frequently accompanies post-viral fatigue 3
- Exercise should be avoided in patients with PEM as it may worsen symptoms; studies show physical activity worsened symptoms in 75% of long COVID patients 3, 6
- Cognitive pacing should be considered alongside physical activity management for those experiencing cognitive dysfunction 3
Pharmacological Options with Some Evidence
- Low-dose naltrexone has shown promise for neuroinflammation in ME/CFS and may help with post-viral fatigue 3
- H1 and H2 antihistamines (particularly famotidine) may alleviate symptoms in some patients but are not curative 3
- For pain management, acetaminophen is recommended as the preferred first-line option for post-COVID myalgia 7
- Amitriptyline has been used successfully in case reports of post-COVID ME/CFS recovery 8
Important Cautions
- Graded exercise therapy and cognitive behavioral therapy remain controversial for management of ME/CFS and should be further investigated before recommending for post-viral conditions 3, 6
- More patients with ME/CFS are unable to work after treatment with CBT and GET than before treatment, suggesting these approaches may be harmful 6
- If considering any nicotine-based therapy (which is not currently recommended), it should be noted that commercially available electronic nicotine-delivery systems are not advised 1
Emerging Treatments Under Investigation
- Anticoagulant regimens have shown promise in addressing abnormal clotting in long COVID 3
- BC007 (a drug that neutralizes G protein-coupled receptor autoantibody levels) is being investigated 3
- Paxlovid has shown potential in both prevention and treatment of long COVID symptoms in early studies 3
While nicotine has theoretical anti-inflammatory properties that might be relevant to long COVID pathophysiology, there is no clinical evidence supporting the use of nicotine patches specifically for chronic fatigue syndrome in long COVID patients. Current guidelines recommend symptom management through pacing strategies and cautious use of medications with better evidence profiles.