A small number of long COVID studies have shown that low dose naltrexone may be able to treat some of its symptoms. While not a cure for long COVID, it does seem to help with at least a few of the possibly more than 200 symptoms that have been documented as being associated with it. Patients with long COVID symptoms who take LDN have been shown to have improved sleep with reduced pain.
What is Long COVID?
Long COVID (or post-acute COVID infection) is used to describe the wide range of symptoms that seem to continue or appear in patients who have recovered from a COVID-19 infection. Symptoms have been shown to be present 3 months after the infection in about 1/3 of patients. Common symptoms of long COVID include fatigue, dizziness, headache, palpitations, chest pain, shortness of breath, fever, difficulty with concentration or thinking (also referred to as brain fog), loss of sense of taste or smell, joint or muscle pain, gastrointestinal symptoms, depression, and anxiety.
There are several hypotheses proposed to explain why symptoms persist even after the infection has passed. The severity of long COVID symptoms does not seem to be related to the severity of the initial infection. There seem to be alterations or damage to certain parts of the immune system, neuroinflammation, and other lasting effects throughout the body.
As of right now, there are no approved treatments for long COVID. Antihistamines and antidepressants have been used in some cases. Antivirals and steroids are also being studied as possible treatments. There are no large, placebo controlled studies that demonstrate any particular treatment is more effective for treating this condition although trials are ongoing or in recruitment.
What is LDN?
LDN is a lower dose of the FDA approved drug naltrexone. At the lower dose it has been shown to effectively treat a variety of conditions such as Crohn’s disease, rheumatoid arthritis, and fibromyalgia. LDN has a high safety profile with few reported side effects. A common side effect is insomnia and vivid dreams but this can be reduced by changing the time the medication is taken.
When naltrexone is used at low doses for treating chronic conditions, it is usually started at around 1mg to 1.5mg taken daily. This dose is titrated up to around 4.5mg daily. This is significantly lower than the dose used to treat addiction, which is approved at 50mg doses. To see the full effect of LDN on long COVID symptoms, it usually must be taken for at least 2-3 months. Due to its effects on multiple pain parameters, it is thought that long COVID may primarily be a central nervous system mediated condition.
Since naltrexone is only commercially available in the higher 50mg dosage, the lower dosages must be made by a compounding pharmacy. A compounding pharmacy can make LDN in capsules in 1.5mg, 3mg, and 4.5mg strengths, which are the common titration steps to the full dosage.
Study Results
Patients who were given LDN to treat their long COVID symptoms showed improvement in self-reported limitation in activities of daily living, energy levels, pain levels, levels of concentration, sleep disturbance and overall recovery from COVID-19 using a Likert scale questionnaire. The largest improvements have often been found in pain – LDN is commonly used to treat chronic pain conditions so this is in alignment with previous studies.
It is important to note that although many patients saw a benefit with LDN, they were not cured. There is no treatment yet that seems effective for all of the symptoms of long COVID and there is no cure that stops the symptoms completely. If the patients cease taking LDN, their symptoms may return. Further research is needed however to confirm how LDN effects this new condition.
The current treatment protocols for long COVID recommend against the use of medications for short term gain that may lead to long term side effects. Most healthcare professionals are cautious to prescribe anything that has not been proven with controlled clinical trials. Many are simply recommending a wait and see approach.
Articles
Addiction drug shows promise lifting long COVID brain fog, fatigue – Reuters
Can an Addiction Drug Treat Long Covid? – Rolling Stone
Safety and efficacy of low dose naltrexone in a long covid cohort; an interventional pre-post study – Brain, Behavior, & Immunity