How fun. Now I have COVID for the 5th time, and I am simultaneously having a shingles outbreak. Turns out there is some evidence COVID may increase the risk for a shingles outbreak in people over 50.
So, I have acute COVID again (3rd time). I am taking both Paxlovid and fluvoxamine since they have different mechanisms that I think should be complimentary. This is not medical advice. Everyone should speak to their own doctor about what is right for them.
There is a hint that fluvoxamine may have prevented the most severe forms of long COVID: those randomized to fluvoxamine were about half as likely to report being less than 60% recovered at follow-up. Small sample size, not statistically significant (low power), but interesting.
A few people requested that I re-post a link to this article I wrote for Cerebrum magazine. It describes how I got the idea to use fluvoxamine as a treatment for COVID-19.
I wonder how many long haulers are having this problem: "It was found during sleep studies on [post-acute COVID] patients...that the REM phase of sleep no longer restricted movement, which wakes you up."
One reason I am disappointed in FDA decision about fluvoxamine EUA is the difficulty in getting COVID diagnosis within first 5 days of illness, when Paxlovid should be started. Even for doctors like me, this can be tricky. Initially thought it was allergies + long-COVID symptoms.
Today NIH updated their COVID treatment guidelines to mention SC2 and TOGETHER Trials. They have not adjusted their stance on fluvoxamine. They still do not recommend either for or against fluvoxamine for COVID. Disappointing that they have not changed recommendation to “for”.
I think Paxlovid+fluvoxamine worked very well for my acute COVID episode. Day 10 now. Off Paxlovid past 2 days. Feeling good, like my long COVID baseline (not like acute illness or long COVID flare). Continuing fluvoxamine & famotidine. Decided to also add some lactoferrin.
Replication of fluvoxamine's benefit for treating acute COVID-19, in Thailand. There is also evidence from this study that fluvoxamine prevents long COVID symptoms:
Early treatment with fluvoxamine, bromhexine, cyproheptadine, and nicl...
Just watched this. I have not been totally convinced that ivermectin works as well as some people think it does, but there is enough evidence for it and low enough risk of harm from the drug, that this should be taken seriously.
H-Hour: 0900, D-Day: 6/1/21
Tuesday, 9am Pacific, I will be talking live in the DarkHorse studio with
@PierreKory
of FLCCC /
@Covid19Critical
on the pandemic, the care of COVID-19 patients and the multidimensional campaign against Ivermectin. Buckle up...
“We know that when you have the COVID infection you have trouble breathing and that’s because there’s infection in your lung, but an additional explanation is that the virus enters the respiratory centers of the brain and causes problems there as well,” l
I think the reason I got sick again is because whatever variant I have is not easily taken care of by antibodies formed against previous variants or by vaccines based on those variants, and because hardly anyone cares about masking and social distancing anymore.
There is good evidence for treating COVID early with monoclonal antibodies and fluvoxamine. It is important to get the word out, so people who become ill will know they can talk to their doctors about treatment options.
@firasd
I don't think it's dishonest to say that there are innovative treatment options, I think it's just true! And while monoclonal antibodies in particular are highly effective, uptake isn't very high, which is part of why Covid is still a problem.
"In a secondary analysis of participants who took at least 80% of their pills...Risk of hospitalization or extended emergency care was reduced by two-thirds, and...[there was] a reduction in mortality risk of 91%."
I find it interesting that after I tweeted that I have acute COVID for 3rd time, there were a lot of appropriate supportive comments, and also some from individuals who seemed to make extreme assumptions about my vaccination status, in one of 2 opposite directions…
A surprise here was the statistically significant benefit of the dopamine and norepinephrine re-uptake inhibitor BUPROPION, which is not an SSRI, but might be a sigma1 receptor agonist, and is a negative allosteric modulator of 5HT3A receptors.
Majority of people in this study reported continued post-COVID symptoms 2 years after acute infection. This is not surprising to me based on accounts I've heard from individuals who had their first SARS-CoV-2 infection more than 2 years ago.
Sotrovimab may be the only MAB that works against Omicron, but it is NOT “the only Covid treatment that works against Omicron”. Fluvoxamine can reduce clinical deterioration, emergency medical care visits, hospitalizations, and deaths.
Doctors can still prescribe fluvoxamine off-label, but it would best to have an official EUA from the FDA to support this. Not everyone can take Paxlovid, and it has problems like rebound. We need multiple treatment options.
Case reports on 2 COVID19 patients showing signs of serotonin excess & improving with cyproheptadine. If this is caused by platelet hyperactivation, an SSRI given early in the course of COVID19 could potentially prevent this.
@farid__jalali
Check out my published case reports on 2 patients with what appears to be an unprovoked serotonin-like syndrome in
#covid19
#medtwitter
please share
@TelehealthBot
This situation seem pretty bad, but there is a good COVID19 outpatient treatment option that many people are ignoring or have not heard about: FLUVOXAMINE.
2. Lack of Rx options. At least one of our mabs not effective vs omicron due to SGTF mutations and as
@EricTopol
points out in his new opinion piece we don’t have paxlovid in quantity
1/ 4 years ago (3/17/2020), I first noticed symptoms of my first episode of COVID-19. About a week later, while experiencing the inflammatory phase, I thought of a possible way to prevent inflammation-related respiratory deterioration using an existing drug called fluvoxamine.
Article states, "In COVID-19 cases, the virus “hijacks” stress-response machinery, including sigma receptors, in order to replicate in the body. Interfering with that signaling appears to be the key...," but RCTs are still needed for these 2 compounds.
New publication including pharmacokinetic modeling of fluvoxamine & fluoxetine: Suggests fluvoxamine dose of 100mg BID may be ideal to ensure occupation of S1R, and fluoxetine level may not get high enough even at FDA maximum dose.
EFFECT OF EARLY TREATMENT WITH FLUVOXAMINE ON RISK OF EMERGENCY CARE AND HOSPITALIZATION AMONG PATIENTS WITH COVID-19: THE TOGETHER RANDOMIZED PLATFORM CLINICAL TRIAL | medRxiv
1/ Just in case any long haulers are interested: I had COVID 1st time March 2020. I think benefits of vaccination are greater than risks for many people, but I had recurrence of long COVID symptoms after the 2-shot Pfizer series (~Jan2021) so chose not to get mRNA boosters.
Important video about Ivermectin for treatment of COVID19. Includes description of a meta-analysis of mortality risk. Raises questions regarding WHO recommendations.
Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among patients with COVID-19: the TOGETHER randomised, platform clinical trial
@amandalhu
Some pro-vax people are also anti-early-treatment for some reason. Sometimes when I post about COVID treatment research findings, some pro-vax people pop out and say they’d prefer to just get vaxxed. Getting vaxxed does not 100% prevent COVID. We need treatments too.
Some assumed I must have got sick a 3rd time due to being unvaccinated/unboosted, so not having strong enough immune response. Others though I must have got COVID a 3rd time because I WAS fully vaccinated/boosted and that this impaired my immune function. Both are wrong.
Meta-analysis has been published: Fluvoxamine for Outpatient Management of COVID-19 to Prevent Hospitalization via
@JAMANetworkOpen
part of
@JAMANetwork
It’s great that Paxlovid will be available, but not everyone with COVID will be able to get it, at least not at first. Fluvoxamine can be prescribed off-label for outpatients with acute COVID NOW.
Pfizer said production of their pill takes ~6-8 months. The pill has to be taken within 5 days of first symptoms to be effective.
There is limited availability of the drug so patients at highest risk must be prioritized to receive these pills.
@EricTopol
@NatureMicrobiol
I'd be very interested in getting a nasal vaccine against this virus, especially if a nasal vaccine might be less likely than other existing vaccines to trigger autoimmune/inflammatory-related long COVID symptom flares.
Final version of our FIASMA article is now published online: Association Between FIASMAs and Reduced Risk of Intubation or Death in Individuals Hospitalized for Severe COVID‐19
So, if Paxlovid only “pauses” viral replication, and the course of illness can just continue on once Paxlovid is stopped, maybe it would work better if combined with something else that has a different mechanism.
Example of “COVID brain”.
I advise trying to avoid getting COVID for as long as possible, at least until we know more about methods of preventing and treating lasting effects of the disease. Research is in progress, but we still don’t know enough about this.
Want to see what a “COVID Brain” can look like?
Here’s mine. The white spots are not supposed to be there. You can’t see the microhemorrhages or swelling.
Infected early March ‘20- pre-vaccine.But the threat is still here for everyone-vax or not, young or old.
Please mask up.
@loofymectin
@LongTiredRoad
@BernieDogs4
@farid__jalali
@AlisaValdesRod1
I think it is very likely that many people with long COVID have hyper-activated platelets which periodically release large amounts of serotonin. SSRIs can prevent platelets from loading up on serotonin, but that will take time since some platelets would be fully loaded already…
Fluvoxamine for Coronavirus | Science | AAAS
Nice quote from the article:”This is good news, since the drug is cheap and widely available, and I hope that this news is immediately affecting clinical practice”
I submitted a comment on our STOP COVID follow-up data to the JAMA network website, alongside the 2-year COVID follow-up article by 'César Fernández-de-las-Peñas' and colleagues. See the comments tab.
@frothtimus
@farid__jalali
EUA application for use of fluvoxamine to treat early COVID was submitted to the FDA, but it could take months for FDA to review that. Omicron is here now, so it makes sense for doctors to just go ahead and prescribe it off-label now, at least for certain high-risk patients.
Fluvoxamine may help prevent severe overloading of the hospitals during this Omicron surge if physicians choose to prescribe it for appropriate high-risk patients.
@MVGutierrezMD
@PutrinoLab
This is true. I had COVID 3 times, Acute COVID symptoms were not as bad 2nd and 3rd time, but long COVID gets worse after each re-infection and then gradually improves to near-baseline over 5-6 months each time. I have heard similar stories from other people.
I think I probably have a strong (maybe even overly strong) immune response to the viral antigens my body has seen, due to both past infections and the Pfizer 2-shot series, but the virus keeps mutating, and is good at evading the immune system, So, none of this was adequate.
Bupropion may be a S1R agonist. This may contribute to its antidepressant activity and also to its apparent benefit in COVID-19. It would be great to see COVID-19 RCTs testing bupropion.
Final article now published in issue: Association Between FIASMAs and Reduced Risk of Intubation or Death in Individuals Hospitalized for Severe COVID‐19: An Observational Multicenter Study - Hoertel - 2021 - Clinical Pharmacology & Therapeutics -Wiley
And there is also evidence from an observational study that SSRIs may reduce the risk for long COVID.
"...28% reduction in risk of PASC was observed for S1R agonist SSRIs and a 25% reduction in risk of PASC was observed for non-S1R agonist SSRIs..."
@LongTiredRoad
@AlisaValdesRod1
Also, many people with severe acute COVID have antibodies to serotonin 5-HT2A receptors, and these antibodies may activate those receptors as if they were serotonin. In this case a drug blocking that receptor (perhaps cyproheptadine or mirtazapine) might help.
@fasc1nate
@Ultracaustique
Here's what spicebush swallowtail caterpillars do if you tap them on the back. They stick put this weird Y-shaped smelly appendage that looks like a snake's tongue.
We need more COVID treatment options like fluvoxamine, especially considering the treatment-resistant COVID variants that have emerged. I'm glad to see that Platforma Catracha has been proactive in providing evidence-informed early COVID treatment for the people of Honduras.
Drug-evasive COVID variants are spreading globally. Very proud of our Fluvoxamine paper showing the world a safe and available option for all patients . Specially for those living in LMICs.
@dr_leshan
@farid__jalali
Will be nice to see the full results. I do think timing of treatment may be very important with fluvoxamine. Easier to stop inflammation before it gets far enough along to do significant damage.
Yes. Inhaled budesonide is in a similar situation. Dear doctors, *please* considering using fluvoxamine and/or inhaled budesonide to treat your high-risk covid outpatients. The randomized trial data are very, very clear on these two.
I'm discussing “Mechanisms of Repurposed Drugs for COVID19” with
@PierreKory
,
@DrRomie
, and 2nd Time Around. Saturday, Jun 12 at 9:00 AM CDT on
@clubhouse
. Join us!
Long-haulers who have had Novavax:
What is your experience with Novavax vs other COVID shots? Do NOT answer unless you have (or have had) Long COVID and have had Novavax.
SE=acute vaccine side effects (1st 2-3 days after shot), LC=long COVID symptom status since shot.
Interesting. The fluvoxamine mechanism described here is a type of antiviral mechanism requiring only low concentration of drug, which might explain why low dose would be effective for very early treatment.
1/ Here's an interesting paper. Seems that spike protein binds to lipopolysaccharide (LPS), which triggers inflammation. This is very consistent with my hypothesis that fluvoxamine's benefit for treating COVID involves activation of the S1R, which reduces cytokine production.
Well, I worked hard, along with
@EricLenze2
and many others on our STOP COVID 1&2 teams, but it was Ed Mills & his
@TogetherTrial
who ultimately got fluvoxamine over the line.
Study suggests very early treatment is needed to detect antiviral treatment effects (or else need huge sample size): Detection of significant antiviral drug effects on COVID-19 with reasonable sample sizes in randomized controlled trials: A modeling study
It looks like I never actually retweeted this, even though
@__ice9
requested all followers to do so, and I think this is potentially very important. Better late than never.
To all of my supposedly 7500+ followers (bots and dead accounts notwithstanding)--
I have one request:
𝗥𝗘𝗧𝗪𝗘𝗘𝗧 𝗧𝗛𝗜𝗦
It is the most important thing I have ever written.
Every critical care physician who reads this and understands it is worth decades of life saved.
I’m thinking we really need to accelerate trials of existing drugs repurposed to treat COVID. Vaccines may not be enough to get this under control any time soon.
Mutations of mutations ...
Now a new UK variant has BOTH the increased ability to infect people like B117 and the changes to the spike protein giving it the ability to evade vaccines 50% of the time like E484K ...
"I feel the need, the need for speed"
@nihillmatic
Did not take fluvoxamine for the first infection in March 2020. I thought of the idea while sick, but it was just a hypothesis at the time. I did take fluvoxamine the other 2 times. Also been taking it for long COVID, and I increased to max dose for acute COVID. Seems to help.
Real-world success with early use of repurposed drugs for treatment of COVID in Honduras. One predictor of worse outcome was if fluvoxamine was not given early enough in course of illness (started after 4 days).
ICER:
“… committee votes 11-2 that the evidence is not adequate to demonstrate a net health benefit for molnupiravir over symptomatic care alone; Paxlovid and fluvoxamine receive more favorable votes”