Lifestyle
Pacing
Activity-management strategy that prevents and mitigates PEM.
37% moderate-to-much-better in TREATME study (n=119, Long COVID).
41 of 68 patients tried this41% improved
Treatment library
Browse Long COVID treatments
Filter by category to find what’s relevant to your symptoms.
Educational only. Not medical advice. Discuss any treatment with your clinician before starting.
Lifestyle
Salt and Fluid Loading
Increases blood volume, lowers plasma norepinephrine, reduces orthostatic tachycardia.
33% moderate-to-much-better in TREATME study (n=1,169, Long COVID).
38 of 68 patients tried this34% improved
Supplements & OTC
H1 Blocking Antihistamines (Cetirizine, Fexofenadine, etc.)
Cornerstone of MCAS treatment, often combined with H2 blockers for synergy.
25% moderate-to-much-better in TREATME study (n=759, Long COVID (2nd/3rd-gen H1)).
32 of 68 patients tried this34% improved
Medications
Low Dose Naltrexone (LDN)
Across multiple cohort studies, LDN improved fatigue, pain, energy and quality of life in 34–58% of Long COVID patients.
34% moderate-to-much-better in TREATME study (n=287, Long COVID).
28 of 68 patients tried this46% improved
Lifestyle
Compression Garments
Abdominal + full lower-body compression reduces heart rate and improves symptoms in POTS during head-up tilt.
26% moderate-to-much-better in TREATME study (n=430, Long COVID).
24 of 68 patients tried this33% improved
Supplements & OTC
Famotidine
May prevent SARS-CoV-2 spike protein entry into endothelial cells; attenuates cytokine storm.
20% moderate-to-much-better in TREATME study (n=300, Long COVID).
22 of 68 patients tried this27% improved
Medications
Beta Blockers
Low-dose propranolol has the strongest evidence in hyperadrenergic POTS — reduces heart rate and orthostatic intolerance, improves exercise capacity.
45% moderate-to-much-better in TREATME study (n=364, Long COVID (cardioselective + non-selective combined)).
21 of 68 patients tried this43% improved
Supplements & OTC
Nattokinase & Lumbrokinase
Fibrinolytic enzymes with antihypertensive, anti-atherosclerotic, lipid-lowering, antiplatelet and neuroprotective effects.
29% moderate-to-much-better in TREATME study (n=341, Long COVID (NK or LK)).
19 of 68 patients tried this37% improved
Medications
Ivabradine (Corlanor)
RCT in hyperadrenergic POTS showed significant heart-rate and quality-of-life improvements with no major side effects.
49% moderate-to-much-better in TREATME study (n=100, Long COVID).
14 of 68 patients tried this50% improved
Medications
Trazodone
ME/CFS experts report success for sleep improvement.
20% moderate-to-much-better in TREATME study (n=40, Long COVID (trazodone or nefazodone)).
14 of 68 patients tried this36% improved
Medications
Antivirals against SARS-CoV-2 (Paxlovid, Ensitrelvir)
Extended Paxlovid courses have shown promise in case series; the Valtrex + Celebrex + 15-day Paxlovid combination produced sustained fatigue improvements at 600+ days.
39% moderate-to-much-better in TREATME study (n=23, Long COVID, Paxlovid ≥10 days).
12 of 68 patients tried this42% improved
Medications
Pyridostigmine (Mestinon)
RCT in 45 ME/CFS patients showed pyridostigmine improved exercise capacity.
34% moderate-to-much-better in TREATME study (n=56, Long COVID).
11 of 68 patients tried this36% improved
Supplements & OTC
Nicotine Patches
Hypothesis: SARS-CoV-2 binds nicotinic acetylcholine receptors, disrupting cholinergic neuromodulation.
43% moderate-to-much-better in TREATME study (n=7, Long COVID (small sample)).
11 of 68 patients tried this45% improved
Medications
Oral Ketotifen
Dual-action: H1 receptor blocker AND mast-cell stabilizer.
24% moderate-to-much-better in TREATME study (n=50, Long COVID).
9 of 68 patients tried this44% improved
Medications
Clopidogrel (Plavix)
Study of 24 Long COVID patients with microthrombi markers: dual antiplatelet therapy (aspirin 75 mg + clopidogrel 75 mg) reduced microclots in all participants.
30% moderate-to-much-better in TREATME study (n=53, Long COVID).
9 of 68 patients tried this44% improved
Medications
Guanfacine ± NAC
Selective α2A-adrenoceptor agonist; case series of 12 Long COVID patients with cognitive impairment showed improvement in 8 with guanfacine + NAC (memory, concentration, executive function).
36% moderate-to-much-better in TREATME study (n=25, Long COVID, guanfacine + NAC).
9 of 68 patients tried this44% improved
Medications
Antivirals against herpesvirus reactivations
Multiple herpesviruses (EBV, VZV, CMV, HHV-6) can reactivate after COVID.
22.5% moderate-to-much-better in TREATME study (n=49, Long COVID (valacyclovir)).
8 of 68 patients tried this38% improved
Medications
Modafinil (Provigil)
Wakefulness-promoting agent with anti-inflammatory and neuroprotective mechanisms.
33% moderate-to-much-better in TREATME study (n=39, Long COVID (modafinil or armodafinil)).
8 of 68 patients tried this38% improved
Supplements & OTC
Oxaloacetate
2025 RCT in Long COVID missed primary fatigue endpoint but showed significant fatigue reduction on secondary endpoints and significant cognitive improvement.
29% moderate-to-much-better in TREATME study (n=14, Long COVID).
8 of 68 patients tried this38% improved
Medications
Maraviroc (± pravastatin)
Targets monocytic-endothelial-platelet axis dysregulation.
42% moderate-to-much-better in TREATME study (n=50, Long COVID).
7 of 68 patients tried this43% improved
Medications
Low Dose Aripiprazole (Abilify)
Stanford retrospective study of 101 ME/CFS patients: 74% experienced improvements in fatigue, brain fog, unrefreshing sleep, and PEM.
32% moderate-to-much-better in TREATME study (n=133, ME/CFS + Long COVID, ≤2 mg dose).
7 of 68 patients tried this43% improved
Lifestyle
Lymphatic Drainage Massage
Manual lymphatic drainage (MLD) and the Perrin Technique target glymphatic/lymphatic dysfunction in Long COVID.
14% moderate-to-much-better in TREATME study (n=14, Long COVID).
7 of 68 patients tried this29% improved
Medications
Midodrine
Effective for orthostatic hypotension and tachycardia in patients with normal/low-normal baseline BP.
26.5% moderate-to-much-better in TREATME study (n=49, Long COVID).
6 of 68 patients tried this33% improved
Medications
Intravenous / Subcutaneous Immunoglobulin (IVIG / SCIG)
Five papers on post-COVID small-fiber neuropathy show 60–100% response rates.
42% moderate-to-much-better in TREATME study (n=91, ME/CFS + Long COVID combined).
6 of 68 patients tried this67% improved
Medications
Cromolyn Sodium
Mast-cell stabilizer that reduces release of inflammatory mediators.
36% moderate-to-much-better in TREATME study (n=33, Long COVID (oral)).
5 of 68 patients tried this40% improved
Medications
GLP-1 Receptor Agonists (Tirzepatide, Semaglutide)
Emerging therapy.
Emerging therapy — not yet reported in the Harvard/Stanford TREATME study.
5 of 68 patients tried this80% improved
Procedures
Hyperbaric Oxygen Therapy (HBOT)
RCT in 73 Long COVID patients: 40 sessions → significant improvements in attention, sleep, pain, energy that persisted at 1 year.
38% moderate-to-much-better in TREATME study (n=13, Long COVID).
5 of 68 patients tried this40% improved
Medications
Rapamycin (low-dose)
Phase 1 trial in ME/CFS: weekly doses up to 6 mg significantly improved fatigue, sleep and orthostatic intolerance over 3 months.
22% moderate-to-much-better in TREATME study (n=18, Long COVID + ME/CFS).
4 of 68 patients tried this50% improved
Procedures
Stellate Ganglion / Sympathetic Field Blocks
Used for sympathetic-nervous-system conditions: CRPS, postherpetic neuralgia, refractory cardiac arrhythmias, anosmia, PTSD.
Emerging therapy — not yet reported in the Harvard/Stanford TREATME study.
4 of 68 patients tried this75% improved