Two already-approved drugs may effectively treat the millions of Americans estimated to have long Covid.
Guanfacine, an Attention Deficit/Hyperactive Disorder (ADHD) drug sold under the name Tenex, and N-acetylcysteine (NAC), a concussion drug that is branded Mucomyst were found to reduce brain fog in two-thirds of patients.
Doctors at Yale University believe the combination protects the brain’s pre-frontal cortex from stress and inflammation – which can break down neural connections and cause the symptoms associated with brain fog.
While study was small – only on 12 patients – the researchers believe they have found an effective treatment for the elusive condition that is available at pharmacies right now.
The Centers for Disease Control and Prevention (CDC) reports that around eight percent of Americans are suffering long Covid, and more than 3,500 have died as a result.
NAC (left) is a concussion drug that strengthens the pre-frontal cortex and prevents brain damage from traumatic brain injuries. Guanfacine (right) is an ADHD medication that helps boost a person’s attention span by strengthening neural connections in a person’s pre-frontal cortex. They can combine to resolve symptoms of brain fog in long Covid patients
Long Covid is an umbrella term for the perplexing range of symptoms that last months after the initial Covid infection clears.
Brain fog is among the most common, along with chronic fatigue, loss of taste and smell and others.
Doctors have struggled to define the condition, let alone develop treatments and cures for its wide-ranging symptoms.
But Dr Arman Fesharaki-Zadeh, a neuropsychiatrist at Yale, in New Haven, Connecticut, decided to test Tenex and Mucomyst on patients – theorizing they combination could boost brain function.
He prescribed the drugs to 12 of his patients that had been living with debilitating cognitive and psychological issues for months.
Because the drugs are already approved by the Food and Drug Administration (FDA), clinicians are allowed to use them off-label – and they have been deemed safe.
Guanfacine received this approval from the FDA in 2009 to treat ADHD. The drug works by strengthening connections in the brain’s pre-frontal cortex.
This is the region of the brain responsible for memory, attention and general brain functioning. Its boost to a person’s attention span is why it works for ADHD.
Dr Arman Fesharaki-Zadeh (pictured), a neuropsychiatrist at Yale, tested the drug combo on 12 patients who were suffering brain fog after Covid infection. It resolved or significantly lessened symptoms in eight of them
The region is vulnerable to inflammation and stress, and these symptoms can cause neurons in this part of the brain to weaken.
As a result, a person will suffer a worse memory and attention – two primary symptoms of brain fog.
Gaunfacine differs from Adderall, the most well-known ADHD drug. The latter works by increasing levels of hormones like dopamine and norepinephrine in the brain – which helps a person stay attentive.
The CDC reports that 7.5 percent of Americans suffer from some long Covid, which includes virus-onset brain fog.
These patients are more likely to be female, and are more likely to be middle-aged or younger.
‘I was just struck by these younger folks who are being devastated by this disease that was continuing to persist,’ Dr Fesharaki-Zadeh said in a statement.
‘As a physician, in the beginning, I felt powerless.’
Because of this drug’s ability to rebuild this brain region, doctors will often prescribe it off-label to treat traumatic brain injuries.
Dr Fesharaki-Zadeh realized the same factors that caused memory loss after a hard hit to the head were also responsible for issues related to Covid – and started to treat them the same way.
He paired guanfacine with NAC, a drug that limits the permanent brain damage a person suffers after a concussion.
‘I had the idea of approaching the treatment from two different perspectives,’ he explained in a statement.
‘We wanted to attack this using a multi-model approach that took advantage of the synergistic relationship between NAC and guanfacine.’
It works similarly, defending neural connections in the pre-frontal cortex from getting broken down by stress and inflammation.
Over the past 14 months, he has prescribed this combination of drugs to 12 patients in his Connecticut clinic.
For the first month of treatment, patients took 1mg of guanfacine before bed and 600mg of NAC at some point during the day.
If they tolerated the drugs well throughout the first month, they would up the nightly dosage of guanfacine to 2mg beyond the first month.
In findings published last month in Neuroimmunology reports, Dr Fesharaki-Zadeh reports that eight patients reported either a severe reduction of symptoms – or their brain fog being resolved all together – within the next 14 months.
Two patients had to drop the regimen after suffering low blood pressure and dizziness – two known side effects of guanfacine.
The other two patients did not follow up on their treatment, so their results are unknown.
One of the patients who found success with the drug cocktail is a nurse whose brain fog symptoms were so severe she had to cut her hours at work.
While she first suffered dizziness from the guanfacine, the side effects eventually passed, and now she no longer suffers from brain fog and has returned to normal.
‘This was not a placebo-controlled trial, but anecdotes like this make one more confident that the relief is really due to the drug and not the placebo effect,’ Dr Amy Arnsten, a Yale neuroscientist who developed guanfacine and contributed to the report, said in a statement.
This was a relatively small study with only few patients and without a placebo group – meaning more research would be needed to prove the drug combo can fix brain fog.
But, because the drugs are available now, Dr Fesharaki-Zadeh recommends patients experiencing brain fog as their doctor for a prescription – citing this case report.
‘There’s a paucity of treatment out there for long COVID brain fog, so when I kept seeing the benefits of this treatment in patients, I felt a sense of urgency to disseminate this information,’ he said.
‘You don’t need to wait to be part of a research trial. You can ask your physician—these drugs are affordable and widely available.’
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