Two drugs already approved could effectively treat the millions of Americans estimated to have long been afflicted with Covid.
Guanfacine, an attention-deficit/hyperactivity disorder (ADHD) drug sold under the name Tenex, and N-acetylcysteine (NAC), a concussion drug branded Mucomyst, reduced brain fog in two-thirds of patients.
Yale University doctors believe the combination protects the brain’s prefrontal cortex from stress and inflammation — which can destroy neural connections and cause the symptoms associated with brain fog.
Although the study was small — on just 12 patients — the researchers believe they’ve found an effective treatment for the elusive condition — one that’s now available in pharmacies.
The Centers for Disease Control and Prevention (CDC) reports that around eight percent of Americans have had long-term illness from Covid and more than 3,500 have died as a result.
NAC (left) is a concussion drug that strengthens the prefrontal cortex and prevents damage from traumatic brain injury. Guanfacine (right) is an ADHD drug that helps increase a person’s attention span by strengthening the neural connections in a person’s prefrontal cortex. They can be combined to solve brain fog symptoms in long covid patients
Long Covid is an umbrella term for the bewildering array of symptoms that persist months after the initial Covid infection has cleared.
Brain fog is among the most common, along with chronic fatigue, loss of taste and smell, and others.
Physicians have struggled to define the condition, much less develop treatments and cures for its widespread symptoms.
But dr Arman Fesharaki-Zadeh, a neuropsychiatrist at Yale, in New Haven, Connecticut, decided to test Tenex and Mucomyst on patients on the theory that their combination could boost brain function.
He prescribed the drugs to 12 of his patients who had been living with debilitating cognitive and psychological problems 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’re considered safe.
Guanfacine received this approval from the FDA in 2009 for the treatment of ADHD. The drug works by strengthening connections in the brain’s prefrontal cortex.
This is the region of the brain responsible for memory, attention and general brain function. Its increase in a person’s attention span is why it works for ADHD.
dr Arman Fesharaki-Zadeh, a neuropsychiatrist at Yale, tested the drug combination on 12 patients suffering from brain fog after contracting Covid. It resolved or significantly reduced symptoms in eight of them
The region is prone to inflammation and stress, and these symptoms can cause neurons in that part of the brain to become weak.
As a result, a person suffers from poorer memory and attention – two main symptoms of brain fog.
Gaunfacine is different 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 alert.
The CDC reports that 7.5 percent of Americans have long-term Covid, which includes virus-induced brain fog.
These patients tend to be female and tend to be middle-aged or younger.
“I was just struck by these younger people who are devastated by this disease that continues to linger,” said Dr. Fesharaki-Zadeh in a statement.
“As a doctor, I felt powerless at first.”
Because of this drug’s ability to rebuild this brain region, doctors often prescribe it off-label to treat traumatic brain injuries.
dr Fesharaki-Zadeh realized the same factors that led to memory loss after a hard blow to the head were also responsible for Covid-related issues – and began treating them in the same way.
He combined 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 address this with a multi-model approach that takes advantage of the synergistic relationship between NAC and guanfacine.”
It works similarly, protecting the neural connections in the prefrontal cortex from being degraded by stress and inflammation.
Over the past 14 months, he has prescribed this combination of drugs to 12 patients at his Connecticut clinic.
For the first month of treatment, patients took guanfacine 1 mg at bedtime and NAC 600 mg at some time during the day.
If they tolerated the medication well during the first month, they would increase the nightly dosage of guanfacine to 2 mg beyond the first month.
In findings published in Neuroimmunology reports last month, Dr. Fesharaki-Zadeh reported that eight patients reported either a significant reduction in symptoms or resolution of their brain fog over the next 14 months.
Has Covid robbed you of your taste or smell? It could mean you have strong immunity
It doesn’t feel like it at the moment, but the loss of smell or taste during a Covid infection could be a good thing.
Scientists believe this is a sign of a strong immune response.
A study found that Covid patients suffering from anosmia – a loss of smell – or agueisia – a loss of taste – were twice as likely to have antibodies long after infection.
Previous research has shown that a strong immune response kills cells that live in the nose and are causing the symptoms.
But it could also be a warning sign of a bad Covid attack, as these cells are usually the first to be infected by the virus.
Two patients had to stop treatment after suffering from low blood pressure and dizziness – two known side effects of guanfacine.
Two other patients have not continued their treatment, so their results are unknown.
One of the patients who has had success with the drug cocktail is a nurse whose brain fog symptoms were so severe that she had to reduce her hours of work.
While she initially suffered from dizziness from guanfacine, the side effects eventually went away, and now she no longer suffers from brain fog and can function normally again.
“This was not a placebo-controlled study, but anecdotes like this give one more confidence that the relief is really due to the drug and not the placebo effect,” said 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 just a few patients and no placebo group — meaning more research would be needed to prove the drug combination could clear brain fog.
But now that the drugs are available, Dr. Fesharaki-Zadeh patients suffering from brain fog to ask their doctor for a prescription – citing this case report.
“There is a lack of treatment options for long Covid brain fog. So as I kept seeing the benefits of this treatment in patients, I felt a sense of urgency to share this information,” he said.
“You don’t have to wait until you’re part of a research experiment. You can ask your doctor – these drugs are affordable and widely available.’