Compounded Medications for Long Haul Syndrome

Author: Bryana Gregory, PharmD, RPh, Physician Liaison

Are you suffering from long haul syndrome after having COVID or the COVID vaccine? Do you suffer from prolonged fatigue, difficulty sleeping, hair loss, headaches, loss of smell, decreased appetite, or brain fog, to name only a few? Are you looking for effective solutions to help you?

Today our Pharmacist and Physician Liaison at Physicians Preference Pharmacy, Bryana Gregory, will share with you compounds that can help nurture and restore your health as you navigate long haul syndrome.

First, what is long haul syndrome or long COVID?

Many patients experience prolonged illness after COVID-19. This is commonly known as ‘long COVID’, though it also referred to as ‘Long Haul COVID Syndrome (LHCS)’ or ‘Post-acute sequelae of COVID-19 (PASC)’.

Long COVID may persist for months after the acute infection and almost half of patients report reduced quality of life. At least 65 million individuals worldwide are estimated to have long COVID.

A puzzling feature of long COVID is that initial disease severity is not an accurate predictor; long COVID frequently occurs in people who had mild-to-moderate COVID cases, as well as in younger adults who did not require respiratory support or intensive care.

What are the symptoms of long COVID?

Many of the symptoms of long COVID are common to COVID-19 vaccine injury (also known as long vax); indeed, both conditions are considered manifestations of “spike protein-related disease” with a significant overlap in symptoms, pathogenesis, and treatment.

A major difference between long COVID and long vax is unresolved organizing pneumonia with persistent respiratory symptoms. Clinicians have also noted that long vax patients tend to have more severe illness due to a higher incidence and severity of neuropathic symptoms and dysautonomia.

Long COVID and long vax are heterogeneous syndromes, meaning their symptoms and clinical features vary widely in presentation, severity, and underlying causes or contributing factors. Both are characterized by the following symptoms:

• prolonged malaise
• headaches
• generalized fatigue
• sleep difficulties
• hair loss
• smell disorder
• decreased appetite
• painful joints
• dyspnea
• chest pain
• cognitive dysfunction
• prolonged neuropsychological symptoms, including multiple domains of cognition

The symptom set of long COVID is, in the majority of cases, very similar to chronic inflammatory response syndrome (CIRS)/myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). An important differentiating factor from CIRS is the observation that long COVID continues to improve on its own, albeit slowly in most cases.

Another important observation is that long COVID includes more young people compared to severe COVID, which affects older people or persons with comorbidities (the simultaneous presence of two or more diseases or medical conditions in a patient). Furthermore, the similarity between mast cell activation syndrome (MCAS) and long COVID has been observed, and many consider long COVID to be a variant of MCAS.

Why are long haul symptoms separated into groups, and what are those groups?

The clinical signs and symptoms can be grouped into the following clusters. The reason for this grouping is to allow organ-specific targeted therapy or individualized therapy:

• Respiratory: shortness of breath, congestion, persistent cough, etc.
• Neurological/psychiatric: brain fog, malaise, tiredness, headaches, migraines, depression, inability to focus or concentrate, altered cognition, insomnia, vertigo, panic attacks, tinnitus, anosmia, phantom smells, etc.
• Musculoskeletal: myalgias, fatigue, weakness, joint pains, inability to exercise, post-exertional malaise, inability to perform normal activities of daily life.
• Cardiovascular: palpitations, arrhythmias, Raynaud-like syndrome, hypotension, and tachycardia on exertion.
• Autonomic: postural tachycardia syndrome (POTs), abnormal sweating.
• Gastrointestinal disturbance: anorexia, weight gain, diarrhea, bloating, vomiting, nausea, etc.
• Dermatologic: itching, rashes, dermatographia.
• Mucus membranes: running nose, sneezing, burning and itchy eyes.

What is the recommended approach to addressing the symptoms of long COVID?

Long COVID, a prolonged illness after COVID-19, may persist for months or years after the acute infection. Patients with long COVID should be managed by healthcare professionals who have experience treating this condition. Early intervention is essential; the response to the protocol will likely be attenuated when time to initiation is delayed.

However, in general, it is likely that patients who did not receive adequate and early intervention (e.g., ivermectin, etc.) and adequate anti-inflammatory/macrophage repolarization support during the acute symptomatic phase of COVID-19 are more likely to develop long COVID.

What is the core problem in long COVID?

The core problem in long COVID is chronic “immune dysregulation.” The primary goal is to help the body to restore and normalize the immune system – in other words, to let the body heal itself. We recommend the use of immune-modulating agents and interventions to normalize the immune system rather than the use of immunosuppressant drugs, which may make the condition worse. However, the concomitant use of a controlled course of an immunosuppressant drug may be appropriate in patients with specific autoimmune conditions.

In addition to treating organizing pneumonia, as noted below, our suggested strategy involves two major approaches i) promote autophagy to help rid the cell of the spike protein and ii) interventions that limit the toxicity/pathogenicity of the spike protein.

Early intervention is essential and patient response will likely be attenuated when the protocol is delayed.

What should patients expect?

Patients should be started on the primary protocol; this should, however, be individualized according to the patient’s particular clinical features. The response to the primary protocol should dictate the addition or removal of additional therapeutic interventions. Second-line therapies should be started in those who have responded inadequately to core therapies and in patients with severe incapacitating disease.

NOTE: Patients with long COVID must not receive further COVID-19 vaccines of any type.

What are the compounds you offer at Physicians Preference Pharmacy to address the symptoms of long-haul syndrome?

• Ivermectin Capsule (BHA/Starch Free)
• Methylene Blue Capsule
• Sirolimus (rapamycin) Capsule
• Low Dose Naltrexone (LDN) Capsule
• Hydroxychloroquine Tablet (not compounded)
• Melatonin SR Capsule
• Vitamin D (compounded cream and non-compounded capsule)
• Sildenafil Sublingual Tablet
• Cortisol Slow Release (Hydrocortisone Capsule)
• Glutathione Sublingual Tablet and Topical Cream
• Vitamin A palmitate nasal spray
• Desiccated and bioidentical thyroid capsule

We Are Here to Help

Are you ready to get your life back? If you are experiencing symptoms from long COVID or long vax and want to learn more about our compounds for long haul, please call our pharmacists today with any questions at 281-828-9088. Our compounded preparations do require a prescription from your provider. It will be our privilege to serve you!