Reviewed against the latest available evidence • Updated regularly as new research emerges
Long COVID is one of the most researched medical conditions in recent years, yet no single treatment has been proven to work for everyone. Hundreds of medications, supplements, rehabilitation strategies and therapies are discussed online. Some are supported by good evidence for specific symptoms, some show early promise, and others remain unproven.
This guide reviews the treatments most commonly discussed in research, specialist Long COVID clinics and patient communities. Rather than focusing on headlines or opinions, we explain what each treatment aims to do, what the current evidence shows and where it fits in Long COVID care today.
Our goal isn’t to recommend treatments, but to help you have better-informed conversations with your healthcare team.
One of the most important things to understand is that Long COVID is unlikely to be a single disease.
Different people may have different underlying biological mechanisms including immune dysregulation, autonomic dysfunction, viral persistence, endothelial dysfunction, mast cell activation and other processes. Because of this, the same treatment may help one person, have little effect on another, or even make symptoms worse.
It’s also important to remember that improving a symptom doesn’t necessarily mean the treatment is treating Long COVID itself. For example, treating iron deficiency, menopause, a bacterial infection or orthostatic intolerance may improve symptoms without addressing the underlying disease.
Throughout this guide, every treatment is reviewed using the same four questions:
- Why is it being discussed?
- What is it trying to treat?
- What does the evidence show?
- Where does it fit in Long COVID care today?
Evidence Ratings
- 🟢 Established clinical use – Established treatments that may help specific symptoms or co-existing conditions.
- 🟡 Promising early research – Encouraging evidence, but larger studies are still needed.
- 🔵 Limited clinical evidence – Research is ongoing, but current evidence is limited or conflicting.
- 🔴 Not supported for routine use – Current evidence does not support routine use in Long COVID.
How to Use This Guide
This is a searchable reference library
Every treatment follows the same format, helping you quickly understand why it’s being discussed, what it’s trying to treat, and what the current evidence shows. This guide is for educational purposes only and does not replace personalised medical advice. Many treatments discussed are prescribed off-label or remain experimental. Long COVID affects people differently, and treatment decisions should always be made with a qualified healthcare professional familiar with your medical history.
Treatments for Dysautonomia, POTS & Orthostatic Intolerance
Why this matters: Dizziness, a racing heart, palpitations, exercise intolerance and feeling worse when standing are common symptoms of Long COVID. The treatments below aim to improve these symptoms and quality of life. They do not treat the underlying causes of Long COVID itself.
- Does Midodrine Help Long COVID?
- Does Fludrocortisone Help Long COVID?
- Does Ivabradine Help Long COVID?
- Does Propranolol Help Long COVID?
- Does Pyridostigmine (Mestinon) Help Long COVID?
- Do Compression Stockings Help Long COVID?
- Do Electrolytes Help Long COVID?
- Does IV Saline Help Long COVID?
Not everyone with Long COVID has dysautonomia or POTS. The treatments below are primarily used for people with symptoms such as dizziness, palpitations, exercise intolerance or feeling worse when standing.
Does Midodrine Help Long COVID?
Why are people talking about it?
Unlike many treatments in this guide, Midodrine is not intended to treat Long COVID itself. It is prescribed to increase blood pressure in people with orthostatic hypotension and is sometimes used in people with Long COVID-related dysautonomia or POTS.
What does the current evidence say?
Evidence supporting Midodrine comes primarily from its established use in autonomic disorders rather than Long COVID-specific clinical trials. Some patients with orthostatic symptoms report improvement, but it does not address the underlying causes of Long COVID.
Current evidence status: 🟢 Established clinical use for orthostatic hypotension. It may help manage symptoms in selected people with Long COVID-related dysautonomia but is not a treatment for Long COVID itself.
Does Fludrocortisone Help Long COVID?
Why are people talking about it?
Fludrocortisone is often discussed by people with Long COVID who experience dizziness, light-headedness or symptoms that worsen when standing. By helping the body retain salt and water, it increases blood volume and is sometimes prescribed for people with dysautonomia or POTS.
What does the current evidence say?
Most evidence comes from its established use in autonomic disorders rather than Long COVID-specific studies. It may improve symptoms in carefully selected people with low blood volume or orthostatic intolerance, but it does not treat the underlying causes of Long COVID.
Current evidence status: 🟢 Established clinical use for selected autonomic disorders. It may help manage symptoms in some people with Long COVID-related dysautonomia but is not a treatment for Long COVID itself.
Does Ivabradine Help Long COVID?
Why are people talking about it?
If your main symptom is a racing heart rather than low blood pressure, you’ve probably come across Ivabradine. Unlike beta-blockers, it slows the heart rate without significantly lowering blood pressure, making it an option for some people with Long COVID-related dysautonomia.
What does the current evidence say?
Most evidence comes from studies in POTS and inappropriate sinus tachycardia rather than Long COVID itself. Early clinical experience is encouraging in selected patients, but Long COVID-specific evidence remains limited.
Current evidence status: 🔵 Limited clinical evidence. Ivabradine is prescribed by some specialists to manage tachycardia in selected people with Long COVID but is not an established treatment for the condition itself.
Does Propranolol Help Long COVID?
Why are people talking about it?
For some people, Long COVID causes a persistently fast heart rate, palpitations or symptoms that worsen with standing or minimal activity. Propranolol and other beta-blockers are sometimes prescribed to slow the heart rate and improve symptom control.
What does the current evidence say?
Propranolol has an established role in treating several cardiovascular conditions and is widely used in POTS and inappropriate sinus tachycardia. However, there is little Long COVID-specific research, and its role is to manage symptoms rather than treat Long COVID itself.
Current evidence status: 🟢 Established clinical use for heart rate control. It may help selected people with Long COVID-related tachycardia but is not a treatment for Long COVID itself.
Does Pyridostigmine (Mestinon) Help Long COVID?
Why are people talking about it?
Pyridostigmine, commonly known by the brand name Mestinon, has attracted increasing interest because it may improve autonomic function in some people with dysautonomia or POTS. It is being explored as a way of improving symptoms such as dizziness, fatigue and exercise intolerance.
What does the current evidence say?
Evidence comes mainly from studies in POTS and other autonomic disorders, with only limited Long COVID-specific research available. Some specialist clinics prescribe Pyridostigmine for carefully selected patients, but more research is needed to understand its role in Long COVID.
Current evidence status: 🔵 Limited clinical evidence. Pyridostigmine is being investigated as a treatment for Long COVID-related dysautonomia, but there is currently insufficient evidence to support its routine use.
Do Compression Stockings Help Long COVID?
Why are people talking about them?
Compression stockings are one of the simplest and most widely recommended strategies for managing Long COVID-related dysautonomia. By reducing blood pooling in the legs, they may improve blood flow back to the heart and brain when standing.
What does the current evidence say?
Compression therapy is recommended in clinical guidance for POTS and orthostatic intolerance and is widely used as part of symptom management. Although it does not treat Long COVID itself, many people find it helps reduce dizziness and improves standing tolerance.
Current evidence status: 🟢 Established supportive management. Compression stockings help manage symptoms of orthostatic intolerance and POTS rather than treat the underlying causes of Long COVID.
Do Electrolytes Help Long COVID?
Why are people talking about them?
Many people with Long COVID, particularly those with dysautonomia or POTS, are advised to increase their fluid and electrolyte intake. Replacing sodium and maintaining hydration may help support blood volume and reduce symptoms when standing.
What does the current evidence say?
Electrolyte solutions form part of standard management for many people with orthostatic intolerance and POTS. While they are not a treatment for Long COVID itself, they may improve symptoms in carefully selected individuals, especially when combined with adequate fluid intake and other supportive measures.
Current evidence status: 🟢 Established supportive management. Electrolytes may help manage symptoms of dysautonomia but are not a treatment for Long COVID.
Does IV Saline Help Long COVID?
Why are people talking about it?
Intravenous (IV) saline is occasionally used in people with severe dysautonomia or POTS who struggle to maintain blood volume despite increased fluid and salt intake. Some people with Long COVID report temporary symptom relief following IV saline infusions.
What does the current evidence say?
IV saline is sometimes used in specialist autonomic clinics for carefully selected people with severe orthostatic intolerance or POTS. While some patients report temporary symptom relief, evidence in Long COVID remains limited.
Current evidence status: 🔵 Limited clinical evidence. IV saline may have a role in selected patients under specialist supervision but is not an established treatment for Long COVID.
Key takeaway: The treatments in this section are designed to manage dysautonomia and orthostatic symptoms, not Long COVID itself. Managing symptoms can make a meaningful difference to quality of life, even when a treatment does not alter the underlying course of Long COVID.
Treatments for Fatigue, Brain Fog & Neuroinflammation
Why this matters: Fatigue, post-exertional malaise (PEM), brain fog and cognitive difficulties are among the most common and disabling symptoms of Long COVID. The treatments below are being investigated because researchers believe they may influence inflammation, immune function or the nervous system. At present, none has been proven to treat Long COVID itself.
Does Low-Dose Naltrexone (LDN) Help Long COVID?
Why are people talking about it?
Few medications have generated as much discussion in the Long COVID community as Low-Dose Naltrexone (LDN). Researchers are investigating whether it may reduce neuroinflammation and help regulate the immune system, making it a potential treatment for symptoms such as fatigue, pain and brain fog.
What does the current evidence say?
Several small studies and observational reports suggest LDN may be associated with improvements in fatigue, pain and cognitive symptoms in some people with Long COVID. However, the available studies are generally small, and larger, well-designed clinical trials are still needed before its effectiveness and safety can be established.
Current evidence status: 🟡 Promising early research. LDN is prescribed off-label by some clinicians and remains an active area of research, but it is not currently an established treatment for Long COVID.
Does Guanfacine Help Long COVID Brain Fog?
Why are people talking about it?
If brain fog is your biggest challenge, you’ve probably come across Guanfacine. Interest grew after a small clinical report suggested that Guanfacine, sometimes combined with the supplement N-acetylcysteine (NAC), might improve attention and executive function in some people with persistent cognitive symptoms.
What does the current evidence say?
Evidence remains very limited and is based mainly on small case series and early clinical experience. Larger clinical trials are needed before it is possible to know whether Guanfacine has a meaningful role in treating Long COVID-related cognitive symptoms.
Current evidence status: 🔵 Limited clinical evidence. Guanfacine is being investigated for Long COVID-related brain fog but is not an established treatment.
Does Fluvoxamine Help Long COVID?
Why are people talking about it?
Originally developed as an antidepressant, Fluvoxamine has attracted growing interest because researchers are investigating whether its anti-inflammatory and neurological effects could help some people with Long COVID, particularly those with persistent fatigue.
What does the current evidence say?
Recent clinical research has reported improvements in fatigue and quality of life in some participants. While these findings are encouraging, additional studies are needed to confirm who is most likely to benefit and whether the results can be reproduced.
Current evidence status: 🟡 Promising early research. Fluvoxamine is an active area of Long COVID research but is not currently an established treatment.
Does Modafinil Help Long COVID Fatigue?
Why are people talking about it?
Severe fatigue and difficulty staying mentally alert are among the most disabling symptoms of Long COVID. Because Modafinil promotes wakefulness, some clinicians have considered whether it might help selected people whose fatigue significantly affects daily life.
What does the current evidence say?
Evidence for Modafinil in Long COVID remains limited. Although it has an established role in other conditions associated with excessive daytime sleepiness, there is currently insufficient research to support its routine use in Long COVID.
Current evidence status: 🔵 Limited clinical evidence. Modafinil may be considered in carefully selected cases under specialist supervision but is not an established treatment for Long COVID.
Does Low-Dose Aripiprazole Help Long COVID?
Why are people talking about it?
Low-dose Aripiprazole has received increasing attention because of its use in some people with ME/CFS, a condition that shares several features with Long COVID, including fatigue, post-exertional malaise and cognitive difficulties.
What does the current evidence say?
Evidence in Long COVID is currently very limited, and much of the interest comes from clinical experience and research in related conditions rather than Long COVID-specific trials. More research is needed before its role can be established.
Current evidence status: 🔵 Limited clinical evidence. Low-dose Aripiprazole remains an experimental approach for Long COVID and is not an established treatment.
Key takeaway: Fatigue and brain fog are among the most challenging symptoms of Long COVID, but they are also some of the most difficult to treat. While several medications are being actively investigated, there is currently no established drug therapy that has been proven to consistently improve these symptoms across the wider Long COVID population.
Treatments for Histamine, Mast Cells & Allergic-Type Symptoms
Why this matters: Some people with Long COVID develop symptoms that resemble histamine intolerance or mast cell activation, including flushing, itching, hives, nasal congestion, dizziness, stomach problems, headaches or reactions to certain foods. Researchers are investigating whether abnormal mast cell activation contributes to symptoms in a subgroup of people with Long COVID. The treatments below aim to manage these symptoms and have not been proven to treat Long COVID itself.
Do Antihistamines Help Long COVID?
Why are people talking about them?
Antihistamines are among the most discussed medications for Long COVID, even by people who have never had allergies. The medicines most commonly mentioned include the H1 antihistamines cetirizine (Zyrtec), loratadine (Clarityn) and fexofenadine (Allegra), together with the H2 blocker famotidine (Pepcid). Researchers are investigating whether reducing histamine activity may improve symptoms in some people.
What does the current evidence say?
Small studies and clinical experience suggest antihistamines may improve symptoms in carefully selected people, particularly those with features suggestive of mast cell activation. However, the evidence remains limited, and larger clinical trials are needed to identify who, if anyone, is most likely to benefit.
Current evidence status: 🟡 Promising early research. Antihistamines are prescribed off-label by some clinicians but are not established treatments for Long COVID.
Does Ketotifen Help Long COVID?
Why are people talking about it?
If you’ve joined a Long COVID or MCAS support group, you’ve probably seen Ketotifen mentioned. Unlike standard antihistamines, Ketotifen also acts as a mast cell stabiliser, making it a treatment of interest when mast cell activation is suspected.
What does the current evidence say?
Evidence in Long COVID is currently limited and comes mainly from clinical experience and research into mast cell disorders rather than Long COVID-specific trials. More research is needed before its role can be established.
Current evidence status: 🔵 Limited clinical evidence. Ketotifen is used by some specialists in carefully selected patients but is not an established treatment for Long COVID.
Does Cromolyn (Sodium Cromoglicate) Help Long COVID?
Why are people talking about it?
Cromolyn, also known as sodium cromoglicate, is another mast cell stabiliser sometimes discussed by people with Long COVID who experience gastrointestinal symptoms, food sensitivities or suspected mast cell activation.
What does the current evidence say?
There are currently no high-quality clinical trials supporting Cromolyn for Long COVID. Interest is based largely on its established use in mast cell disorders and the theory that mast cell activation may contribute to symptoms in some patients.
Current evidence status: 🔵 Limited clinical evidence. Cromolyn may be considered in selected cases but is not an established treatment for Long COVID.
Does Montelukast Help Long COVID?
Why are people talking about it?
Montelukast is best known as an asthma medication, but it has also attracted interest because it blocks leukotrienes, inflammatory chemicals that may contribute to respiratory symptoms and inflammation in some people.
What does the current evidence say?
Evidence for Montelukast in Long COVID remains limited. Researchers are investigating whether it may help selected patients, particularly those with ongoing respiratory or allergic-type symptoms, but there is currently insufficient evidence to support routine use.
Current evidence status: 🔵 Limited clinical evidence. Montelukast is being investigated but is not an established treatment for Long COVID.
Does Famotidine Help Long COVID?
Why are people talking about it?
Although Famotidine is commonly used to reduce stomach acid, it also blocks H2 histamine receptors. This has led researchers to investigate whether it might influence symptoms in some people with Long COVID, particularly when combined with H1 antihistamines.
What does the current evidence say?
Early studies and clinical experience have reported possible benefits in some patients, but results remain inconsistent and larger clinical trials are needed. Famotidine should not be confused with treatments that directly target the underlying causes of Long COVID.
Current evidence status: 🟡 Promising early research. Famotidine is being investigated as part of histamine-targeted treatment strategies but is not an established treatment for Long COVID.
Key takeaway: Histamine and mast cell-targeted treatments have generated significant interest in Long COVID research and patient communities. While some people report symptom improvement, it remains unclear which patients, if any, are most likely to benefit. At present, these treatments are best viewed as an active area of research rather than established therapies for Long COVID.
Immune-Modulating Treatments
Why this matters: One of the biggest questions in Long COVID research is whether an overactive, underactive or dysregulated immune system continues to drive symptoms in some people. If that’s true, medications that modify the immune response could potentially help selected patients. The challenge is that Long COVID doesn’t appear to affect everyone’s immune system in the same way, which makes finding the right treatment much more complicated.
Do Corticosteroids Help Long COVID?
Why are people talking about them?
Corticosteroids are powerful anti-inflammatory medications used to treat many autoimmune and inflammatory conditions. It’s understandable that researchers have explored whether they could also help some people with Long COVID, particularly when ongoing inflammation is suspected.
So… do they treat Long COVID?
Current evidence does not support the routine use of corticosteroids for Long COVID. However, they remain important treatments for many other medical conditions, including autoimmune diseases, asthma flare-ups and inflammatory disorders. If your doctor prescribes corticosteroids, it’s important to understand what they’re treating, as it may be another diagnosed condition rather than Long COVID itself.
Current evidence status: 🔴 Current evidence does not support routine use for Long COVID. Corticosteroids remain established treatments for many inflammatory conditions when there is a recognised medical indication.
Does Hydroxychloroquine Help Long COVID?
Why are people talking about it?
Hydroxychloroquine is widely used to treat autoimmune diseases such as lupus and rheumatoid arthritis. Because immune dysregulation is one of the leading theories behind Long COVID, researchers have explored whether it might also have a role here.
So… does it treat Long COVID?
At present, there is no convincing evidence that Hydroxychloroquine improves Long COVID itself. However, it remains an important treatment for several autoimmune diseases. If someone with Long COVID also has an autoimmune condition, treating that condition may improve their overall health without necessarily treating Long COVID directly.
Current evidence status: 🔴 Current evidence does not support routine use for Long COVID. Hydroxychloroquine remains an established treatment for several autoimmune diseases.
Does Colchicine Help Long COVID?
Why are people talking about it?
Colchicine has been used for decades to reduce inflammation in conditions such as gout and recurrent pericarditis. Because it affects several inflammatory pathways, researchers have investigated whether it could also benefit some people with Long COVID.
So… does it treat Long COVID?
The theory is scientifically interesting, but the evidence is still evolving. Some early studies have reported encouraging findings, while others have shown little or no clear benefit. At the moment, there isn’t enough evidence to recommend Colchicine as a routine treatment for Long COVID. Like many medications in this guide, it may still be prescribed when there is another recognised medical reason.
Current evidence status: 🔵 Limited clinical evidence. Colchicine remains an active area of research but is not an established treatment for Long COVID.
Does IVIG Help Long COVID?
Why are people talking about it?
IVIG (intravenous immunoglobulin) is probably one of the treatments people ask about most often. It’s already used to treat a number of autoimmune and neurological conditions, so it’s understandable that researchers are exploring whether carefully selected people with Long COVID could also benefit.
So… does it treat Long COVID?
The honest answer is we don’t know yet. Early research is encouraging for some patient groups, but studies remain small and IVIG is expensive, resource-intensive and not without risks. Larger clinical trials are needed before doctors know who, if anyone, is most likely to benefit.
Current evidence status: 🔵 Limited clinical evidence. IVIG remains an experimental treatment for Long COVID and should only be considered under specialist supervision.
Does SCIG Help Long COVID?
Why are people talking about it?
SCIG (subcutaneous immunoglobulin) works in a similar way to IVIG but is given under the skin rather than into a vein. Some people wonder whether it could offer similar benefits with greater convenience.
So… does it treat Long COVID?
At the moment, there is very little research looking specifically at SCIG in Long COVID. Most experience comes from other immune conditions where immunoglobulin therapy is already an established treatment.
Current evidence status: 🔵 Limited clinical evidence. There is currently insufficient evidence to support SCIG as a treatment for Long COVID.
Does Rapamycin Help Long COVID?
Why are people talking about it?
Rapamycin has attracted growing interest because it influences important pathways involved in immune regulation, inflammation and cellular ageing. Researchers are investigating whether these effects could be relevant in some people with Long COVID.
So… does it treat Long COVID?
Right now, it’s far too early to know. Most of the interest comes from laboratory research and early clinical studies rather than large trials in people with Long COVID. More research is needed to understand both its potential benefits and its risks.
Current evidence status: 🔵 Limited clinical evidence. Rapamycin remains an experimental treatment for Long COVID.
Do JAK Inhibitors Help Long COVID?
Why are people talking about them?
JAK inhibitors, such as Baricitinib, are already used to treat several autoimmune and inflammatory diseases. Because they target specific immune pathways, researchers are exploring whether they could help carefully selected people with Long COVID.
So… do they treat Long COVID?
This remains an active area of research. At present, there isn’t enough evidence to recommend JAK inhibitors as routine treatments for Long COVID, and they can have significant side effects that require careful specialist monitoring.
Current evidence status: 🔵 Limited clinical evidence. JAK inhibitors remain experimental treatments for Long COVID and should only be used under specialist supervision.
Key takeaway: Immune-modulating medications are among the most scientifically interesting treatments being investigated for Long COVID. Some may eventually prove helpful for carefully selected groups of patients, while others may not. For now, the most important question isn’t simply “Does this medication work?” but “What is this medication trying to treat?” Understanding that distinction makes it much easier to interpret new research and discuss treatment options with your healthcare team. rather than established therapies for Long COVID as a whole.
Antiviral Treatments & Viral Reactivation
Why this matters: One of the biggest questions in Long COVID research is whether viruses continue to play a role after the initial infection. Researchers are investigating two main possibilities. The first is that SARS-CoV-2 may persist in some people. The second is that Long COVID may be associated with the reactivation of dormant viruses, such as Epstein-Barr virus (EBV) or herpes simplex virus (HSV), in a subgroup of patients. These are active areas of research, but they are not yet proven explanations for everyone with Long COVID.
Can Antiviral Medications Treat Long COVID?
Why are people talking about them?
If you’ve spent time reading about viral persistence or EBV reactivation, you’ve almost certainly come across antiviral medications. The theory is simple: if an active virus is contributing to symptoms, reducing viral activity might improve health. It’s a logical question—and one researchers around the world are actively investigating.
What problem are researchers trying to treat?
Depending on the medication, the goal may be to target persistent SARS-CoV-2, reactivated herpes viruses such as EBV or HSV, or another diagnosed viral infection. These are different situations, and it’s important not to assume they are all the same.
So… do antivirals treat Long COVID?
The honest answer is we don’t know yet. Some studies have reported encouraging findings, while others have found little or no benefit. It’s possible that antiviral medications may help a subgroup of patients, but researchers are still trying to understand who those patients might be.
Current evidence status: 🔵 Limited clinical evidence. Antiviral medications remain an active area of Long COVID research but are not established treatments for Long COVID.
Does Paxlovid Help Long COVID?
Why are people talking about it?
Paxlovid quickly became one of the most talked-about Long COVID treatments after researchers began asking whether persistent SARS-CoV-2 could be contributing to ongoing symptoms.
What problem is it trying to treat?
Paxlovid is designed to reduce replication of the SARS-CoV-2 virus. Researchers are investigating whether it could benefit people if viral persistence proves to be part of their illness.
So… does it treat Long COVID?
At the moment, the answer remains uncertain. Some early reports generated excitement, but larger studies have not shown consistent benefits across all patients. Researchers continue to investigate whether specific groups of people might benefit.
Current evidence status: 🔵 Limited clinical evidence. Paxlovid remains under investigation and is not an established treatment for Long COVID.
Does Remdesivir Help Long COVID?
Why are people talking about it?
Remdesivir was one of the first antiviral drugs used to treat acute COVID-19, making it a natural candidate for researchers investigating viral persistence.
What problem is it trying to treat?
Like Paxlovid, the aim is to reduce any ongoing SARS-CoV-2 activity if it is contributing to Long COVID symptoms.
So… does it treat Long COVID?
So far, current research has not shown convincing benefits in people with established Long COVID. Research into antiviral strategies continues, but routine use is not supported.
Current evidence status: 🔴 Current evidence does not support routine use for Long COVID.
Does Molnupiravir Help Long COVID?
Why are people talking about it?
Molnupiravir is another antiviral originally developed for acute COVID-19. Researchers have explored whether antiviral treatment could reduce the risk of Long COVID or improve symptoms after the condition has developed.
What problem is it trying to treat?
Its primary target is SARS-CoV-2, particularly during the early stages of infection.
So… does it treat Long COVID?
Most research has focused on preventing Long COVID rather than treating established illness. At present, there is no good-quality evidence that Molnupiravir improves Long COVID once symptoms have become established.
Current evidence status: 🔴 Current evidence does not support routine use for established Long COVID.
Treating Viral Reactivation
Some people with Long COVID are also found to have evidence of reactivated viruses such as Epstein-Barr virus (EBV), herpes simplex virus (HSV) or varicella-zoster virus (VZV). Researchers are investigating whether viral reactivation contributes to symptoms in a subgroup of patients.
It’s important to remember that treating viral reactivation and treating Long COVID are not necessarily the same thing. If an antiviral improves symptoms by treating another diagnosed viral illness, that doesn’t automatically mean it is treating Long COVID itself.
Does Valacyclovir (Valtrex) Help Long COVID?
Why are people talking about it?
Valacyclovir is commonly discussed because it’s used to treat herpes viruses such as HSV and shingles, and some doctors also prescribe it when clinically significant herpes virus reactivation is suspected.
What problem is it trying to treat?
Valacyclovir treats herpes virus infections—it does not target SARS-CoV-2.
So… does it treat Long COVID?
There is currently no good-quality evidence that Valacyclovir treats Long COVID itself. However, if someone has a diagnosed herpes virus infection or clinically significant viral reactivation, treating that infection may improve their overall health and reduce symptoms that overlap with Long COVID. Those are two different goals.
Current evidence status: 🟢 Established clinical use for herpes virus infections. It is not an established treatment for Long COVID itself.
Does Acyclovir Help Long COVID?
Why are people talking about it?
Acyclovir is closely related to Valacyclovir and appears in Long COVID discussions for the same reason—its role in treating herpes virus infections.
What problem is it trying to treat?
Acyclovir is designed to treat infections caused by herpes viruses such as HSV and VZV.
So… does it treat Long COVID?
There is currently no convincing evidence that Acyclovir treats Long COVID itself. However, it remains an important treatment for recognised herpes virus infections where antiviral therapy is appropriate.
Current evidence status: 🟢 Established clinical use for herpes virus infections. It is not an established treatment for Long COVID.
Does Valganciclovir Help Long COVID?
Why are people talking about it?
Valganciclovir occasionally appears in discussions about Long COVID because it is active against viruses such as cytomegalovirus (CMV) and has also been studied in some people with ME/CFS who were thought to have evidence of herpes virus reactivation.
What problem is it trying to treat?
The aim is to treat specific viral infections or clinically significant viral reactivation—not Long COVID itself.
So… does it treat Long COVID?
There is currently insufficient evidence to support Valganciclovir as a routine treatment for Long COVID. Because it can cause significant side effects, it should only be used when there is a recognised medical indication and appropriate specialist supervision.
Current evidence status: 🔵 Limited clinical evidence. Valganciclovir remains an experimental approach in the context of Long COVID.
Key takeaway: Antiviral medications are trying to answer an important scientific question: are ongoing viruses contributing to symptoms in some people with Long COVID? It’s a compelling theory, but one that is still being tested. For now, antiviral medications remain established treatments for specific viral infections, while their role in Long COVID continues to be investigated.nt, no antiviral medication has been proven to consistently treat Long COVID, although research is continuing rapidly.
Hormones, Metabolism & Nutritional Deficiencies
Why this matters: Long COVID doesn’t happen in isolation. Hormones, vitamin deficiencies and underlying metabolic conditions can all influence how you feel. Correcting a deficiency or treating menopause won’t cure Long COVID, but it may improve symptoms that overlap with it, such as fatigue, brain fog, poor sleep or reduced exercise tolerance.
Does HRT Help Long COVID?
Why are people talking about it?
If you’ve noticed your symptoms become worse before your period, during perimenopause or after menopause, you’re certainly not alone. Many women with Long COVID describe the same pattern, which has led researchers to investigate whether hormones such as oestrogen, progesterone and testosterone influence the immune system, nervous system and blood vessels.
So… does it actually help?
There is currently no good-quality evidence that Hormone Replacement Therapy (HRT) treats Long COVID itself. However, treating menopause or hormone deficiency may improve symptoms that overlap with Long COVID, including poor sleep, fatigue, brain fog and hot flushes. Researchers are still trying to understand whether hormonal changes play a direct role in Long COVID.
Current evidence status: 🟢 Established clinical use for menopause and hormone deficiency. HRT should not be considered a treatment for Long COVID itself, but it may improve quality of life in people whose symptoms overlap with perimenopause or menopause.
Does Testosterone Help Long COVID?
Why are people talking about it?
Testosterone is increasingly being discussed because low levels can contribute to fatigue, muscle weakness, reduced exercise capacity and low mood. Researchers are investigating whether hormone deficiencies might explain some symptoms in a subgroup of people with Long COVID.
So… does it actually help?
There is currently no evidence that testosterone treats Long COVID itself. However, testosterone replacement remains an established treatment for people with confirmed testosterone deficiency and should only be considered after appropriate medical assessment.
Current evidence status: 🟢 Established clinical use for testosterone deficiency. It is not an established treatment for Long COVID.
Do Iron Infusions Help Long COVID?
Why are people talking about them?
Fatigue is one of the most common symptoms of Long COVID, but it can also be caused by iron deficiency. Researchers are also investigating whether changes in iron metabolism contribute to Long COVID in some people, making this an active area of research.
So… do they actually help?
Iron infusions do not treat Long COVID itself. However, correcting iron deficiency—particularly when oral iron has failed or isn’t suitable—may improve symptoms related to low iron stores. That’s why checking for treatable causes of fatigue remains an important part of Long COVID care.
Current evidence status: 🟢 Established clinical use for iron deficiency. Iron infusions treat iron deficiency, not Long COVID, but they may improve symptoms when both conditions coexist.
Do Vitamin B12 Injections Help Long COVID?
Why are people talking about them?
Brain fog, fatigue and tingling sensations are common in both Long COVID and vitamin B12 deficiency, so it’s understandable that many people wonder whether B12 injections could help.
So… do they actually help?
There is currently no evidence that vitamin B12 injections treat Long COVID itself. However, identifying and correcting vitamin B12 deficiency is important because untreated deficiency can cause serious neurological problems and symptoms that overlap with Long COVID.
Current evidence status: 🟢 Established clinical use for vitamin B12 deficiency. Vitamin B12 injections treat deficiency, not Long COVID itself.
Does Vitamin D Help Long COVID?
Why are people talking about it?
Vitamin D has been discussed since the early days of the pandemic because of its role in bone health, the immune system and muscle function. Many people with Long COVID also ask whether low vitamin D could be contributing to ongoing symptoms.
So… does it actually help?
Correcting vitamin D deficiency is good medical practice and may improve symptoms related to deficiency. However, there is currently no convincing evidence that vitamin D supplementation improves Long COVID in people with normal vitamin D levels.
Current evidence status: 🟢 Established clinical use for vitamin D deficiency. Vitamin D replacement treats deficiency, not Long COVID itself.
Does Metformin Help Long COVID?
Why are people talking about it?
Metformin attracted attention after studies suggested it might reduce the risk of developing Long COVID when taken during acute COVID-19. More recently, researchers have investigated whether it might also help people already living with Long COVID.
So… does it actually help?
At present, there is no convincing evidence that Metformin improves established Long COVID. Its strongest evidence relates to reducing the risk of Long COVID when used early during acute infection in selected patients rather than treating symptoms once Long COVID has developed.
Current evidence status: 🔵 Limited clinical evidence. Metformin continues to be studied but is not an established treatment for Long COVID.
Do GLP-1 Medications Help Long COVID?
Why are people talking about them?
Medications such as Semaglutide (Ozempic®, Wegovy®) and Tirzepatide (Mounjaro®, Zepbound®) have attracted growing interest because researchers are investigating whether their effects on inflammation, metabolism and weight regulation could influence Long COVID symptoms in some people.
So… do they actually help?
Clinical trials are underway, but it is still too early to know whether GLP-1 medications have a meaningful role in treating Long COVID. Until more evidence becomes available, they should be considered an active area of research rather than an established treatment.
Current evidence status: 🟡 Promising early research. GLP-1 medications are being actively studied but are not established treatments for Long COVID.
Key takeaway: Sometimes the best way to improve life with Long COVID isn’t by finding a new treatment—it’s by identifying something else that can be treated. Correcting iron deficiency, managing menopause or replacing low vitamin B12 won’t cure Long COVID, but it may remove additional barriers to recovery and improve day-to-day quality of life.
Treatments for Pain, Headaches & Neurological Symptoms
Why this matters: Long COVID isn’t just about fatigue. Many people also develop burning pain, tingling, headaches, migraines, muscle pain or symptoms suggestive of small fibre neuropathy. The treatments below aim to reduce these symptoms and improve quality of life. They do not treat the underlying causes of Long COVID itself.
Does Gabapentin Help Long COVID?
Why are people talking about it?
If you’ve developed burning pain, tingling, electric shock sensations or nerve pain since COVID, you’ve probably come across Gabapentin. It’s commonly prescribed for neuropathic pain and is sometimes used when Long COVID affects the nervous system.
So… does it actually help?
There are currently no high-quality studies showing that Gabapentin treats Long COVID itself. However, it has an established role in treating neuropathic pain from many different causes and may help people whose symptoms are consistent with nerve pain.
Current evidence status: 🟢 Established clinical use for neuropathic pain. Gabapentin may help manage nerve pain associated with Long COVID but is not a treatment for Long COVID itself.
Does Pregabalin Help Long COVID?
Why are people talking about it?
Pregabalin works in a similar way to Gabapentin and is often discussed by people living with nerve pain, burning sensations or widespread pain after COVID. For some people, it may also improve sleep disrupted by chronic pain.
So… does it actually help?
Like Gabapentin, Pregabalin has an established role in treating neuropathic pain but has not been proven to treat Long COVID itself. If nerve pain is one of your main symptoms, your clinician may consider it as part of symptom management.
Current evidence status: 🟢 Established clinical use for neuropathic pain. It may help manage symptoms in selected people but is not a treatment for Long COVID.
Does Duloxetine Help Long COVID?
Why are people talking about it?
Although Duloxetine is best known as an antidepressant, it’s also widely used to treat chronic nerve pain and fibromyalgia. Because some people with Long COVID experience similar symptoms, it has become part of the conversation.
So… does it actually help?
There is currently no convincing evidence that Duloxetine treats Long COVID itself. However, it remains an established treatment for several chronic pain conditions and may be appropriate when those conditions overlap with Long COVID.
Current evidence status: 🟢 Established clinical use for neuropathic pain and chronic pain syndromes. It is not an established treatment for Long COVID.
Does Amitriptyline Help Long COVID?
Why are people talking about it?
Amitriptyline has been used for decades in low doses to treat chronic pain, migraines and nerve pain. It’s sometimes prescribed to people with Long COVID whose headaches, sleep problems or neuropathic pain are particularly troublesome.
So… does it actually help?
There is currently no evidence that Amitriptyline changes the course of Long COVID. However, it may improve symptoms such as chronic headaches, migraine or nerve pain in carefully selected patients.
Current evidence status: 🟢 Established clinical use for chronic pain and migraine prevention. It treats specific symptoms rather than Long COVID itself.
Does Topiramate Help Long COVID?
Why are people talking about it?
Some people develop frequent migraines or persistent headaches after COVID. Topiramate is a medication commonly used to prevent migraines, which is why it occasionally appears in Long COVID discussions.
So… does it actually help?
Topiramate has not been shown to treat Long COVID itself. However, if Long COVID has triggered a migraine disorder, treating the migraine may significantly improve day-to-day quality of life.
Current evidence status: 🟢 Established clinical use for migraine prevention. It is not a treatment for Long COVID itself.
Key takeaway: Living with less pain doesn’t necessarily mean Long COVID has improved—but it can make a huge difference to everyday life. Treating headaches, migraines or neuropathic pain won’t cure Long COVID, but for many people it can make work, sleep and daily activities much more manageable.
Treatments Targeting Blood Flow, Blood Vessels & Clotting
Why this matters: Researchers increasingly believe that changes affecting blood vessels, the lining of blood vessels (the endothelium), the smallest blood vessels (the microcirculation) and blood clotting may contribute to Long COVID in at least some people.
Over the past few years, studies have reported findings including endothelial dysfunction, microvascular abnormalities, pulmonary microangiopathy, changes in blood clotting and microclots. At present, researchers still don’t know whether these represent different processes or different parts of the same biological pathway. They also don’t know whether they occur in everyone with Long COVID or only in specific subgroups.
The treatments below aim to improve blood flow or reduce abnormal clotting in carefully selected situations. They should not be considered routine treatments for Long COVID itself.
Does Aspirin Help Long COVID?
Why are people talking about it?
If you’ve read about microclots, endothelial dysfunction or abnormal blood clotting, Aspirin has probably appeared somewhere along the way. Because it reduces platelet activity, researchers are investigating whether it could improve blood flow or reduce abnormal clotting in some people with Long COVID.
What problem is it trying to treat?
The aim is not to treat Long COVID directly, but to reduce platelet activation if abnormal clotting or impaired microcirculation is contributing to symptoms.
So… does it treat Long COVID?
At the moment, there isn’t a clear answer. Aspirin is an established treatment for several cardiovascular conditions, but there is currently no good-quality evidence that it routinely improves Long COVID. Like all medicines that affect blood clotting, it also carries a risk of bleeding.
Current evidence status: 🔵 Limited clinical evidence. Aspirin should only be used when there is an appropriate medical indication or under medical supervision.
Do Blood Thinners Help Long COVID?
Why are people talking about them?
Blood thinners, also called anticoagulants, became a major topic of discussion after researchers proposed that abnormalities affecting blood clotting, endothelial function or the microcirculation might contribute to symptoms in some people with Long COVID.
What problem are they trying to treat?
The goal is to improve blood flow and reduce abnormal clotting in patients where these mechanisms are thought to be contributing to symptoms. Anticoagulants are also established treatments for many other vascular conditions, including deep vein thrombosis (DVT), pulmonary embolism (PE) and antiphospholipid syndrome (APS).
So… do they treat Long COVID?
This remains one of the most debated areas of Long COVID research. Some early studies and clinical reports have suggested possible benefits in selected patients, while others have not shown clear improvements. Researchers are still trying to identify whether anticoagulation benefits a specific subgroup rather than everyone with Long COVID.
Current evidence status: 🔵 Limited clinical evidence. Anticoagulants remain an active area of research but are not established treatments for Long COVID itself.
Does Rivaroxaban (Xarelto®) Help Long COVID?
Why are people talking about it?
Rivaroxaban is one of the anticoagulants most frequently mentioned in Long COVID discussions, particularly when doctors suspect abnormalities affecting blood clotting, endothelial function or the small blood vessels.
What problem is it trying to treat?
Rivaroxaban is designed to prevent or treat blood clots. In Long COVID, researchers are investigating whether it may also improve symptoms in carefully selected patients with evidence of vascular abnormalities.
So… does it treat Long COVID?
There is currently no convincing evidence that Rivaroxaban treats Long COVID itself. However, if someone has another recognised condition requiring anticoagulation—such as a previous blood clot or another vascular disorder—it remains an important and well-established treatment. Researchers continue to investigate whether selected people with Long COVID may also benefit.
Current evidence status: 🟢 Established clinical use for preventing and treating blood clots. It is not an established treatment for Long COVID itself.
Does Apixaban (Eliquis®) Help Long COVID?
Why are people talking about it?
Apixaban is discussed for much the same reason as Rivaroxaban. Interest comes from research exploring whether improving blood flow or reducing abnormal clotting could help some people with Long COVID.
What problem is it trying to treat?
Like other direct oral anticoagulants, Apixaban is used to prevent and treat blood clots. Researchers are investigating whether these same mechanisms could benefit carefully selected Long COVID patients.
So… does it treat Long COVID?
At present, there is no good-quality evidence that Apixaban routinely improves Long COVID symptoms. However, it remains an established treatment for recognised clotting disorders and other approved medical conditions.
Current evidence status: 🟢 Established clinical use for preventing and treating blood clots. It is not an established treatment for Long COVID itself.
Does Triple Therapy Help Long COVID?
Why are people talking about it?
If you’ve researched microclots, you’ve probably come across triple therapy. This approach combines several medications that affect platelet function and blood clotting and was developed from the theory that abnormalities in clotting or the microcirculation may contribute to symptoms in some people with Long COVID.
What problem is it trying to treat?
The aim is to improve blood flow in carefully selected patients where abnormal clotting is suspected to play a role.
So… does it treat Long COVID?
At present, evidence comes mainly from small observational studies and clinical experience. There are no large randomised clinical trials showing that triple therapy is safe or effective for Long COVID. Because combining blood-thinning medications substantially increases the risk of bleeding, this approach should only be considered under specialist supervision.
Current evidence status: 🔵 Limited clinical evidence. Triple therapy remains experimental and is not an established treatment for Long COVID.
Key takeaway: Blood vessels are much more than simple pipes. They help regulate blood flow, oxygen delivery, inflammation and many other vital functions. Researchers are actively investigating whether problems affecting the endothelium, the microcirculation or blood clotting contribute to Long COVID in some people. While this remains one of the most promising areas of research, it’s also one of the most complex. For now, treatments that affect blood clotting should be viewed as established therapies for recognised vascular conditions and as experimental approaches for Long COVID until stronger evidence becomes available.here is a subgroup of patients who could benefit while balancing the very real risks of bleeding.
Worth knowing: It’s possible to believe that microclots or blood vessel changes play a role in Long COVID andrecognise that the best treatment is still unknown. Those two ideas are not contradictory.
Treatments for Coexisting Conditions
Why this matters: Living with Long COVID doesn’t stop you developing other medical conditions. Some people are diagnosed with bacterial infections, viral reactivation, fungal infections or other illnesses that require treatment in their own right. Treating these conditions may improve symptoms and quality of life, but it doesn’t necessarily mean the treatment is acting directly on Long COVID.
Why Are Antibiotics Sometimes Prescribed to People with Long COVID?
Why are people talking about them?
At first glance, antibiotics might seem like an unusual treatment for a condition that usually begins with a viral infection. However, there are several legitimate reasons why someone living with Long COVID might be prescribed one.
Some antibiotics, particularly Azithromycin, also have anti-inflammatory and immunomodulatory effects and are already used at low doses in certain chronic respiratory diseases. In other situations, a doctor may diagnose a bacterial infection—such as pneumonia, sinusitis or a urinary tract infection—or investigate another condition, including Lyme disease, where antibiotic treatment may be appropriate.
What problem are they trying to treat?
Depending on the situation, antibiotics may be used to:
- Treat a confirmed bacterial infection.
- Reduce inflammation in selected chronic respiratory conditions.
- Treat another diagnosed medical condition where antibiotics are the recognised standard of care.
So… do antibiotics treat Long COVID?
Current evidence does not support the routine use of antibiotics to treat Long COVID itself. However, treating a confirmed bacterial infection or another diagnosed condition may significantly improve health and reduce symptoms that overlap with Long COVID. These are two different goals, and it’s important not to confuse them.
Current evidence status: 🔵 Limited clinical evidence. Antibiotics remain essential treatments for diagnosed bacterial infections and certain inflammatory conditions, but they are not established treatments for Long COVID itself.
Does Azithromycin Help Long COVID?
Why are people talking about it?
Azithromycin deserves separate mention because it’s discussed for more than one reason. As well as treating bacterial infections, it has anti-inflammatory and immunomodulatory properties and is already prescribed at low doses in some chronic lung diseases. Researchers are investigating whether these effects could benefit selected people with Long COVID.
What problem is it trying to treat?
Depending on the clinical situation, Azithromycin may be used to treat a bacterial infection or to reduce airway inflammation in specific chronic respiratory conditions.
So… does it treat Long COVID?
At present, there isn’t enough good-quality evidence to recommend Azithromycin as a routine treatment for Long COVID. If your doctor prescribes it, it’s important to understand what condition they’re trying to treat.
Current evidence status: 🔵 Limited clinical evidence. Azithromycin remains an active area of research but is not an established treatment for Long COVID.
Does Doxycycline Help Long COVID?
Why are people talking about it?
Doxycycline occasionally appears in Long COVID discussions because it has both antibiotic and anti-inflammatory properties. It may also be prescribed when doctors suspect another condition requiring antibiotic treatment, including certain tick-borne infections where clinically appropriate.
What problem is it trying to treat?
Doxycycline is primarily used to treat bacterial infections. In some situations, clinicians may prescribe it for its recognised anti-inflammatory effects or to treat another diagnosed condition rather than Long COVID itself.
So… does it treat Long COVID?
There is currently no convincing evidence that Doxycycline treats Long COVID. However, it remains an established treatment for several bacterial infections and other recognised medical conditions where appropriate.
Current evidence status: 🟢 Established clinical use for recognised bacterial infections. It is not an established treatment for Long COVID itself.
Do Antifungal Medications Help Long COVID?
Why are people talking about them?
Some people living with Long COVID also develop fungal infections, such as oral thrush, particularly after repeated courses of antibiotics or other medical treatments. Others wonder whether immune dysregulation may contribute to fungal infections in some individuals, although this remains an area of ongoing research.
What problem are they trying to treat?
Antifungal medications are designed to treat diagnosed fungal infections. They are not intended to treat Long COVID itself.
So… do they treat Long COVID?
There is currently no evidence that antifungal medications treat Long COVID directly. However, if someone has a confirmed fungal infection, treating that infection may improve their overall health and reduce symptoms that overlap with Long COVID.
Current evidence status: 🟢 Established clinical use for diagnosed fungal infections. They are not established treatments for Long COVID itself.
Does Ivermectin Help Long COVID?
Why are people talking about it?
Few medications have generated as much debate as Ivermectin. During the COVID-19 pandemic, it became the subject of intense public interest, and some people with Long COVID have reported improvements while taking it.
What problem is it trying to treat?
Ivermectin is an established treatment for specific parasitic infections. Researchers have also investigated whether it might have antiviral or anti-inflammatory effects, but these remain unproven in Long COVID.
So… does it treat Long COVID?
Some people report feeling better while taking Ivermectin, but current research has not demonstrated that it is an effective routine treatment for Long COVID. Reported improvements may reflect natural symptom variation, treatment of another condition or benefits in a subgroup that has not yet been identified. More high-quality research is needed.
Current evidence status: 🔴 Current evidence does not support routine use for Long COVID.
Does Fenbendazole Help Long COVID?
Why are people talking about it?
Fenbendazole is a veterinary antiparasitic medication that occasionally appears in online discussions about Long COVID despite having no recognised role in treating the condition.
What problem is it trying to treat?
Fenbendazole is licensed for treating parasitic infections in animals. It is not an approved treatment for Long COVID.
So… does it treat Long COVID?
There is currently no reliable scientific evidence supporting Fenbendazole as a treatment for Long COVID.
Current evidence status: 🔴 Current evidence does not support its use for Long COVID.
Key takeaway: One of the most important questions you can ask about any treatment is: “What is this medication trying to treat?” Sometimes the answer is Long COVID itself. Sometimes it’s another medical condition that exists alongside Long COVID. Understanding that difference makes it much easier to interpret research studies, online discussions and your own treatment journey.
Gut Health & the Microbiome
Why this matters: The gut is home to trillions of bacteria, viruses and other microorganisms that play an important role in digestion, immunity and overall health. Researchers have found that some people with Long COVID have changes in their gut microbiome, leading to growing interest in treatments that aim to restore a healthier balance. Although this is an exciting area of research, it’s still unclear whether these changes are a cause of Long COVID, a consequence of the illness, or both.
Do Probiotics Help Long COVID?
Why are people talking about them?
Probiotics are among the most commonly used supplements for Long COVID. Interest comes from studies showing that some people have an altered gut microbiome after COVID-19, and because the gut plays an important role in regulating the immune system.
What problem are they trying to treat?
The aim is to support a healthier balance of beneficial gut bacteria and, potentially, improve gut health, immune function and inflammation.
So… do they treat Long COVID?
Some early studies suggest probiotics may improve certain symptoms in selected patients, but results have been inconsistent. Different probiotic strains behave differently, making it difficult to recommend one specific product.
Current evidence status: 🟡 Promising early research. Probiotics remain an active area of research but are not established treatments for Long COVID.
Do Prebiotics Help Long COVID?
Why are people talking about them?
Unlike probiotics, prebiotics feed the beneficial bacteria already living in the gut. Researchers believe supporting these bacteria may help restore a healthier microbiome.
What problem are they trying to treat?
The goal is to improve gut microbial diversity and encourage the production of beneficial compounds that support intestinal health.
So… do they treat Long COVID?
There is currently very little Long COVID-specific research. Although prebiotics support general gut health, their role in Long COVID remains uncertain.
Current evidence status: 🔵 Limited clinical evidence.
Does Butyrate Help Long COVID?
Why are people talking about it?
Butyrate is a short-chain fatty acid naturally produced by beneficial gut bacteria. It helps maintain the intestinal barrier and has anti-inflammatory effects, making it an interesting area of Long COVID research.
What problem is it trying to treat?
Researchers are investigating whether improving butyrate production could support gut barrier function, immune regulation and inflammation.
So… does it treat Long COVID?
At present, evidence remains limited. While butyrate is biologically interesting, there is not yet enough research to recommend supplementation specifically for Long COVID.
Current evidence status: 🔵 Limited clinical evidence.
Does a Healthy Diet Help Restore the Gut Microbiome?
Why are people talking about it?
Many researchers believe diet may influence the gut microbiome more than any single supplement. Fibre-rich foods, fermented foods and a varied diet are all associated with a healthier microbial community.
What problem is it trying to treat?
The aim is to support the gut microbiome naturally and encourage the growth of beneficial bacteria.
So… does it treat Long COVID?
A healthy diet is important for overall health and may support recovery, but there is currently no specific diet proven to treat Long COVID itself.
Current evidence status: 🟢 Established advice for general health. It is not a specific treatment for Long COVID.
Do Antimicrobial Mouthwashes Help Long COVID?
Why are people talking about them?
Researchers have investigated whether reducing the amount of virus or harmful bacteria in the mouth could influence COVID-19 transmission or recovery. This has led some people to wonder whether antimicrobial mouthwashes could also help Long COVID.
What problem are they trying to treat?
The proposed aim is to reduce microorganisms in the mouth rather than treat Long COVID itself.
So… do they treat Long COVID?
There is currently no convincing evidence that antimicrobial mouthwashes improve Long COVID symptoms. However, they may still be recommended for specific dental or oral health conditions.
Current evidence status: 🔴 Current evidence does not support routine use for Long COVID.
Do Saline Nasal Rinses Help Long COVID?
Why are people talking about them?
Saline nasal rinses are commonly recommended for chronic sinus symptoms, allergies and nasal congestion. Many people with Long COVID also experience ongoing nasal irritation, congestion or post-viral sinus symptoms.
What problem are they trying to treat?
Saline rinses help clear mucus, allergens and irritants from the nasal passages while keeping the lining of the nose moist.
So… do they treat Long COVID?
They do not treat Long COVID itself, but they may improve nasal symptoms in people with chronic rhinitis, sinus congestion or dryness.
Current evidence status: 🟢 Established supportive treatment for nasal symptoms. They are not treatments for Long COVID itself.
Key takeaway: Looking after your gut health is an important part of overall wellbeing, and researchers continue to investigate the connection between the microbiome and Long COVID. While this is one of the most exciting areas of research, current evidence suggests that gut-directed therapies should be viewed as supportive measures rather than proven treatments for Long COVID.
Advanced & Procedural Therapies
Why this matters: Unlike medications, these treatments involve specialised procedures performed in hospitals or private clinics. Some are already established therapies for other medical conditions, while others remain experimental in the context of Long COVID. They often receive considerable media attention and can be expensive, making it especially important to understand what the current evidence actually shows.
Does Hyperbaric Oxygen Therapy (HBOT) Help Long COVID?
Why are people talking about it?
Hyperbaric Oxygen Therapy (HBOT) is one of the most discussed non-drug treatments for Long COVID. During treatment, patients breathe nearly 100% oxygen inside a pressurised chamber. Researchers are investigating whether increasing oxygen delivery to tissues could improve fatigue, brain fog and other persistent symptoms.
What problem is it trying to treat?
HBOT is thought to improve oxygen delivery while potentially influencing inflammation, brain function, blood vessel health and tissue repair. Researchers are also exploring whether it may help restore abnormalities affecting the microcirculation or the endothelium in some patients.
So… does it treat Long COVID?
Several small clinical trials have reported improvements in fatigue, cognitive function and quality of life in some people with Long COVID. However, results have not been consistent across all studies, and larger trials are still needed to determine which patients, if any, are most likely to benefit.
Current evidence status: 🟡 Promising early research. HBOT is one of the more encouraging procedural therapies being investigated but is not currently an established treatment for Long COVID.
Does Therapeutic Apheresis (Including HELP Apheresis) Help Long COVID?
Why are people talking about it?
Therapeutic apheresis has received considerable attention, particularly in Germany, where some private clinics offer it to people with Long COVID. Interest comes from the theory that removing certain components from the blood could improve circulation or reduce immune abnormalities.
What problem is it trying to treat?
Researchers are investigating whether therapeutic apheresis could remove substances such as inflammatory proteins, abnormal antibodies or factors affecting blood flow. Some clinics also propose that it may reduce microvascular abnormalities, although this remains controversial.
So… does it treat Long COVID?
Some patients report improvements following treatment, but current evidence comes mainly from observational studies and clinical experience. There are currently no large, high-quality randomised trials demonstrating that therapeutic apheresis is a safe and effective treatment for Long COVID.
Current evidence status: 🔵 Limited clinical evidence. Therapeutic apheresis remains experimental and should only be considered within specialist centres or clinical research.
Does Ozone Therapy Help Long COVID?
Why are people talking about it?
Ozone therapy is promoted by some clinics as a way of improving oxygen utilisation, circulation or immune function. It has attracted attention in Long COVID because of these proposed effects.
What problem is it trying to treat?
The proposed aim is to influence inflammation, oxidative stress and blood flow, although the biological mechanisms remain uncertain.
So… does it treat Long COVID?
At present, there is very little high-quality evidence supporting ozone therapy for Long COVID. Existing studies are generally small and insufficient to determine whether it provides meaningful clinical benefit.
Current evidence status: 🔴 Current evidence does not support routine use for Long COVID.
Do Stem Cell Therapies Help Long COVID?
Why are people talking about them?
Stem cell therapies have generated interest because of their potential regenerative and immune-modulating properties. Researchers are exploring whether they could help repair tissue damage or reduce chronic inflammation.
What problem are they trying to treat?
The goal is to promote tissue repair, influence immune regulation and potentially improve recovery in carefully selected patients.
So… do they treat Long COVID?
Although several research groups are investigating stem cell therapies, there is currently insufficient clinical evidence to support their routine use for Long COVID. Many commercial clinics advertise stem cell treatments despite the lack of robust evidence.
Current evidence status: 🔵 Limited clinical evidence. Stem cell therapy remains experimental for Long COVID.
Do Exosome Therapies Help Long COVID?
Why are people talking about them?
Exosomes are tiny particles released by cells that help cells communicate with one another. Experimental exosome therapies have received growing attention because researchers believe they may influence inflammation and tissue repair.
What problem are they trying to treat?
Researchers are investigating whether exosomes could reduce inflammation, support healing and improve recovery following viral illness.
So… do they treat Long COVID?
Current research remains at a very early stage, and there is no convincing clinical evidence supporting exosome therapy for Long COVID outside research settings.
Current evidence status: 🔴 Current evidence does not support routine use for Long COVID.
Does Faecal Microbiota Transplantation (FMT) Help Long COVID?
Why are people talking about it?
Growing research suggests that some people with Long COVID have changes in their gut microbiome. Because faecal microbiota transplantation (FMT) aims to restore a healthier balance of gut bacteria, researchers have begun investigating whether it could play a role in carefully selected patients.
What problem is it trying to treat?
The goal is to restore the gut microbiome and, potentially, improve immune regulation and inflammation through changes in gut bacteria.
So… does it treat Long COVID?
At present, evidence remains extremely limited. Although the scientific rationale is interesting, there is not enough research to recommend FMT as a treatment for Long COVID outside approved clinical studies.
Current evidence status: 🔵 Limited clinical evidence. FMT remains an experimental approach for Long COVID.
Key takeaway: Advanced therapies often generate significant interest because they offer new ways of thinking about Long COVID. Some, such as Hyperbaric Oxygen Therapy, have shown encouraging early results, while others remain largely experimental. At present, none of these procedures can be considered established treatments for Long COVID, and more high-quality clinical trials are needed before they can be recommended routinely.
Emerging Immune Therapies
Why this matters: Long COVID research is moving rapidly, and new treatments continue to enter clinical trials. Among the most closely watched are monoclonal antibodies and other targeted immune therapies. While these medicines have transformed the treatment and prevention of COVID-19 in some situations, their role in Long COVID remains uncertain.
Do Monoclonal Antibodies Help Long COVID?
Why are people talking about them?
Monoclonal antibodies became widely known during the COVID-19 pandemic because they helped protect vulnerable people from severe illness or treated early SARS-CoV-2 infection. Researchers are now investigating whether some of these therapies could also benefit carefully selected people with Long COVID, particularly if persistent viral reservoirs contribute to symptoms in a subgroup of patients.
What problem are they trying to treat?
Unlike medications that suppress inflammation, antiviral monoclonal antibodies are designed to recognise and neutralise the SARS-CoV-2 virus. If viral persistence proves to be an important driver of Long COVID in some patients, these medicines could potentially have a future role. However, this remains an active area of research.
So… do they treat Long COVID?
At present, there is no convincing evidence that monoclonal antibodies routinely improve Long COVID. Their effectiveness also depends on whether they continue to neutralise the circulating SARS-CoV-2 variants, which evolve over time.
Current evidence status: 🔵 Limited clinical evidence. Monoclonal antibodies remain an active area of research but are not established treatments for Long COVID.
Does Evusheld (Tixagevimab/Cilgavimab) Help Long COVID?
Why are people talking about it?
Evusheld was originally developed to provide passive immunity for people who were unlikely to respond adequately to COVID-19 vaccination. Because it successfully neutralised earlier SARS-CoV-2 variants, researchers explored whether it might also have a role in Long COVID.
What problem is it trying to treat?
The aim is to neutralise SARS-CoV-2 if persistent viral infection contributes to ongoing symptoms.
So… does it treat Long COVID?
Current evidence remains limited. In addition, Evusheld is no longer effective against many of the newer SARS-CoV-2 variants, meaning its clinical role has changed significantly since it was first introduced.
Current evidence status: 🔵 Limited clinical evidence. Evusheld is not an established treatment for Long COVID.
Does Pemgarda (Pemivibart) Help Long COVID?
Why are people talking about it?
Pemgarda (pemivibart) is a newer monoclonal antibody developed to provide protection against COVID-19 in certain immunocompromised people. Because it targets more recent viral variants than some earlier monoclonal antibodies, researchers are interested in whether therapies like Pemgarda could eventually play a role in Long COVID.
What problem is it trying to treat?
Like other antiviral monoclonal antibodies, its aim is to neutralise SARS-CoV-2 rather than suppress the immune system.
So… does it treat Long COVID?
There is currently no clinical evidence showing that Pemgarda improves established Long COVID. Its approved use is for COVID-19 prevention in selected high-risk patients rather than treatment of Long COVID.
Current evidence status: 🔵 Limited clinical evidence. Its role in Long COVID remains unknown.
Does Sipavibart Help Long COVID?
Why are people talking about it?
Sipavibart is another next-generation monoclonal antibody developed to provide protection against newer SARS-CoV-2 variants. As newer antibodies become available, researchers continue to explore whether antiviral therapies could eventually benefit carefully selected people living with Long COVID.
What problem is it trying to treat?
The goal is to neutralise SARS-CoV-2 if ongoing viral persistence contributes to symptoms.
So… does it treat Long COVID?
At present, there is no evidence demonstrating that Sipavibart treats Long COVID. Research is still at a very early stage.
Current evidence status: 🔵 Limited clinical evidence. Sipavibart is not an established treatment for Long COVID.
Could Future Targeted Immune Therapies Change Long COVID Treatment?
Long COVID research is evolving rapidly. Future treatments may include newer monoclonal antibodies, antiviral therapies and other targeted medicines designed to address the specific biological mechanisms driving symptoms in different groups of patients.
It’s increasingly clear that Long COVID is unlikely to be a single disease with a single treatment. Instead, future care may involve identifying the underlying biological processes affecting each individual—such as viral persistence, immune dysregulation, autonomic dysfunction or vascular abnormalities—and selecting treatments that target those specific mechanisms.
Current evidence status: 🟡 Promising future direction. This is one of the most active areas of Long COVID research, but further clinical trials are needed before targeted immune therapies can be recommended routinely.
Key takeaway: Monoclonal antibodies and other targeted immune therapies represent one of the most exciting areas of Long COVID research. While current evidence does not support their routine use, future generations of antiviral and immune-targeted treatments may play an important role as researchers better understand the different biological pathways driving Long COVID.
Conclusion
Long COVID remains one of the most complex medical conditions researchers have faced in recent years. Although there is currently no single treatment proven to work for everyone, progress is happening at an extraordinary pace.
Over the past few years, scientists have identified several biological pathways that may contribute to Long COVID, including immune dysregulation, viral persistence, autonomic dysfunction, endothelial dysfunction, microvascular abnormalities and changes in the gut microbiome. It’s becoming increasingly clear that these mechanisms are unlikely to affect every person in the same way, which helps explain why responses to treatment vary so much.
Some of the treatments in this guide are already well-established therapies for other medical conditions. Others are prescribed off-label by experienced clinicians, while many remain experimental and are still being evaluated in clinical trials. As our understanding of Long COVID improves, treatment is likely to become more personalised, with therapies selected according to the underlying biological processes affecting each individual rather than using a one-size-fits-all approach.
If there’s one message we’d like you to take away, it’s this:
The absence of a proven treatment today doesn’t mean progress isn’t being made. Every year brings new clinical trials, new discoveries and a better understanding of this condition. What remains uncertain today may become standard care in the future.
We hope this guide has helped you better understand not only which treatments are being discussed, but also why they’re being investigated, what they’re trying to treat and what the current evidence actually shows.
Living with Long COVID can be overwhelming, but good information is one of the most powerful tools you have. We will continue updating this guide as new evidence emerges so you always have access to the latest research in one place.
Medical Disclaimer
The information on this page is provided for educational purposes only and should not be considered medical advice.
Long COVID is a complex condition, and no single treatment has been proven to work for everyone. Many of the therapies discussed in this guide are prescribed off-label, meaning they are used outside the conditions for which they were originally licensed. Others remain experimental or are currently being evaluated in clinical trials.
This guide aims to summarise the current scientific evidence as accurately and fairly as possible at the time of publication. Medical knowledge evolves rapidly, and recommendations may change as new research becomes available.
Every person’s medical history, symptoms and underlying health conditions are different. A treatment that is appropriate for one individual may be ineffective—or even harmful—for another. Decisions about treatment should always be made with a qualified healthcare professional who understands your individual circumstances.
LongCovidJourney does not recommend or endorse any specific medication, supplement, clinic or healthcare provider. Our goal is to help you understand the evidence, ask informed questions and have more productive conversations with your healthcare team.
If you think you may have a medical emergency, seek immediate medical attention or contact your local emergency services.
Key References & Further Reading
This guide is based on peer-reviewed research, international clinical guidelines and evidence summaries. Below are some of the key publications that informed this article.
Clinical Guidelines
- National Institute for Health and Care Excellence (NICE). COVID-19 rapid guideline: Managing the long-term effects of COVID-19 (NG188). Regularly updated clinical guidance for the assessment and management of Long COVID.
Major Reviews
- Davis HE, McCorkell L, Vogel JM, Topol EJ, et al. Long COVID: major findings, mechanisms and recommendations. Nature Reviews Microbiology. 2023. A landmark review summarising the biological mechanisms thought to contribute to Long COVID, including viral persistence, immune dysregulation, endothelial dysfunction, autonomic dysfunction and microvascular abnormalities.
- Zeraatkar D, Ling M, Kirsh S, et al. Interventions for the management of Long COVID (post-COVID condition): Living systematic review. The BMJ. 2024. A continuously updated systematic review evaluating both drug and non-drug treatments for Long COVID.
- Crook H, Raza S, Nowell J, Young M, Edison P. Long COVID—mechanisms, risk factors, and management.The BMJ. 2021. A comprehensive overview of Long COVID, including current understanding of mechanisms, diagnosis and management.
- Greenhalgh T, Sivan M, Delaney B, Evans R, Milne R. Long COVID—an update for primary care. The BMJ.2022. Practical guidance for clinicians caring for people with Long COVID in primary care.
Cognitive & Neurological Symptoms
- Aretouli E, Malik M, Widmann C, et al. Cognitive and mental health outcomes in Long COVID. The BMJ.2025. A state-of-the-art review summarising current evidence on brain fog, cognitive impairment and neuropsychiatric symptoms associated with Long COVID.
About This Guide
Medical knowledge evolves rapidly, particularly in Long COVID. This guide is reviewed regularly and updated to reflect new high-quality evidence as it becomes available. Wherever possible, we prioritise systematic reviews, randomised controlled trials, large observational studies and recognised clinical guidelines over anecdotal reports or preliminary findings.