People’s Pharmacy: Nicotine patch helped a long COVID-19 patient

Q. I am using nicotine patches for long COVID-19 according to the instructions recommended by the researchers who came up with the idea. This has helped me with my short-term memory. The dose I am using is a 10- to 12-day cycle: two days at 3.5 milligrams, seven days at 7 milligrams, and then ramping down for one to three days at 3.5 milligrams.

I’m not experiencing any addictive effects and likely never will at this dose and length of time. More is not better, though. Some folks try this therapy for months instead of days. That might be a mistake and lead to nicotine dependence.

A. As far as we can tell, there have been no long-term, well-controlled clinical trials of nicotine patches for symptoms of long COVID-19. That said, German researchers conclude that “… LDTN (low-dose transcutaneous nicotine) appears to be a promising and safe procedure to relieve LC (long COVID) symptoms with no expected long-term harm” (Bioelectronic Medicine, Feb. 27).

The explanation for this treatment involves the cholinergic nervous system. The German scientists point out that SARS-CoV-2 binds to crucial nicotinic acetylcholine receptors in the nervous system. This can lead to impaired nerve transmission and symptoms such as brain fog, memory problems and fatigue.

The investigators suggest that nicotine may reverse the effects of the virus on cholinergic nerve receptors. Anyone who contemplates this low-dose nicotine patch therapy should be under medical supervision.

Q. You wrote recently about MAO inhibitors as antidepressants. I hope they become more widely available. No other antidepressant has worked for me for 25 years. I’ve tried virtually every drug category and most of the commonly prescribed meds.

You have to watch your diet with MAOIs. However, I eat an avocado every day and frequently have cheddar cheese. I don’t care for aged meats, which I know can be a problem. I experienced a multiday moderate headache from soy sauce, but I would get migraines from MSG and chocolate even prior to MAOIs.

Two doctors have prescribed meds that don’t mix well with Parnate – a urologist (doxazosin) and a pain doctor (duloxetine.) Since they enter all my meds into a program, I wonder why it’s not flagged. It’s important for the patient to be vigilant to avoid food and drug interactions. Please let others know this option can be helpful.

A. The monoamine oxidase inhibitors (MAOIs) were the first antidepressants to be developed. They were discovered accidentally when the tuberculosis drug, isoniazid, was found to lift the mood of patients suffering from TB.

Antidepressant drugs such as isocarboxazid (Marplan), phenelzine (Nardil) and tranylcypromine (Parnate) were approved by the Food and Drug Administration in the late 1950s and early 1960s. In 2006, the FDA approved a transdermal patch containing the MAOI selegiline (Emsam).

Many doctors abandoned such medications when different antidepressants became available. Concerns about drug and food interactions played a role in this shift.

People who have not responded to other antidepressants may benefit from treatment with an MAOI-type medicine (Journal of Affective Disorders, May 1). This will require very careful supervision by a physician familiar with such drugs and, as you suggested, patient vigilance to avoid dangerous interactions. You can learn more about the pros and cons of MAOIs and other antidepressants in our “eGuide to Dealing with Depression.” This online resource is located under the Health eGuides tab at www.PeoplesPharmacy.com.

Email Joe and Teresa Graedon via their website: www.PeoplesPharmacy.com.