Treatments

41 approaches, grouped by what they target. Each colour marks a category that carries across the Atlas, so you can recognise it wherever a treatment appears.

Autonomic & volumeActivity & rehabMicrobiome & gutImmune & mast cellCoagulation & vascularAntiviralCognitive & neuroMood & sleepMetabolic & energyWhole-person care

Autonomic & volume (10)

Steady the autonomic nervous system and expand blood volume — easing the racing heart, dizziness, and worse-on-standing of POTS and dysautonomia. Mostly the first things tried.

Autonomic & volumeBeta-blockers (propranolol, bisoprolol)When the heart races on standing, a low-dose beta-blocker can take the edge off.Autonomic & volumeCompression garmentsA simple, drug-free way to keep blood from pooling in the legs.Autonomic & volumeCoordinated nonpharmacologic care (bundle)The least glamorous option for orthostatic symptoms is also the one with the best recent showing.Autonomic & volumeFludrocortisoneFludrocortisone is a steroid that makes the body hold onto salt and water, expanding blood volume.Autonomic & volumeHydrationexpand blood volume to ease POTS symptoms Autonomic & volumeIvabradineA drug that calms a racing heart without lowering blood pressure, which makes it well suited to POTS.Autonomic & volumeManaging electrolytessodium, potassium, magnesium balance — and salt-limited cases Autonomic & volumeMidodrineWhere a racing heart is not the whole story, the problem is often vessels that will not tighten on standing.Autonomic & volumePyridostigmineA drug that strengthens the body's own brake on heart rate.Autonomic & volumeSalt and fluid loadingThe first and cheapest step for a racing, dizzy circulation: give it more volume to work with.

Activity & rehab (5)

Activity management and PEM-aware rehabilitation. The point is staying within your limits and avoiding the exertion that triggers a crash — not pushing through.

Activity & rehabBreathing retraining / physiotherapy (breathing pattern disorder)A great deal of post-COVID breathlessness comes not from damaged lungs but from a breathing pattern that has slipped into something fast, shallow, and upper-chest.Activity & rehabGraded exercise therapy (GET)Graded exercise therapy asks you to steadily increase activity regardless of symptoms.Activity & rehabInspiratory muscle trainingFor long COVID breathlessness, one of the few options with real trial support is inspiratory muscle training: strengthening the muscles you breathe in with, using a small…Activity & rehabPacing / energy-envelope managementPacing is the practice of keeping activity inside an energy budget so you avoid the delayed crash that follows overexertion.Activity & rehabRecumbent / supine-biased rehabilitation (PEM-bounded)Upright exercise can be the exact thing that floors you, yet gentle movement done lying down may be tolerable.

Microbiome & gut (4)

Target the gut microbiome and barrier, on the theory that gut disruption drives fatigue, brain fog, and immune problems felt far from the gut.

Microbiome & gutButyrate / SCFA supplementationIf long COVID depletes the bacteria that make butyrate, why not supply butyrate directly?Microbiome & gutDietary fiber and prebioticsThe cheapest way to support a depleted gut is to feed the bacteria you want to grow.Microbiome & gutFecal microbiota transplantationIf a few strains help, would resetting the whole microbiome help more?Microbiome & gutSIM01 synbioticThe first randomized trial to show that fixing the gut can ease long COVID.

Immune & mast cell (4)

Calm an over-reactive immune response — especially mast-cell activation and the histamine-driven flushing, hives, and gut and heart symptoms it can cause.

Immune & mast cellH1/H2 antihistaminesCheap, familiar allergy drugs are among the most-tried long COVID treatments, on the theory that overactive mast cells are flooding the body with histamine.Immune & mast cellIVIGSome long COVID looks like the immune system turning on the body's own control receptors, and IVIG is the treatment people reach for when they suspect that.Immune & mast cellMast cell stabilizersIf overactive mast cells are part of the problem, stabilizing them at the source is the next step beyond antihistamines.Immune & mast cellQuercetin / luteolin / montelukast / low-histamine dietWhen mast cells seem to be flaring, most people start with diet changes and over-the-counter compounds long before any prescription.

Coagulation & vascular (4)

Aim at the clotting and blood-vessel-lining problems — microclots and endothelial dysfunction — thought to impair oxygen delivery. Several are experimental.

Coagulation & vascularAnticoagulation / antiplatelet therapyOne of the most debated long COVID treatments: thinning the blood to clear microclots.Coagulation & vascularFibrin-targeting antibodyOne of the most striking long COVID findings is that a clotting protein, fibrin, may itself drive brain inflammation, and that an antibody aimed at fibrin protected the brain in…Coagulation & vascularImproving endothelial functionmeasures and investigational treatments for the vessel lining Coagulation & vascularTherapeutic apheresis (H.E.L.P.)An invasive blood-filtering procedure marketed by some private clinics for long COVID, often at great expense.

Antiviral (3)

Target persistent or reactivated virus, on the theory that a lingering reservoir keeps the illness going. Largely investigational.

AntiviralAntivirals for EBV (valacyclovir / valganciclovir)If Epstein-Barr reactivation is part of your long COVID, reaching for antivirals seems obvious: there is a virus, so treat the virus.AntiviralMonoclonal antibodies vs reservoirIf long COVID is partly driven by virus that never fully cleared, then attacking that reservoir, with antivirals or lab-made antibodies, could help.AntiviralReservoir-targeting antiviralsIf the virus never fully left, then clearing that hidden reservoir could treat long COVID at its root rather than chasing its symptoms.

Cognitive & neuro (2)

Target brain inflammation and the cognitive, “brain fog” end of long COVID. Mostly early-stage.

Cognitive & neuroGuanfacine + N-acetylcysteineThere is no treatment approved for long COVID cognitive symptoms, and anyone promising a cure is ahead of the evidence.Cognitive & neuroMicroglial modulators (CSF1R inhibitors, anti-CCL11, NSAIDs, tetracyclines)Some of the most interesting ideas for COVID brain fog target the brain's own immune cells, the microglia.

Mood & sleep (3)

Address the mood, anxiety, and sleep changes that have biological roots in long COVID — not simply a reaction to being unwell.

Mood & sleepAntidepressants / SSRIsDepression and anxiety are common in long COVID, and antidepressants can genuinely help with those symptoms.Mood & sleepCBT / CBT-I (supportive)Cognitive behavioural therapy is genuinely useful for some things in long COVID and genuinely harmful when misapplied to others.Mood & sleepFluvoxamine / SSRIAn antidepressant with anti-inflammatory properties, tested as a way to prevent long COVID.

Metabolic & energy (4)

Support cellular energy production and metabolism, targeting the mitochondrial dysfunction behind much of the fatigue and exercise intolerance.

Metabolic & energyCoenzyme Q10 (CoQ10)mitochondrial energy support — plausible, weak evidence alone Metabolic & energyLow-dose naltrexone (LDN)A well-known drug, at a tiny fraction of its usual dose, that may quiet the inflammation behind long COVID fatigue.Metabolic & energyMetforminOne of the few long COVID findings from a large randomized trial: a cheap diabetes drug, taken early in infection, lowered the chance of developing long COVID by about 40 percent.Metabolic & energyOxaloacetateA metabolic supplement aimed squarely at long COVID fatigue.

Whole-person care (3)

Multi-target plans that treat the underlying drivers together — sleep, autonomic symptoms, inflammation, pacing — rather than one symptom at a time.

Whole-person careTreat the biological substrate (anti-inflammatory, sleep, POTS, pacing)Sometimes the most effective way to lift mood in long COVID is not to target mood directly, but to treat the biological drivers underneath it: inflammation, broken sleep,…Whole-person careTreat the substrate (pacing, POTS, sleep) + vaccinationBrain fog rarely has a single cause you can aim a drug at, which is why the honest approach is indirect: stop fixing the fog directly and start removing the things that make it…Whole-person careTreat the substrate (POTS, dysautonomia) + cardiac surveillanceChest pain and palpitations after COVID are frightening, and they most often trace back to an autonomic problem rather than the heart itself.