Nicotine Gum, Patches Used to Combat Long COVID Fog

Some people with long COVID are turning to an unlikely remedy: nicotine gum and patches. Though typically used to quit smoking, nicotine is now being explored as a possible way to ease symptoms such as brain fog and fatigue.

One such case, detailed in a recent article in Slate , describes a woman who found significant relief from debilitating brain fog after trying low-dose nicotine gum. Her experience, while anecdotal, aligns with findings from a small but interesting study from Germany.

The study involved four participants suffering from symptoms related to long COVID. The researcher administered low-dose nicotine patches once daily and noticed marked improvements in the participants' symptoms. Tiredness, weakness, shortness of breath and trouble with exercise rapidly improved - by day six at the latest.

For those who had lost their sense of taste or smell, it took longer, but these senses came back fully within 16 days. Although it's not possible to draw definitive conclusions on cause and effect from such a small study, the results could pave the way for larger studies.

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While some people slowly recover from COVID, others remain unwell for years, especially those who became sick before vaccines were available. Between 3% and 5% of people continue to experience symptoms months, and sometimes even years, after the initial infection. In the UK, long COVID affects around 2.8% of the population .

Brain fog and other neurological symptoms of long COVID are thought to result from a combination of factors - including inflammation, reduced oxygen to the brain, vascular damage and disruption to the blood-brain barrier . Research continues as there is still a lot we don't know about this condition.

The researcher in the German study thinks that long COVID symptoms, such as fatigue, brain fog and mood changes, might partly be due to problems with a brain chemical called acetylcholine, a neurotransmitter. This chemical is important for many functions in the body, including memory, attention and regulating mood.

Normally, acetylcholine works by attaching to special "docking sites" on cells called nicotinic acetylcholine receptors, which help send signals in the brain and nervous system. But the COVID virus may interfere with these receptors, either by blocking them or disrupting how they work. When this happens, the brain may not be able to send signals properly, which could contribute to the mental and physical symptoms seen in long COVID.

So why would nicotine potentially be useful? Nicotine binds to the same receptors and might help restore normal signalling, but the idea that it displaces the virus directly is still speculative.

Nicotine is available in different forms, such as patches, gum, lozenges and sprays. Using nicotine through the skin, for example, with a patch, keeps the amount in the blood steady without big spikes. Because of this, people in the study didn't seem to develop a dependence on it.

Chewing nicotine gum or using a lozenge can cause spikes in nicotine levels, since the nicotine is absorbed gradually through the lining of the mouth. But unlike a patch, which delivers a steady dose, the user has more control over how much nicotine they take in when using gum or lozenges.

There are mixed results on the effectiveness of nicotine on cognitive functions such as memory and concentration. But most studies agree that it can enhance attention. Larger studies are needed to gauge the effectiveness of nicotine specifically for long COVID symptoms.

Not without risks

Despite its benefits, nicotine is not without risks . Even in gum or patch form, it can cause side-effects like nausea, dizziness, increased heart rate and higher blood pressure.

Some of these stimulant effects on heart rate may be useful for people with long COVID symptoms such as exercise intolerance. But this needs to be closely monitored. Long-term use may also affect heart health. For non-smokers, the risk of developing a nicotine dependency is a serious concern.

So are there any options to treat long COVID symptoms?

There are some studies looking at guanfacine in combination with N-acetylcysteine, which have shown improvement in brain fog in small groups of people. There has been at least one clinical trial exploring nicotine for mild cognitive impairment in older adults, though not in the context of long COVID. Given that anecdotal reports and small studies continue to draw attention, it is likely that targeted trials are in development.

The main recommendations by experts are to implement lifestyle measures. Slowly increasing exercise, having a healthy diet, avoiding alcohol, drugs and smoking, sleeping enough, practising mindfulness and doing things that stimulate the brain are all thought to help brain fog.

For those grappling with long COVID or persistent brain fog, the idea of using nicotine patches or gum might be tempting. But experts caution against self-medicating with nicotine. The lack of standardised dosing and the potential for addiction and unknown long-term effects make it a risky experiment.

While nicotine isn't a cure and may carry real risks, its potential to ease long COVID symptoms warrants careful study. For now, those battling brain fog should approach it with caution - and always under medical supervision. What's clear, though, is the urgent need for more research into safe, effective treatments for the lingering effects of COVID.

Dipa Kamdar does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.