Germany's New Long COVID Therapy Guide Recommends Four Existing Drugs

Long COVID continues to affect many people long after their initial infection. The condition, marked by symptoms lasting over four weeks, can lead to severe health issues, including chronic fatigue syndrome (ME/CFS). Now, German health authorities have released new guidance to help doctors treat patients more effectively. In October 2024, Germany’s Federal Institute for Drugs and Medical Devices (BfArM) published a Therapy Compass for long COVID. The document highlights four existing drugs that may help manage symptoms: Ivabradine, Agomelatine, Vortioxetine, and Metformin. These medications are already approved for other conditions but are now recommended for off-label use in long COVID cases.

A 2023 roundtable discussion had previously stressed the need for better access to such treatments. Participants agreed that repurposing available drugs could improve care for patients struggling with persistent symptoms. Metformin, for example, has shown promise in reducing long COVID risk in overweight individuals when taken early in the infection.

Long COVID is defined by symptoms lasting more than four weeks, while post-COVID refers to cases extending beyond twelve weeks. Common issues include extreme fatigue, breathing difficulties, and heart problems. The new guidelines aim to provide clearer options for doctors treating these complex conditions. The Therapy Compass offers a structured approach to managing long COVID with existing medications. By endorsing off-label treatments, BfArM hopes to ease the burden on patients and healthcare providers. The move follows growing recognition of the condition’s long-term impact on health.