Capitol Hill Blue Forums Science and Technology Health, Medicine & the healing Sciences Medications that might help against SARS-CoV-2

There are many medications being proposed as potentially repurposed (existing drugs for other conditions that might work for COVID-19.

This thread is started as a place to talk about new research, results from existing randomized controlled trials, promising news about medications, etc.

Studies already published have included repurposed drugs, as listed below.

These are mainly against non-structural proteins of SARS-CoV2: the main 3C-like protease (Lopinavir, Ritonavir, Indinavir, Atazanavir, Nelfinavir, and Clocortolone), RNA-dependent RNA polymerase (Remdesivir and Ribavirin), and the papain-like protease (Mycophenolic acid, Telaprevir, Boceprevir, Grazoprevir, Darunavir, Chloroquine, Hydroxychloroquine, and Formoterol).

The best-documented multi-target drugs repurposed for COVID-19 therapy are as follows: antiviral drugs commonly used to treat AIDS/HIV (Atazanavir, Efavirenz, and Dolutegravir Ritonavir, Raltegravir, and Darunavir, Lopinavir, Saquinavir, Nelfinavir, and Indinavir), HCV (Grazoprevir, Lomibuvir, Asunaprevir, Ribavirin, and Simeprevir), HBV (Entecavir), HSV (Penciclovir), CMV (Ganciclovir), parasites (Ivermectin), bacterial infections (Azithromycin) and Ebola (Remdesivir), anticoagulant drug (Dabigatran), and an antifungal drug (Itraconazole).

ARBs and ACE Inhibitors might have some use too. They can steer the immune system reactions away from inflammatory toward the anti-inflammatory path, because they mess with one of the receptors the virus uses.

MEDCRAM on YouTube has some very detailed talks primarily for doctors by a pulmonary specialist working at Loma Linda. They get pretty complicated but if you have any biochemistry or medical training they are not that hard to follow. I like the fact that he uses evidence from scientific journal papers to back everything up.

By the way, every patient he sees who he thinks has the virus gets hydroxychloroquine, zinc, and ivermectin.

He even has one on what he's taking and doing to stay healthy seeing Covid-19 patients every day. I'm trying to duplicate that since I am high-risk.

In principle I don't like that. One-size-fits-all approach, using treatments that haven't been approved yet and haven't seen bona fide scientific proof of safety and efficacy doesn't seem like good medical practice to me.

Again, the value I grant to such *opinions* of someone not involved in randomized clinical trials is pretty much zero.

I'll wait for the conclusion of the RCTs before forming an opinion.

I'm high risk too; what I'm doing is using strict PPE, isolating as much as possible, practicing social distancing and lots of hand-washing and surface disinfection. I won't use unproven medication cocktails.

How about this? It's a release of preliminary data from a retrospective study done on Covid-19 patients in Indonesia. Very simple arms: Those who lived versus those who died. They found the usual strong correlations with sex, age, and co-morbidities, but they also had Vitamin D blood levels. When they factored out the other things, they found that patients with low Vitamin D levels were over 10 TIMES as likely to die, than patients with normal levels (>30 ng/ml). That not 10%, it's 10 times.

Indonesia Preliminary Results

This has not been peer-reviewed yet, but their analysis looks pretty reasonable. If it's true, it means we could probably cut our death rates by 10 times just by correcting everybody's Vitamin D levels. And a huge percentage of people in the US have Vitamin D insufficiency or actual deficiency. In particular, a lot of people with dark skin can't make much from our non-tropical sunlight and inside work. Also more than half the elderly have deficiency!

Correcting your Vitamin D level is usually as simple as taking 2500 iu per day of Vitamin D3. I actually take about 8000 iu per day for my MS but I do monitor my blood level. I doubt 2500 iu per day could harm anybody unless their doctor has warned them not to take it.

There has also been some correlative information about hyperferritinemia (high blood iron) and COVID-19. Some of that relationship, however, seems to run far ahead of observation. What is completely unknown (and why I have my doubts about some of the assertions) is whether the hyperferritinemia is a risk factor for cytokine storms, or if the virus itself is the causative factor for the hyperferritinemia. As may be immediately apparent, I have no expertise, and only limited experience, in the fields of biology and biochemistry (I used to be an EMT in my early adult worklife), but I am greatly interested and a quick study (or at least, used to be) so I want to understand this.

For me, the connections between treatments and this virus, that are best understood (by me), are the mechanisms that the medications address. Hydrochloroquine, for example, is used as a cytokine inhibitor (as I understand it), which for someone not succeptible to hyperproduction of cytokines or other inflammatory agents, would actually be worse for fighting off the disease process itself - by inhibiting the production of the very antibodies necessary to fight the virus (antigens). Am I misunderstanding this relationship?

The list of potential medications is long and daunting, but the mechanisms that they implicate is smaller. Each of those mechanisms, though, it seems to me, represents a double-edged sword - creating the possibility of side effects at least as deadly as, or potentially increasing the mortality of, the disease itself. We have little enough understanding of the disease to go tromping off into "cures" that may be of marginal value based on panicky expediency rather than careful analysis.

That's one thing I like about Vitamin D: The high safe level is 100 ng/ml. Nobody is ever harmed by keeping their blood levels below that number. Doctors routinely treat Vitamin D deficiency with single injections of 90,000 iu followed by high D3 supplementation. There has been some concern in the past about Vitamin D overdose causing calcium deposits, but it's extremely rare to see that at blood levels below 100 ng/ml. One case had a patient taking some huge overdose because of a label mixup, and he had no overdose symptoms.

There have been hundreds of peer-reviewed journal papers showing Vitamin D participation in all sorts of immune and other bodily functions. I have never seen one on the back-edge of the Vitamin D sword. So taking a safe amount of Vitamin D3 is extremely unlikely to harm anyone. It's also extremely cheap.

Ask you doctor, or look up your blood level in your medical records if you had it tested. Your doctor can tell you about the recent clinical info that supports regular Vitamin D supplementation. The optimal value seems to be 30 ng/ml. Most Americans are below that, and some are far below that.

That Indonesia paper was far from the first on the topic. In regards to Covid-19, doctors have reported that their ICU patients (including young people) are almost uniformly deficient in Vitamin D.

Good information.

People with very low level (like 15-20) will probably not have it corrected with 2,500 units per day. One standard treatment is 50,000 units per week times 6 weeks then recheck, often people need another 6 weeks of the high dose before they can go back to maintenance doses. Beware: vitamin D above 75 has been associated with increased mortality due to calcium deposit in arteries. Best level is around 50.

I couldn't agree more. Which is exactly why I was so against the push for HCQ + AZ.

I was keeping my D level right at 100 ng/ml, which is what Scripp's Clinic still lists as the maximum "normal" level on their patient test results page. But my PCP recommended getting it down to 70 or so. That's what I do by taking about 8000 iu / day. 70 is about what they observe in life guards. Like I say, I'm a special case because of my MS, and I do get it measured regularly. That Indonesia paper counted everybody with >30 ng/ml as normal. I'm sure 50 would be great for most people.

I never understood why anyone would give AZ for a virus, especially with HCQ: That's one of the listed dangerous combinations since both elongate the QT interval.

Yes, the combination is riskier for QTc prolongation than each one separately. I think the rationale for adding AZ is the strong anti-inflammatory effect. AZ often helps bronchitis more due to its anti-inflammatory effect than to its antibiotic effect.