Angela Reiersen, MD, MPE @AngelaReiersen Twitter profile

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Angela Reiersen, MD, MPE

7 months

We are still recruiting Missouri & Illinois residents for our fluvoxamine long COVID trial. See this flyer for contact info.

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Angela Reiersen, MD, MPE

@AngelaReiersen

24 days

How fun. Now I have COVID for the 5th time, and I am simultaneously having a shingles outbreak. Turns out there is some evidence COVID may increase the risk for a shingles outbreak in people over 50.

Increased Risk of Herpes Zoster in Adults ≥50 Years Old Diagnosed With COVID-19 in the United States

AbstractBackground. Case reports have described herpes zoster (HZ) in patients with coronavirus disease 2019 (COVID-19). However, this constitutes low-qual

academic.oup.com

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

So, I have acute COVID again (3rd time). I am taking both Paxlovid and fluvoxamine since they have different mechanisms that I think should be complimentary. This is not medical advice. Everyone should speak to their own doctor about what is right for them.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

Ontario becomes the first province to list fluvoxamine as a COVID-19 treatment to consider via @CTVNews

Ontario becomes the first province to list fluvoxamine as a COVID-19 treatment to consider

Ontario has become the first province to list an inexpensive and well-known antidepressant as a treatment doctors can 'consider' for patients with a mild COVID-19 infection in a bid to keep them out...

www.ctvnews.ca

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Angela Reiersen, MD, MPE

@AngelaReiersen

1 year

There is a hint that fluvoxamine may have prevented the most severe forms of long COVID: those randomized to fluvoxamine were about half as likely to report being less than 60% recovered at follow-up. Small sample size, not statistically significant (low power), but interesting.

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

Fluvoxamine: an inexpensive pill that works against Covid-19.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

Just published a new paper with @Bradley_A_Fritz , @EricLenze2 , @farid__jalali , and @HoertelN . It seems that any of several antidepressants can have protective effects against severe COVID outcomes (ER visits, hospitalizations).

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

A few people requested that I re-post a link to this article I wrote for Cerebrum magazine. It describes how I got the idea to use fluvoxamine as a treatment for COVID-19.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

I wonder how many long haulers are having this problem: "It was found during sleep studies on [post-acute COVID] patients...that the REM phase of sleep no longer restricted movement, which wakes you up."

Pulmonologist With Long COVID Gives Tips for Its Treatment

A pulmonologist involved in the development of a guideline for the management of long COVID reflects on his experience with the condition and provides advice for clinicians.

www.medscape.com

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

More information about potential effects of melatonin on COVID-19.

Melatonin drugs inhibit SARS-CoV-2 entry into the brain and virus-induced damage of cerebral small...

Cellular and Molecular Life Sciences - COVID-19 is a complex disease with short- and long-term respiratory, inflammatory and neurological symptoms that are triggered by the infection with...

link.springer.com

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

One reason I am disappointed in FDA decision about fluvoxamine EUA is the difficulty in getting COVID diagnosis within first 5 days of illness, when Paxlovid should be started. Even for doctors like me, this can be tricky. Initially thought it was allergies + long-COVID symptoms.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

Doctor Submits Fluvoxamine EUA Application to FDA | MedPage Today

Doctor Submits Fluvoxamine EUA Application to FDA

Group of physician-scientists believes data support authorization for treating COVID-19

www.medpagetoday.com

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

Today NIH updated their COVID treatment guidelines to mention SC2 and TOGETHER Trials. They have not adjusted their stance on fluvoxamine. They still do not recommend either for or against fluvoxamine for COVID. Disappointing that they have not changed recommendation to “for”.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

I think Paxlovid+fluvoxamine worked very well for my acute COVID episode. Day 10 now. Off Paxlovid past 2 days. Feeling good, like my long COVID baseline (not like acute illness or long COVID flare). Continuing fluvoxamine & famotidine. Decided to also add some lactoferrin.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 months

Replication of fluvoxamine's benefit for treating acute COVID-19, in Thailand. There is also evidence from this study that fluvoxamine prevents long COVID symptoms: Early treatment with fluvoxamine, bromhexine, cyproheptadine, and nicl...

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

Old drug fluvoxamine, new hope for COVID-19 | SpringerLink

Old drug fluvoxamine, new hope for COVID-19

European Archives of Psychiatry and Clinical Neuroscience -

link.springer.com

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

Just watched this. I have not been totally convinced that ivermectin works as well as some people think it does, but there is enough evidence for it and low enough risk of harm from the drug, that this should be taken seriously.

Bret Weinstein

@BretWeinstein

3 years

H-Hour: 0900, D-Day: 6/1/21 Tuesday, 9am Pacific, I will be talking live in the DarkHorse studio with @PierreKory of FLCCC / @Covid19Critical on the pandemic, the care of COVID-19 patients and the multidimensional campaign against Ivermectin. Buckle up...

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

Nice WSJ article about fluvoxamine.

Opinion | Is Fluvoxamine the Covid Drug We’ve Been Waiting For?

A 10-day treatment costs only $4 and appears to greatly reduce symptoms, hospitalization and death.

www.wsj.com

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

Antidepressant prevents most serious COVID-19 complications - Futurity

Antidepressant prevents most serious COVID-19 complications

New research confirms an earlier study that the antidepressant fluvoxamine prevents some of the most serious complications of COVID-19.

www.futurity.org

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

This meta-analysis is now published: Ivermectin for Prevention and Treatment of COVID-19 Infectio... : American Journal of Therapeutics

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

More evidence that fluoxetine may have a protective effect against bad outcomes in patients with COVID-19.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

“We know that when you have the COVID infection you have trouble breathing and that’s because there’s infection in your lung, but an additional explanation is that the virus enters the respiratory centers of the brain and causes problems there as well,” l

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

I think the reason I got sick again is because whatever variant I have is not easily taken care of by antibodies formed against previous variants or by vaccines based on those variants, and because hardly anyone cares about masking and social distancing anymore.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

There is good evidence for treating COVID early with monoclonal antibodies and fluvoxamine. It is important to get the word out, so people who become ill will know they can talk to their doctors about treatment options.

Kelsey Piper

@KelseyTuoc

2 years

@firasd I don't think it's dishonest to say that there are innovative treatment options, I think it's just true! And while monoclonal antibodies in particular are highly effective, uptake isn't very high, which is part of why Covid is still a problem.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

"In a secondary analysis of participants who took at least 80% of their pills...Risk of hospitalization or extended emergency care was reduced by two-thirds, and...[there was] a reduction in mortality risk of 91%."

Antidepressant may prevent severe COVID-19, follow-up study indicates - The Source - Washington...

Researchers at Washington University School of Medicine have found that the drug fluvoxamine has been shown, in a pair of studies conducted on two continents, to be an effective treatment for people...

source.wustl.edu

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

Here is the new fluvoxamine fact sheet from Ontario COVID-19 Science Advisory Table. It contains useful information for prescribers and pharmacists.

Fluvoxamine: What Prescribers and Pharmacists Need to Know - Ontario COVID-19 Science Advisory Table

covid19-sciencetable.ca

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

ICU patients in Croatia taking fluvoxamine 100mg TID showed reduced mortality compared to matched controls.

BPS Publications

The British Journal of Clinical Pharmacology is a leading international clinical pharmacology journal published by the British Pharmacological Society.

bpspubs.onlinelibrary.wiley.com

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

I find it interesting that after I tweeted that I have acute COVID for 3rd time, there were a lot of appropriate supportive comments, and also some from individuals who seemed to make extreme assumptions about my vaccination status, in one of 2 opposite directions…

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

Interesting article about NAC. N-acetyl cysteine: A tool to perturb SARS-CoV-2 spike protein conformation

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

Fluvoxamine EUA application has been submitted.

David Boulware, MD MPH

@boulware_dr

2 years

#IDTwitter we submitted EUA Application for #Fluvoxamine for #COVID19 to @US_FDA with the assistance of @EricLenze2 @AngelaReiersen @drklausner @ShohamTxID , and Ed Mills If you want to sign a letter of support (names are not public & will be reviewed)

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

A surprise here was the statistically significant benefit of the dopamine and norepinephrine re-uptake inhibitor BUPROPION, which is not an SSRI, but might be a sigma1 receptor agonist, and is a negative allosteric modulator of 5HT3A receptors.

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Angela Reiersen, MD, MPE

@AngelaReiersen

1 year

Majority of people in this study reported continued post-COVID symptoms 2 years after acute infection. This is not surprising to me based on accounts I've heard from individuals who had their first SARS-CoV-2 infection more than 2 years ago.

Post–COVID-19 Symptoms 2 Years After SARS-CoV-2 Infection

This cross-sectional study compares the presence of post–COVID-19 symptoms 2 years after acute SARS-CoV-2 infection between hospitalized and nonhospitalized patients.

jamanetwork.com

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

Our full paper on possible mechanisms of fluvoxamine in treating COVID19 has now been published in @FrontiersIn Pharmacology.

Frontiers | Fluvoxamine: A Review of Its Mechanism of Action and Its Role in COVID-19

Fluvoxamine is a well-tolerated, widely available, inexpensive selective serotonin reuptake inhibitor that has been shown in a small, double-blind, placebo-c...

www.frontiersin.org

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

See this new article about fluvoxamine for treatment of COVID-19, including a video abstract which is available on the journal website.

Fluvoxamine for the Early Treatment of SARS-CoV-2 Infection: A Review of Current Evidence

Drugs - SARS-CoV-2 infection causes COVID-19, which frequently leads to clinical deterioration and/or long-lasting morbidity. Academic and governmental experts throughout the USA met in 2021 to...

link.springer.com

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

Sotrovimab may be the only MAB that works against Omicron, but it is NOT “the only Covid treatment that works against Omicron”. Fluvoxamine can reduce clinical deterioration, emergency medical care visits, hospitalizations, and deaths.

US ships out all remaining supplies of the only Covid mAb treatment that works against Omicron

Right as the new Omicron variant is poised to increase rapidly across the US, the federal government has effectively run out of the only monoclonal antibody treatment that works against it, and at...

endpts.com

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

Doctors can still prescribe fluvoxamine off-label, but it would best to have an official EUA from the FDA to support this. Not everyone can take Paxlovid, and it has problems like rebound. We need multiple treatment options.

Opinion | Why Won’t the FDA Let Doctors Prescribe Fluvoxamine for Covid?

Trials show it keeps patients from getting sicker, but the agency won’t approve its emergency use.

www.wsj.com

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

Case reports on 2 COVID19 patients showing signs of serotonin excess & improving with cyproheptadine. If this is caused by platelet hyperactivation, an SSRI given early in the course of COVID19 could potentially prevent this. @farid__jalali

Marc J. Saint-Jour

@MarcJ2327

3 years

Check out my published case reports on 2 patients with what appears to be an unprovoked serotonin-like syndrome in #covid19 #medtwitter please share @TelehealthBot

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

This situation seem pretty bad, but there is a good COVID19 outpatient treatment option that many people are ignoring or have not heard about: FLUVOXAMINE.

Prof Peter Hotez MD PhD

@PeterHotez

2 years

2. Lack of Rx options. At least one of our mabs not effective vs omicron due to SGTF mutations and as @EricTopol points out in his new opinion piece we don’t have paxlovid in quantity

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

Check Interactions of COVID19 drugs with each other and with your other medications here.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 months

1/ 4 years ago (3/17/2020), I first noticed symptoms of my first episode of COVID-19. About a week later, while experiencing the inflammatory phase, I thought of a possible way to prevent inflammation-related respiratory deterioration using an existing drug called fluvoxamine.

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

Column: With fluvoxamine, doctors find an old drug that may actually work against COVID-19

Forget hydroxychloroquine or Ivermectin. But there is one existing medicine that shows signs of benefiting COVID-19 patients: fluvoxamine.

www.latimes.com

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

Article states, "In COVID-19 cases, the virus “hijacks” stress-response machinery, including sigma receptors, in order to replicate in the body. Interfering with that signaling appears to be the key...," but RCTs are still needed for these 2 compounds.

Two common compounds show effectiveness against COVID-19 virus in early testing - UF Health

A pair of over-the-counter compounds has been found in preliminary tests to inhibit the virus that causes COVID-19, University of Florida Health researchers…

ufhealth.org

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

@Covid19Crusher Increase in melatonin level may be one reason for fluvoxamine’s apparent benefit. Maybe they are even better given together.

Fluvoxamine, melatonin and COVID-19

Psychopharmacology -

link.springer.com

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

New publication including pharmacokinetic modeling of fluvoxamine & fluoxetine: Suggests fluvoxamine dose of 100mg BID may be ideal to ensure occupation of S1R, and fluoxetine level may not get high enough even at FDA maximum dose.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

New study finds antidepressants like Prozac may help patients survive Covid-19

A growing body of evidence suggests Covid-19 patients on SSRIs are less likely to die. The most recent study examined fluoxetine, known by the brand name Prozac.

www.inverse.com

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

EFFECT OF EARLY TREATMENT WITH FLUVOXAMINE ON RISK OF EMERGENCY CARE AND HOSPITALIZATION AMONG PATIENTS WITH COVID-19: THE TOGETHER RANDOMIZED PLATFORM CLINICAL TRIAL | medRxiv

Effect of Early Treatment with Fluvoxamine on Risk of Emergency Care and Hospitalization Among...

Background Recent evidence indicates a potential therapeutic role of fluvoxamine for COVID-19. In the TOGETHER randomized platform clinical trial for acutely symptomatic patients with COVID-19, we...

www.medrxiv.org

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Angela Reiersen, MD, MPE

@AngelaReiersen

6 months

1/ Just in case any long haulers are interested: I had COVID 1st time March 2020. I think benefits of vaccination are greater than risks for many people, but I had recurrence of long COVID symptoms after the 2-shot Pfizer series (~Jan2021) so chose not to get mRNA boosters.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

This article describes one mechanism that might possibly contribute to neurological symptoms of COVID-19: viral ORF proteins forming amyloid.

Neurotoxic amyloidogenic peptides in the proteome of SARS-COV2: potential implications for neurol...

Nature Communications - Here the authors report the formation of toxic clumps of protein, similar to amyloid assemblies found in Alzheimer’s disease and suggest their possible role for some...

www.nature.com

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

Important video about Ivermectin for treatment of COVID19. Includes description of a meta-analysis of mortality risk. Raises questions regarding WHO recommendations.

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among patients with COVID-19: the TOGETHER randomised, platform clinical trial

Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among...

Treatment with fluvoxamine (100 mg twice daily for 10 days) among high-risk outpatients with early diagnosed COVID-19 reduced the need for hospitalisation defined as retention in a COVID-19 emergency...

www.thelancet.com

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

@amandalhu Some pro-vax people are also anti-early-treatment for some reason. Sometimes when I post about COVID treatment research findings, some pro-vax people pop out and say they’d prefer to just get vaxxed. Getting vaxxed does not 100% prevent COVID. We need treatments too.

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

For more information, see:

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

Some assumed I must have got sick a 3rd time due to being unvaccinated/unboosted, so not having strong enough immune response. Others though I must have got COVID a 3rd time because I WAS fully vaccinated/boosted and that this impaired my immune function. Both are wrong.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

Meta-analysis has been published: Fluvoxamine for Outpatient Management of COVID-19 to Prevent Hospitalization via @JAMANetworkOpen part of @JAMANetwork

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

Thanks to Sharyn Alfonsi and the @60Minutes @CBS team for this excellent story about our fluvoxamine studies. @EricLenze2 @WUSTLmed #COVID19 #60Minutes #fluvoxamine COVID-19 research points to repurposed drugs

COVID-19 research points to repurposed drugs

60 Minutes reports on a 40-year-old OCD pill that may prevent severe symptoms in COVID patients.

www.cbsnews.com

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

It’s great that Paxlovid will be available, but not everyone with COVID will be able to get it, at least not at first. Fluvoxamine can be prescribed off-label for outpatients with acute COVID NOW.

Alina Chan

@Ayjchan

2 years

Pfizer said production of their pill takes ~6-8 months. The pill has to be taken within 5 days of first symptoms to be effective. There is limited availability of the drug so patients at highest risk must be prioritized to receive these pills.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

Blog entry: “Treatments for COVID-19” - from Harvard Health (includes section on fluvoxamine).

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

This is an important study by @farid__jalali and colleagues on platelets & serotonin in COVID19.

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

I know I already tweeted this article, but I think it is very good, so I am tweeting it again. Fluvoxamine for Coronavirus

Fluvoxamine for Coronavirus

www.science.org

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Angela Reiersen, MD, MPE

@AngelaReiersen

1 year

@EricTopol @NatureMicrobiol I'd be very interested in getting a nasal vaccine against this virus, especially if a nasal vaccine might be less likely than other existing vaccines to trigger autoimmune/inflammatory-related long COVID symptom flares.

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

My article is on page 9. It describes how I got the idea to use fluvoxamine as a treatment for COVID-19.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

And remember, fluvoxamine increases melatonin levels, so this could have something to do with fluvoxamine's benefits as well.

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

I agree with this tweet by @farid__jalali . We need BOTH vaccines AND early treatment options for COVID.

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

Final version of our FIASMA article is now published online: Association Between FIASMAs and Reduced Risk of Intubation or Death in Individuals Hospitalized for Severe COVID‐19

Association Between FIASMAs and Reduced Risk of Intubation or Death in Individuals Hospitalized for...

Clinical Pharmacology & Therapeutics is a cross-disciplinary clinical medicine journal publishing advances in the nature, action, efficacy, and evaluation of therapeutics.

ascpt.onlinelibrary.wiley.com

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

So, if Paxlovid only “pauses” viral replication, and the course of illness can just continue on once Paxlovid is stopped, maybe it would work better if combined with something else that has a different mechanism.

StereoMatch

@stereomatch2

2 years

@AngelaReiersen @DrSyedHaider2 @drbeen_medical @ichudov @Aguirre1Gustavo @DarrellMello @drakchaurasia @Canal1point5 Summary seems to be that Paxlovid simply pauses the viral replication process - once it wears off - in 2-8 days the process continues - remnants in cells are used to synthesize whole live virus again which has been reported to infect others again (!)

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

Example of “COVID brain”. I advise trying to avoid getting COVID for as long as possible, at least until we know more about methods of preventing and treating lasting effects of the disease. Research is in progress, but we still don’t know enough about this.

Dr. Alice 💕

@calirunnerdoc

2 years

Want to see what a “COVID Brain” can look like? Here’s mine. The white spots are not supposed to be there. You can’t see the microhemorrhages or swelling. Infected early March ‘20- pre-vaccine.But the threat is still here for everyone-vax or not, young or old. Please mask up.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

@loofymectin @LongTiredRoad @BernieDogs4 @farid__jalali @AlisaValdesRod1 I think it is very likely that many people with long COVID have hyper-activated platelets which periodically release large amounts of serotonin. SSRIs can prevent platelets from loading up on serotonin, but that will take time since some platelets would be fully loaded already…

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

Fluvoxamine for Coronavirus | Science | AAAS Nice quote from the article:”This is good news, since the drug is cheap and widely available, and I hope that this news is immediately affecting clinical practice”

Fluvoxamine for Coronavirus

www.science.org

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Angela Reiersen, MD, MPE

@AngelaReiersen

6 months

@ShaneyWright Maybe I can talk to some of my WashU ophthalmology colleagues and see if they are interested in looking into this.

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Angela Reiersen, MD, MPE

@AngelaReiersen

1 year

I submitted a comment on our STOP COVID follow-up data to the JAMA network website, alongside the 2-year COVID follow-up article by 'César Fernández-de-las-Peñas' and colleagues. See the comments tab.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

With COVID cases increasing again in some places, it is time to spread the word about fluvoxamine (again).

Drew Comments

@sjs856

2 years

Stream episode Fluvoxamine for COVID-19, with Dr. Angela Reiersen by COVID Unfiltered podcast | Listen online for free on SoundCloud

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

@frothtimus @farid__jalali EUA application for use of fluvoxamine to treat early COVID was submitted to the FDA, but it could take months for FDA to review that. Omicron is here now, so it makes sense for doctors to just go ahead and prescribe it off-label now, at least for certain high-risk patients.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

Fluvoxamine may help prevent severe overloading of the hospitals during this Omicron surge if physicians choose to prescribe it for appropriate high-risk patients.

Ely Rabani #GazaCeasefireNow

@radsci

2 years

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

@Canal1point5 @SerpinaLonghaul @YochaiReemMD @MrsProctor2010 @PeterHotez In this study, long COVID patients with higher “anxiety” tended to also have higher evidence of neuronal damage. So, high anxiety should be a reason to assess and address the neurological dysfunction that could be causing the anxiety.

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Angela Reiersen, MD, MPE

@AngelaReiersen

1 year

@MVGutierrezMD @PutrinoLab This is true. I had COVID 3 times, Acute COVID symptoms were not as bad 2nd and 3rd time, but long COVID gets worse after each re-infection and then gradually improves to near-baseline over 5-6 months each time. I have heard similar stories from other people.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

I think I probably have a strong (maybe even overly strong) immune response to the viral antigens my body has seen, due to both past infections and the Pfizer 2-shot series, but the virus keeps mutating, and is good at evading the immune system, So, none of this was adequate.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

Bupropion may be a S1R agonist. This may contribute to its antidepressant activity and also to its apparent benefit in COVID-19. It would be great to see COVID-19 RCTs testing bupropion.

Possible involvement of sigma-1 receptors in the anti-immobility action of bupropion, a dopamine...

Sigma receptors particularly, sigma-1 subtype is known to modulate the release of catecholamines in the brain and may participate in the mechanism of action of various antidepressants. The present...

pubmed.ncbi.nlm.nih.gov

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

Final article now published in issue: Association Between FIASMAs and Reduced Risk of Intubation or Death in Individuals Hospitalized for Severe COVID‐19: An Observational Multicenter Study - Hoertel - 2021 - Clinical Pharmacology & Therapeutics -Wiley

Association Between FIASMAs and Reduced Risk of Intubation or Death in Individuals Hospitalized for...

Clinical Pharmacology & Therapeutics is a cross-disciplinary clinical medicine journal publishing advances in the nature, action, efficacy, and evaluation of therapeutics.

ascpt.onlinelibrary.wiley.com

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Angela Reiersen, MD, MPE

@AngelaReiersen

1 year

And there is also evidence from an observational study that SSRIs may reduce the risk for long COVID. "...28% reduction in risk of PASC was observed for S1R agonist SSRIs and a 25% reduction in risk of PASC was observed for non-S1R agonist SSRIs..."

Assessing the Effect of Selective Serotonin Reuptake Inhibitors in the Prevention of Post-Acute...

Importance Post-acute sequelae of COVID-19 (PASC) produce significant morbidity, prompting evaluation of interventions that might lower risk. Selective serotonin reuptake inhibitors (SSRIs) potenti...

www.medrxiv.org

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

@LongTiredRoad @AlisaValdesRod1 Also, many people with severe acute COVID have antibodies to serotonin 5-HT2A receptors, and these antibodies may activate those receptors as if they were serotonin. In this case a drug blocking that receptor (perhaps cyproheptadine or mirtazapine) might help.

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Angela Reiersen, MD, MPE

@AngelaReiersen

1 year

@fasc1nate @Ultracaustique Here's what spicebush swallowtail caterpillars do if you tap them on the back. They stick put this weird Y-shaped smelly appendage that looks like a snake's tongue.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

We need more COVID treatment options like fluvoxamine, especially considering the treatment-resistant COVID variants that have emerged. I'm glad to see that Platforma Catracha has been proactive in providing evidence-informed early COVID treatment for the people of Honduras.

Plataforma Catracha

@Plat_Catracha

2 years

Drug-evasive COVID variants are spreading globally. Very proud of our Fluvoxamine paper showing the world a safe and available option for all patients . Specially for those living in LMICs.

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Angela Reiersen, MD, MPE

@AngelaReiersen

1 year

@dr_leshan @farid__jalali Will be nice to see the full results. I do think timing of treatment may be very important with fluvoxamine. Easier to stop inflammation before it gets far enough along to do significant damage.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

PCPs: It really is a good idea to treat outpatients with COVID very early! You might even be able to help prevent overloading of ERs and hospitals!

Flavio Abdenur

@AbdenurFlavio

2 years

Yes. Inhaled budesonide is in a similar situation. Dear doctors, *please* considering using fluvoxamine and/or inhaled budesonide to treat your high-risk covid outpatients. The randomized trial data are very, very clear on these two.

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

What are all these megakaryocytes doing in the brain capillaries of COVID patients?

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

I'm discussing “Mechanisms of Repurposed Drugs for COVID19” with @PierreKory , @DrRomie , and 2nd Time Around. Saturday, Jun 12 at 9:00 AM CDT on @clubhouse . Join us!

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Angela Reiersen, MD, MPE

@AngelaReiersen

6 months

Long-haulers who have had Novavax: What is your experience with Novavax vs other COVID shots? Do NOT answer unless you have (or have had) Long COVID and have had Novavax. SE=acute vaccine side effects (1st 2-3 days after shot), LC=long COVID symptom status since shot.

less SE, LC improved

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less SE, LC stable

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less SE, LC worse

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same/worse SE, LC worse

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

Interesting. The fluvoxamine mechanism described here is a type of antiviral mechanism requiring only low concentration of drug, which might explain why low dose would be effective for very early treatment.

Ernesto de Bernardis, MD 🌉🇪🇺🌍🪐

@debe

3 years

@AngelaReiersen

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Angela Reiersen, MD, MPE

@AngelaReiersen

7 months

1/ Here's an interesting paper. Seems that spike protein binds to lipopolysaccharide (LPS), which triggers inflammation. This is very consistent with my hypothesis that fluvoxamine's benefit for treating COVID involves activation of the S1R, which reduces cytokine production.

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

Well, I worked hard, along with @EricLenze2 and many others on our STOP COVID 1&2 teams, but it was Ed Mills & his @TogetherTrial who ultimately got fluvoxamine over the line.

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

Study suggests very early treatment is needed to detect antiviral treatment effects (or else need huge sample size): Detection of significant antiviral drug effects on COVID-19 with reasonable sample sizes in randomized controlled trials: A modeling study

Detection of significant antiviral drug effects on COVID-19 with reasonable sample sizes in...

Using a viral dynamics model, Shingo Iwami and colleagues investigate the sample sizes required to detect significant antiviral drug effects on COVID-19 in randomized controlled trials.

journals.plos.org

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

It looks like I never actually retweeted this, even though @__ice9 requested all followers to do so, and I think this is potentially very important. Better late than never.

ice9

@__ice9

3 years

To all of my supposedly 7500+ followers (bots and dead accounts notwithstanding)-- I have one request: 𝗥𝗘𝗧𝗪𝗘𝗘𝗧 𝗧𝗛𝗜𝗦 It is the most important thing I have ever written. Every critical care physician who reads this and understands it is worth decades of life saved.

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Angela Reiersen, MD, MPE

@AngelaReiersen

3 years

I’m thinking we really need to accelerate trials of existing drugs repurposed to treat COVID. Vaccines may not be enough to get this under control any time soon.

C. Michael Gibson MD

@CMichaelGibson

3 years

Mutations of mutations ... Now a new UK variant has BOTH the increased ability to infect people like B117 and the changes to the spike protein giving it the ability to evade vaccines 50% of the time like E484K ... "I feel the need, the need for speed"

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

@Canal1point5 @SerpinaLonghaul @YochaiReemMD @MrsProctor2010 @PeterHotez In other words, anxiety should perhaps give stronger reason for proper assessment and treatment of potential CNS damage, rather than a reason to discount a long COVID patient’s symptoms as being caused by anxiety.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

@nihillmatic Did not take fluvoxamine for the first infection in March 2020. I thought of the idea while sick, but it was just a hypothesis at the time. I did take fluvoxamine the other 2 times. Also been taking it for long COVID, and I increased to max dose for acute COVID. Seems to help.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

@richardemoe @eongmobl @loofymectin @drbeen_medical @EduEngineer @Same_Sarikei @Covid19Critical @chrismartenson @DrTessaT @fynn_fan @DCGreenZone1 @farid__jalali @deNutrients I believe in evidence-based medicine, but some EBM proponents look at mortality results like this and interpret this as evidence for NO effect because p-value is not less than 0.05, even though the point estimate suggests there most likely is an effect, but study has low power.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

Real-world success with early use of repurposed drugs for treatment of COVID in Honduras. One predictor of worse outcome was if fluvoxamine was not given early enough in course of illness (started after 4 days).

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

Medication for autoantibodies also effective for Long COVID

As part of an individual treatment attempt and thanks to medication originally developed for treating heart disease, a team of doctors at the Department of Ophthalmology at Universitätsklinikum…

www.fau.eu

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

@star9girl9 @YoDoctorYo Might help to tell your PCP fluvoxamine is in the Johns Hopkins treatment guidelines.

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

ICER: “… committee votes 11-2 that the evidence is not adequate to demonstrate a net health benefit for molnupiravir over symptomatic care alone; Paxlovid and fluvoxamine receive more favorable votes”

ICER Publishes Final Evidence Report and Policy Recommendations on Outpatient Treatments for...

Independent appraisal committee votes 11-2 that the evidence is not adequate to demonstrate a net health benefit for molnupiravir over symptomatic care alone; Paxlovid and fluvoxamine receive more...

icer.org

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Angela Reiersen, MD, MPE

@AngelaReiersen

2 years

Nice to see fluvoxamine showing up on more hospital protocols.

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