u/MagicC

Original post:

https://www.reddit.com/r/covidlonghaulers/comments/1ufndby/7_months_in_and_i_finally_found_a_medicine_combo/

Update 1:

https://www.reddit.com/r/covidlonghaulers/comments/1um5iwg/comment/ovgep9p/?screen_view_count=2

Hey folks,

I promised I'd get my follow-up CRP test, but then I caught a cold/flu from my preschool aged daughter, so I had to wait. I finally got it done today, and my inflammation had gone from 23.3 mg/L on May 12, 2026 to 11.3 mg/L on July 17, 2026, after about a month on Naltrexa (aka Contrave). That tracks with how I'm feeling - better, but not completely normal.

Subjectively speaking, I'm definitely doing a lot better, but I'm still very reliant on my H1/H2 antihistamine stack. If I forget to take it, I get a terribly anxious stomach. I'm hopeful that maybe a few months from now, I'll have controlled the inflammation enough that I can wean off the antihistamines, but we'll see.

Tomorrow, I'm flying with my daughter to the US to visit my family (without my wife to help). This wouldn't have been a realistic goal a month ago, and now I'm feeling nervous, but confident that I can pull it off. I'm also going to try going to try yoga, and see how my body responds. Wish me luck!

Here's my timeline so far:

• Late November 2025: had the worst case of COVID of my life, crackling lungs, sore chest, difficulty moving or breathing without uncontrollable coughing. Lasted about 4 weeks in the acute phase, and slowly turned into long COVID as I got the worst symptoms under control
• Late December 2025 onward: symptoms of brain fog, PEM, difficulty catching my breath, and pain in my solar plexus among others.
• May 12, 2026: Blood work showed elevated inflammation — CRP (C-reactive protein) at 23.3 mg/L, well above the normal range (0.0–5.0) and flagged by the lab as "moderate inflammation" (10–40 range). No other abnormalities found in the ~15 lab tests I ordered for myself based on online research for alternative hypotheses to explain my exhaustion besides COVID (e.g. vitamin B, vitamin D, testosterone, blood sugar, etc).
• June 2, 2026: Went to a cardiologist for a cardiac stress test. Objectively documented exhaustion after only ~8 minutes of moderate walking, heart rate maxed out. Heart itself was normal — ruled out cardiac causes, confirming this was exertional intolerance/PEM, not a cardiac problem. Cardiologist recommended moderate exercise.
• June 3-Jun 12, 2026 - ~7500 steps per day for 10 days while continuing my normal work-from-home routine
• June 12-13, 2026 - Crashed and slept for 14 hours straight and woke up still exhausted.
• June 13, 2026 - Doctor flaked on my doctor's appointment
• June 15, 2026: Started using off-label Naltrexa (aka Contrave) on my own initiative, after 6 months and three failed attempts to get a doctor to take LDN seriously as a treatment option. (I live in Costa Rica, and prescription drugs are much more loosely controlled here.)
• June 18, 2026 (Day 3): First real-world test — hiking in Fraijanes with my kids for Father's Day. Rough outcome: even 50 meters of uphill walking wiped me out. Not a miracle cure, but an honest data point. Importantly, I didn't crash the next day.
• June 23, 2026 (Day 8): Unplanned stress test — had to move ~600 lbs of construction materials during a windstorm emergency. I did 45 minutes of high-stress physical labor, before my morning dose that day. Felt fine the rest of the week; only needed a 3-hour nap on Saturday, June 27, and woke up refreshed rather than crashed.
• ~July 2, 2026 (Week 2.5): Walked 45 minutes at a fast pace while talking on the phone with my brother the entire time — something that would have been impossible a month earlier.
• July 17, 2026 (~1 month on Naltrexa): Follow up CRP (C-reactive protein) test at 11.3 mg/L. Feeling noticeably better across the board.

If anyone else is trying Naltrexa (sold as Contrave in the US), let me know, I'm interested to hear if anyone else is having these kinds of results.

Here's my current stack:

Before bed:

180 mg fexofenodine (generic Allegra)
20 mg famotidine (generic Pepsid AC)
400 mg Magnesium Glycinate + 80 mg Magnesium
4 psyllium husk fiber capsules
1 probiotic capsule
16 oz of water

In the morning:

180 mg fexofenodine (generic Allegra)
20 mg famotidine (generic Pepsid AC)
1 Contrave (aka Naltreva) pill, which is a prescription drug with 90 mg of extended release bupropion (generic wellbutrin) + 8 mg of Naltrexone
4 psyllium husk fiber capsules
16 oz of water
cup of tea or coffee

Original post:

https://www.reddit.com/r/covidlonghaulers/comments/1ufndby/7_months_in_and_i_finally_found_a_medicine_combo/

Hey folks, I promised I would update, and I wanted to share a couple of tweaks. One was the result of someone who I was DMing with after my first post. They told me that they were taking 120 mg of famotidine (vs. my 20 mg), and it made me think, "Whoa, is that safe?" So I looked it up and discovered that 80 mg is a pretty well-established dose, and 160 mg has been tested safely under a doctor's supervision for some cases, and so I doubled my famotidine to 40 mg per day, and suddenly, my anxiety was much reduced! I also added a second fexofenodine, because I realized, the reason I cut back from 2 a day to 1 a day was it was making me too sedated, and now I'm much less sleepy.

Something else I forgot to mention in my first post - I had bad POTS before, and now, I have much less severe POTS. It's still tough getting up and down sometimes, but nothing like as bad as it was before. I can play with my 4 year old daughter again!

One thing I've had to deal with, now that my brain fog is subsiding a bit, is the real mess that my life is in after 7+ months of chronic illness. And so I made a list of all the overdue projects, and I'm starting to attack them a bit at a time. I'm not exactly making a dent yet, but I'm at least facing the problems, and no longer forgetting everything...

I had one day where I "hit the wall" a bit and needed a 3 hour nap, but unlike before, the nap actually refreshed me, and the next day I felt back to "new normal" (i.e. good enough to function).

Anyway, I had my most productive week at work in a long time (albeit still only maybe 50% of how productive I was before all of this), and I'm hoping this is the start of the long climb back to normal health, but we'll see. I'll continue updating as I proceed. Here's my current stack:

Before bed:

180 mg fexofenodine (generic Allegra)
20 mg famotidine (generic Pepsid AC)
400 mg Magnesium Glycinate + 80 mg Magnesium
4 psyllium husk fiber capsules
1 probiotic capsule
16 oz of water

In the morning:

180 mg fexofenodine (generic Allegra)
20 mg famotidine (generic Pepsid AC)
1 Contrave (aka Naltreva) pill, which is a prescription drug with 90 mg of extended release bupropion (generic wellbutrin) + 8 mg of Naltrexone
4 psyllium husk fiber capsules
16 oz of water
cup of tea or coffee

I've been struggling with LC since November of last year, with severe fatigue and brain fog. But, long story short, for the first time since November, I feel more or less normal!

Here's my stack:

Before bed:

180 mg fexofenodine (generic Allegra)
20 mg famotidine (generic Pepsid AC)
400 mg Magnesium Glycinate + 80 mg Magnesium
4 psyllium husk fiber capsules
1 probiotic capsule
16 oz of water

In the morning:
1 Contrave (aka Naltreva) pill, which is a prescription drug with 90 mg of extended release bupropion (generic wellbutrin) + 8 mg of Naltrexone
4 psyllium husk fiber capsules
16 oz of water

The psyllium husk helps keep the medicine from becoming too harsh on my stomach. But the newest med, and what has made a massive difference in my brain fog and chronic fatigue, chronic inflammation, and poor recovery from exertion, is the Contrave (bupropion and LDN).

About 6 weeks ago, I was feeling depressed and exhausted, and decided to go to a cardiologist to get my heart condition via a stress test. She told me nothing was wrong with my heart, and approved me trying to do 7500 steps a day to see if I'd recovered enough to begin reconditioning. I tried that for a week, and collapsed in exhaustion that weekend, sleeping 14 hours and getting up still exhausted. So I was definitely not better.

I finally pursued low-dose naltrexone, and when I was researching it, I discovered this formulation called Contrave aka Naltreva if you're outside the US, which contains bupropion, an effective anti-depressant. The combo is usually used for weight loss. That sounded perfect, because I'm also about 20 lbs overweight. And unlike LDN (which I had requested before and gotten rejected by a doctor, because it was off-label), Contrave was easy to get.

It's kind of expensive without insurance ($199 per month via GoodRx), but if you have insurance, the manufacturer program keeps it to $99 per month. Or you can come visit/live in Costa Rica like me, and find it for less than ~$1 per day, under the name Naltreva. haha

And of course, if you can't afford this, you can cobble together regular generic wellbutrin (~$9 per month) and naltrexone ($36 per month), and use the normal LDN dilution process (i.e. put a pill with x mg of naltrexone into a glass with x ml of distilled water, let it dissolve, mix it up, and take it with an eyedropper) or try to get LDN through a compounding pharmacy via your doctor. I haven't tried this myself, but I'm hopeful it would have comparable effects.

Anyway, the first week I started using bupropion/naltrexone, I immediately felt significantly better from the very first day onward. And the effect has continued to increase with time.

For example, earlier this week, I had a big challenge, when there was an emergency at my family's construction site due to a windstorm blowing sheet metal off our new building. There was no one to work on it but me and my father-in-law, so we had to climb on the roof and move hundreds of pounds of sheet metal and weights to keep everything from blowing away. It was the most physical labor I've done in over a year. Normally, this would have absolutely destroyed me with PEM (post-exertional malaise) for a week, and the next day I wouldn't have been able to get out of bed. But this time, I just took some aspirin when I got home and tylenol before bed, and the next day I felt perfectly fine!

Just so you understand my path, I have had 4 vaccines, but I've always been susceptible to long covid. And in November I caught it again. I had crackling mucus sounds in my lungs and felt the sickest I've ever been for like a month, before I discovered that I needed H1 and H2 inhibitors (the Allegra/Pepsid combo) to tamp down the acute symptoms. Once the acute symptoms were under control, it really felt like doctors weren't willing to keep working on the chronic exhaustion and brain fog symptoms. I had a telehealth doc tell me, "Count yourself lucky that you found anything that works for you at all!"

I tried a lot of supplements (NAC, Quercetin, CoQ10, Bromelain, Nattokinase, L-Theanine, Lion's Mane Mushroom extract, etc) in various combinations, and nothing seemed to help. I was continuing to work at my job and take care of my family as best I could, but I started describing myself to family members as "chronically ill", and basically dropped out of all social activities. It was work, kids, internet, and sleep, and that was it. And I was feeling like I was really bad at my job (which involves a lot of thinking and analysis), because my memory was so bad.

And now, I feel normal again! Anyway, I told my sister about my improvement, and she said, "You should share this with people, maybe it'll help the other long-haul folks!"

So there it is. If you have had similar results from this stack, please chime in. If you haven't tried it yet, but you're suffering from MCAS (mast cell phenotype) long covid symptoms and depression, exhaustion, and chronic inflammation (I had a blood workup a few months ago, and my PCR was 23.3, vs a baseline of 0-5, indicating strong inflammation), this might help you too! So give it a try! I've also read that LDN (low-dose naltrexone) has been seen to have a lasting effect at moving the immune system equilibrium to a less-reactive state, so that eventually you can get off the meds altogether, so I hope this experience gives you some hope and something new to try!

I will come back and update this post periodically over the coming months, to update you on my progress. Hoping to have good news, but I will report either way.

*edited to add a nightly probiotic capsule that I forgot to include in my stack, and added the term "post-exertional malaise (PEM)" to my account, because I couldn't think of it before, but I remember it now haha