Pharmacological Approaches to the Management of Long COVID

Long COVID represents a multifaceted clinical syndrome characterized by persistent symptoms such as fatigue, dyspnea, cognitive impairment, and autonomic dysfunction that extend beyond the acute phase of infection. The heterogeneity of its manifestations and underlying pathophysiological mechanisms, including chronic inflammation, immune dysregulation, endothelial dysfunction, viral persistence, and autonomic imbalance, has complicated the development of targeted therapies. Current pharmacological treatment strategies are largely symptomatic and repurposed from established therapies for related conditions. These include the use of anti-inflammatory and immunomodulatory agents, cardiovascular and autonomic regulators, anticoagulants, and antiplatelet therapies to address microthrombosis, and agents for neurological and psychiatric symptoms. Additionally, novel therapeutics under investigation target viral reservoirs, mitochondrial dysfunction, and abnormal coagulation pathways. While clinical trials remain limited and evidence is evolving, a precision-medicine approach integrating patient phenotype and underlying mechanisms may enhance treatment efficacy. This review synthesizes the current pharmacological strategies, evaluates emerging therapeutic candidates, and highlights the importance of robust clinical trials to establish effective and safe interventions for Long COVID.