COVID-19: the place of metabolic correctors in the therapy of patients with post-COVID syndrome

The frequency of post-COVID syndrome in patients treated on an outpatient basis ranges from 10% to 35%, while in patients who have had a severe disease requiring hospitalization, the frequency of post-COVID syndrome can reach 80%. Increased fatigue, defined as a feeling of physical and mental fatigue or exhaustion in the form of muscle weakness, slow reactions, drowsiness and reduced concentration, is the most common (17,5-72%), often the leading complaint of patients with post-COVID syndrome. In 63% of patients, even 6 months after discharge from the hospital, increased fatigue and muscle weakness were noted. Since there is reason to believe that hypoxia and acidosis with a violation of the processes of formation and use of energy occur in asthenic syndrome, it seems appropriate to use metabolic correctors in this situation, which include the drug meldonium. Meldonium works as an antihypoxant, antioxidant, cytoprotector, angioprotector and energy protector, which gives grounds to speak of the so-called multimodal or supranosological effect of the drug. This article describes the mechanism of action and the main clinical effects of meldonium. Meldonium reduces the synthesis of carnitine, which leads to inhibition of β-oxidation of free fatty acids, glycolysis is activated and the formation of adenosine triphosphate in cells increases. Data are given on the effectiveness of meldonium in coronary heart disease and coronary brain disease, chronic heart failure, diabetes mellitus and asthenic syndrome. The positive effect of the drug on lipid and carbohydrate metabolism is described. Two clinical cases are presented confirming the effectiveness of meldonium in post-COVID syndrome and such a common manifestation of it as asthenia. The conclusion is made about the expediency of including meldonium in the complex therapy of patients with post-infectious asthenic syndrome in a pandemic.

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