Low-dose Naltrexone & Mestinon RCT in ME/CFS and Long COVID

Prof David Systrom presented clinical trials on the efficacy of low-dose naltrexone (LDN) and pyridostigmine (Mestinon) in ME/CFS. His presentation touched upon his presentation on the day one of the conference, in which he reported on reduced preload in ME/CFS, resulting in insufficient blood flow to the heart, thus reducing pumping performance. Pyridostigmine (Mestinon) demonstrated in a pilot study that it has the ability to increase preload. The mechanism of action is thought to be an improvement in vascular tone in an upright position, thus improving blood flow. LDN is already being used for off-label treatment. Initial clinical efficacy studies in fibromyalgia are currently underway. The mechanism of action of LDN is a reduction in natural killer cells and pro-inflammatory cytokines, thereby reducing the chronic inflammatory response. A clinical trial (LIFT) is currently being conducted with 160 ME/CFS patients with orthostatic intolerance to investigate the efficacy of a combination of LDN and Mestinon.