A substantial number of people struggle with long COVID after acute infection. Fatigue is often one of the most debilitating features. Fluvoxamine and metformin have shown some initial promise for this indication, but there is very limited robust evidence. The investigators of this RCT evaluated the efficacy of metformin and fluvoxamine vs placebo in the reduction of fatigue in patients with long COVID. Fluvoxamine showed a significant reduction in the Fatigue Severity Scale after 60 days, with persistence to 90 days. Whether this effect was related to improvement in undiagnosed depression or due to another mechanism of action (such as immunomodulatory effects) was not assessed. Metformin did not show a statistically significant benefit. 

Fluvoxamine may be a useful option to improve quality of life in affected patients.

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