Is the post-COVID-19 syndrome a severe impairment of acetylcholine-orchestrated neuromodulation that responds to nicotine administ... (Leitzke, 2023)

Is the post-COVID-19 syndrome a severe impairment of acetylcholine-orchestrated neuromodulation that responds to nicotine administration?
Leitzke, 2023

Following a SARS-CoV-2 infection, many individuals suffer from post-COVID-19 syndrome. It makes them unable to proceed with common everyday activities due to weakness, memory lapses, pain, dyspnea and other unspecific physical complaints. Several investigators could demonstrate that the SARS-CoV-2 related spike glycoprotein (SGP) attaches not only to ACE-2 receptors but also shows DNA sections highly affine to nicotinic acetylcholine receptors (nAChRs). The nAChR is the principal structure of cholinergic neuromodulation and is responsible for coordinated neuronal network interaction. Non-intrinsic viral nAChR attachment compromises integrative interneuronal communication substantially. This explains the cognitive, neuromuscular and mood impairment, as well as the vegetative symptoms, characterizing post-COVID-19 syndrome. The agonist ligand nicotine shows an up to 30-fold higher affinity to nACHRs than acetylcholine (ACh). We therefore hypothesize that this molecule could displace the virus from nAChR attachment and pave the way for unimpaired cholinergic signal transmission. Treating several individuals suffering from post-COVID-19 syndrome with a nicotine patch application, we witnessed improvements ranging from immediate and substantial to complete remission in a matter of days.


Senior Member
I may try this, since I have long COVID on top of my ME/CFS.

The study only appears to have 4 patients though, so the benefits of nicotine might not pan out to the wider long COVID community.

Having said that, I found a Reddit post detailing the substantial benefits one long COVID patient obtained from nicotine gum (14 mg nicotine per day). He reports less fatigue, increased concentration, much better mood, improved tactile sensation and sense of smell.

Nicotine activates the nicotinic acetylcholine alpha 7 receptor, which in turn activates the cholinergic anti-inflammatory pathway, which puts the brakes on the innate immune response.

When taking nicotine, it might be worth adding the supplement galantamine, as this is a positive allosteric modulator of the nicotinic acetylcholine alpha 7 receptor. So galantamine should boost the effect of nicotine.


Senior Member
That's interesting, I just came across this article about Nicotine that downregulate DAT in the striatum in adult ADHD
Neuroimaging studies show a high striatal dopamine transporter (DAT) availability in most adults with ADHD; this can be reduced by stimulants. Nicotine seems to have a stimulant-like action on the DAT.

Full article: ADHD in adolescence and adulthood, with a special focus on the dopamine transporter and nicotine (

lot's of articles about the alpha7 nicotinic receptor stimulation to improve attention in ADHD and Schizophrenia!


nicotinamide can be severely out of whack in some patients when they measure it in those metabolomic studies. But the variance is high; many patients ate normal, some have results 10 standard deviations away.

this link is a screengrab i posted here ages ago, showing that for women, nicotinamide was the most different between patients and controls in the naviaux study:
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I tried nicotine lozenges a few times, but no cigar (pun intended), but that doesn't mean it won't work for someone else. One one of the social media groups I'm on there is an ME/CFS patient who says they derive great benefit from nicotine.