Metformin May Prevent Long COVID & Reduce CFS/Fibromyalgia Flareups Caused by COVID

Published: April 5, 2023

Metformin for Long COVID and CFS/FMS

A Lancet preprint study of over 1,000 overweight people with COVID showed dramatic benefits when they were treated with metformin, a drug commonly used to treat diabetes. In addition to preventing over 40% of ER visits/hospitalizations/deaths, it also decreased the risk of developing Long COVID by a dramatic 42%! And when the treatment was started within the first four days of the infection, this protection was even higher, cutting the risk in half.

As COVID can sometimes flare people's CFS/fibromyalgia, I think it is reasonable for anybody with these conditions to keep a supply of metformin on hand at home so they can begin taking it immediately at the onset of symptoms (and perhaps a positive COVID home test). By printing a copy of either the Lancet published study, or a MedPage Today article also on this topic, Finally, a Potential Therapy to Prevent Long COVID, and bringing it to your physician, I suspect they would be willing to prescribe metformin 500 mg tablets (#41 tablets) for you to keep at home in case you get symptoms of COVID.

The study also confirms the decreased risk of hospitalization or death from COVID found in people taking metformin in two other studies (study 1, study 2).

Metformin has been suggested to have antiviral activity against COVID, as well as acting to balance inflammation by working as an antioxidant. It was most effective when started within the first four days of COVID symptoms.

Metformin Benefits in CFS and Fibromyalgia

Like Long COVID, chronic fatigue syndrome and fibromyalgia represent an energy crisis. Metformin helps increase energy production in cells by improving insulin sensitivity. Our published research showed that over 90% of people with CFS/FMS had an average 91% increase in quality-of-life by increasing energy production using the S.H.I.N.E.® Protocol, a treatment approach that optimizes for Sleep, Hormones/Hypotension, Immunity, Nutrition, and mild Exercise as able.

Those who are overweight may see particular benefits in energy production from the improved insulin sensitivity that comes from taking metformin, as insulin resistance can be a result of excess body fat.

In those with fibromyalgia prone to higher diabetes risk, previous research also showed that metformin helped relieve pain.

Some other COVID studies began with 1,500 mg a day of metformin, which may be associated with nausea or diarrhea. In the Lancet published study, the metformin dose was slowly increased over 6 days, with 500mg on day 1; then 500mg twice daily for 4 days; then 500mg in mornings plus 1,000mg in the evening through 14 days.

Summary of Efficacy

To summarize, 10.6% of COVID patients who treated with placebo developed Long COVID. That compares to only 6.3% who took metformin, a reduction of 42% of cases (50% when the treatment began within four days of symptom onset). This is quite extraordinary. It also dramatically decreased hospitalizations — and at a cost of less than $10 per person.

This shows that not only is Long COVID treatable, but simply having given $10 worth of metformin early in each infection of this pandemic could have prevented over 5 million US cases of Long COVID. And it could prevent millions of cases in the future.

In this study, three days of ivermectin treatment (which is too short of a treatment course in my opinion) was associated with about a 30% lower risk of Long COVID symptoms in the first 60 days after infection, though this protection disappeared if treatment was not started until after the first 60 days. But in my reading of the scientific literature overall, ivermectin (I use approx. 27 mg a day for five days) decreases death and hospitalization rate by about 30-70%.

How I Treat COVID

So the bottom line? I treat COVID, starting as soon as possible, with:

  1. Metformin (Rx) 500 mg tablets. One tablet twice a day the first day. If well tolerated without problematic nausea, indigestion, or diarrhea, I give 500 mg each morning and then 1,000 mg at bedtime for total of 14 days.
  2. Ivermectin (Rx) 27 mg a day for five days.
  3. Pepcid (famotidine – over-the-counter) 40 mg twice a day till symptoms resolve.
  4. Nutritional and herbal support.

If you are interested in learning more about my approach to treating CFS/FMS/Long COVID, email me at and ask for the free information sheets for these.

Love and blessings,

Dr. T

Jacob Teitelbaum, MD

is one of the world's leading integrative medical authorities on fibromyalgia and chronic fatigue. He is the lead author of eight research studies on their effective treatments, and has published numerous health & wellness books, including the bestseller on fibromyalgia From Fatigued to Fantastic! and The Fatigue and Fibromyalgia Solution. His newest book (June 10, 2024) is You Can Heal From Long COVID. Dr. Teitelbaum is one of the most frequently quoted fibromyalgia experts in the world and appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and Fox News Health.

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