Summary
Pyridostigmine is tracked by OSMF as an investigational option for Long COVID; no regulator has approved it for this indication, and most post-viral conditions have no approved disease-modifying therapy at all. ClinicalTrials.gov lists 1 registered trial linking Pyridostigmine to Long COVID: 1 is currently recruiting. The most advanced is Phase 2 (NCT06366724, sponsored by Brigham and Women's Hospital). It plans or enrolled 160 participants. Registered activity dates to 2024. The literature layer holds 3 publications for this pair: 1 curated reference and 2 other publications. The dated items are from 2025. Items here are search-derived or curated references rather than classified trial reports; treat them as leads to read, not as graded evidence.
Long COVID / PASC is tracked on the OSMF post-viral programme alongside ME/CFS, Long COVID, POTS and MCAS. Across the programme, 423 candidate agents are logged for Long COVID, most of them preliminary; this page isolates the record for one of them.
Evidence table
| Evidence tier | C · Preliminary |
|---|---|
| Evidence score | 12.5 (trials 4.0, literature 3.5, tier 5, approved bonus 0.0) |
| Registered trials | 1 total: 1 recruiting, 0 active / not yet recruiting, 0 completed, 0 other |
| Linked publications | 3 (2 other publications, 1 curated reference) |
| Agent type | Other (Other / Unclassified) |
| Development stage (any indication) | Investigational |
| Mechanism / class | Not recorded |
| Data sources | OSMF therapeutic agent database, ClinicalTrials.gov, PubMed |
How the evidence score is calculated
- Each registered trial scores by status (recruiting / active / enrolling 3, completed 2.5, not yet recruiting 2, unknown 1, terminated / withdrawn / suspended 0.5) plus a phase bonus (phase 3-4 +2, phase 2 +1, phase 1 +0.5). The trial component is capped at 30.
- Each literature item scores by design (Cochrane review 5, meta-analysis 4, systematic review 3, RCT 3, clinical trial publication 2, curated reference 1.5, other PubMed record 1). The literature component is capped at 30.
- The existing evidence tier adds 15 (A / Strong), 10 (B / Moderate), 5 (C / Preliminary) or 0 (D / Anecdotal).
- Agents approved for any indication (max clinical phase 4) add 5, because an approved agent has an established safety profile that lowers the barrier to repurposing trials.
- The score ranks what has been studied, not what works. It does not read effect sizes or directions of effect.
Registered clinical trials
| NCT ID | Title | Status | Phase | Enrolment |
|---|---|---|---|---|
| NCT06366724 | LIFT: Life Improvement Trial Brigham and Women's Hospital · 2024 | recruiting | Phase 2 | 160 |
Published literature
- Curated reference (PACVS Evidence Map) Beneficial effect on hemodynamics in POTS; particularly relevant for hyperadrenergic phenotype; 21-RCT systematic review (2025)PACVS Evidence Map · 2025
- Review (PubMed validation search) PubMed record PMID 41862909
- Case report (PubMed validation search) PubMed record PMID 39479090
Mechanism and notes
No mechanism of action is recorded for this pair in the source databases.
Clinical notes: Crossover RCT + review supports hemodynamic benefit, esp hyperadrenergic POTS. 30-60mg TID. Cholinergic SE dose-limiting. Reasonable targeted option.
Safety: Cholinergic side effects (GI cramping, diarrhea, salivation, sweating, bradycardia). Avoid in asthma, mechanical obstruction. Overdose risk cholinergic crisis.
Dosing in studies: 30–60 mg TID (sometimes 30 mg); titrate; study durations often 4–8 weeks for hemodynamic assessment.
Frequently asked questions
Is Pyridostigmine approved for Long COVID?
Pyridostigmine is tracked by OSMF as an investigational option for Long COVID; no regulator has approved it for this indication, and most post-viral conditions have no approved disease-modifying therapy at all. Approval status for the specific indication should always be confirmed with the relevant regulator and prescribing information.
Is Pyridostigmine in clinical trials for Long COVID?
ClinicalTrials.gov lists 1 registered trial linking Pyridostigmine to Long COVID: 1 is currently recruiting. The most advanced is Phase 2 (NCT06366724, sponsored by Brigham and Women's Hospital). It plans or enrolled 160 participants. Registered activity dates to 2024.
What does the evidence show for Pyridostigmine in Long COVID?
Trials of Pyridostigmine in Long COVID are registered but none has completed, so there is no outcome evidence from those studies yet; the record is a signal of research interest. OSMF's existing evidence tier for this pair is C (Preliminary), taken from the OSMF therapeutic agent database, which grades agents by the volume and design of condition-specific evidence rather than by effect size.
Cite this page
Data: ClinicalTrials.gov, PubMed, Open Targets, ChEMBL, DGIdb and the OSMF therapeutic agent database. Last updated 2026-10-07. Page built 2026-10-07.