Nicotine Patches and Chronic Viruses: My Experience

Nicotine Patches, Long COVID, Epstein-Barr, and Brain Fog: My Unexpected Recovery Path

This spring, I noticed something troubling — a wave of severe illness moving through my patient community. Many of them were hit hard, not by a single infection, but by a cascade of viral flares after the long winter: COVID, RSV, influenza, and chronic Epstein-Barr virus (EBV). Eventually, I got hit too.

And it hit hard.

I developed severe POTS (postural orthostatic tachycardia syndrome), brain fog, debilitating insomnia, and deep muscle and joint fatigue. Everyday tasks became impossible. I couldn’t stand for long, walk, or even do laundry. My heart rate would spike to 120 just turning over in bed. I experienced chest pain, and by April, I could barely set up for my own classes. My husband had to step in to help with everything. I knew what I was dealing with — long COVID, compounded by chronic EBV reactivation.

As a functional medicine practitioner, I’ve supported my immune system and nervous system for years. But this time, all the usual strategies weren’t enough. The vagus nerve work, somatic practices, breathwork — they brought little to no relief.

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The Unexpected Turn: Nicotine Patches

In my desperation for relief and recovery, I came across a small study — just four people — exploring the use of nicotine patches for long COVID. There were no massive clinical trials or gold-standard evidence, but the individual case reports were compelling, and the theory behind it was solid.

Here’s what I found — and what I tried.

Week 1: The Hard Start

Under physician guidance, I started 7mg nicotine patches, the lowest available dose. I’d used nicotine tablets in the past for ulcerative colitis flares (another area where nicotine shows promise), but they made me sick. The patches, with their 24-hour slow release, were a different story — and possibly the key.

The first week was rough. I was on the couch all day playing video games and trying to rest. My heart rate was still out of control, so I started beta blockers to keep things manageable.

But — I slept through the night for the first time in a year.

Week 2: Brain Reboot

I started to feel a shift. My mental clarity and endurance began returning slowly. I didn’t feel like I was dragging my brain through mud anymore. Tasks that felt impossible just a week earlier were becoming doable again.

Week 3: Weaning and Watching

By the third week, I didn’t need beta blockers every day — just when I crashed or accidentally overdid it. I felt more stable, more me. My goal is to stay on the patches through week 4, then taper to every other day, and monitor closely. If the insomnia or POTS flares return, I’ll adjust.

This may become a seasonal or reactivation support tool for me, especially through the winter or during flare cycles.

Why Nicotine Might Help

Let’s talk science for a moment.

Long COVID is thought to involve dysautonomia and neuroinflammation — disruptions in the nervous system and immune system that affect nearly every part of the body. Recent research points to the cholinergic anti-inflammatory pathway, which uses acetylcholine to regulate inflammation, heart rate, cognition, and immune response.

Nicotinic acetylcholine receptors are a key part of this system — and they may be disrupted by the SARS-CoV-2 virus. One 2023 study proposes that the virus binds to these receptors, blocking their function and contributing to symptoms like brain fog, fatigue, pain, and autonomic dysfunction. Nicotine could potentially displace the virus (or its remnants) from these receptors, restoring normal function.

The Risks and Considerations

• Nicotine is addictive. While I’ve felt no euphoric “high” or cravings from the low-dose patch, this is something to monitor.

• Long-term use could reduce cellular sensitivity, so this may not be a forever solution.

• Everyone responds differently — this is not a one-size-fits-all remedy. Please work with a provider if you consider trying this.

Ending Thoughts

Nicotine patches are not a miracle cure, but they offered me a breakthrough when nothing else helped. As always, I recommend approaching any new treatment with curiosity, caution, and professional guidance. The science is still emerging, but if you’ve been stuck in the fog of long COVID or EBV reactivation, it may be worth a conversation with your healthcare provider.

I’ll keep sharing updates as my journey continues. If you’re dealing with long COVID, chronic fatigue, or nervous system dysregulation, know that you’re not alone — and healing is still possible.

References:

1. Leitzke M. Is the post-COVID-19 syndrome a severe impairment of acetylcholine-orchestrated neuromodulation that responds to nicotine administration? Bioelectron Med. 2023;9(1):2.

2. Leitzke M, et al. Autonomic balance determines the severity of COVID-19 courses. Bioelectron Med. 2020;6(1):22.

3. Piovesana R, et al. Cholinergic modulation of neuroinflammation. Int J Mol Sci. 2021;22(9):4912.

4. O’Brien BCV, et al. SARS-CoV-2 spike ectodomain targets α7 nicotinic acetylcholine receptors. J Biol Chem. 2023;299(5):104707.

5. CDC. How to use nicotine patches.