Therapeutic Algorithm for Use of Melatonin in Patients With COVID-19

Abstract

The coronavirus, COVID-19, has infected hundreds of thousands and killed tens of thousands of individuals worldwide. This highly infectious condition continues to ravage the world population and has yet to reach it peak infective rate in some countries. Many conventional drugs including hydroxychloroquine/chloroquine, lopinavir, remdesivir, etc., have been repurposed as treatments for this often deadly disease, but there is no specifically-designed effective drug available; also, the drugs mentioned have significant side effects and their efficacy is unknown. New drugs and vaccines are being designed as COVID-19 treatment, but their development and testing will require months to years. Time is not a luxury that this crisis has. Thus, there is a serious unmet need for the identification of currently-available and safe molecules which can be used to slow or treat COVID-19 disease. Here, we suggest melatonin be given consideration for prophylactic use or treatment alone or in combination with other drugs. Melatonin's multiple actions as an anti-inflammatory, anti-oxidant, and anti-viral (against other viruses) make it a reasonable choice for use. Melatonin is readily available, can be easily synthesized in large quantities, is inexpensive, has a very high safety profile and can be easily self-administered. Melatonin is endogenously-produced molecule in small amounts with its production diminishing with increased age. Under the current critical conditions, large doses of melatonin alone or in combination with currently-recommended drugs, e.g., hydroxychloroquine/chloroquine, to resist COVID-19 infection would seem judicious.

Targeting Host Defense System and Rescuing Compromised Mitochondria to Increase Tolerance against Pathogens by Melatonin May Impact Outcome of Deadly Virus Infection Pertinent to COVID-19

“…Melatonin is a naturally occurring molecule assumed to be present in every species [ 19 ]. Due to its antioxidant, anti-inflammatory, as well as other properties [ 20 , 21 , 22 , 23 , 24 , 25 ], it has been speculated to be a promising molecule for treating COVID-19 patients [ 18 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ], and also other deadly viral infectious diseases [ 48 , 49 , 50 , 51 ]. A small scale clinical trial has also shown promising results [ 52 ].…”

General Approach to the Clinical Care of Solid Organ Transplant Recipients with COVID-19 Infection

“…In transplant recipients with COVID-19, depression, anxiety, and sleep disturbances associated with COVID-19 can worsen non-adherence to immunosuppressive therapy and increase the risk of allograft rejection [ 58 ]. Melatonin is an effective drug for anxiety and sleep disturbances, which might also be beneficial for clinical outcomes of patients with COVID-19 due to its anti-inflammatory and anti-oxidant properties [ 59 , 60 ].…”

Melatonin, coronavirus, cardiovascular disease, and the geriatric emergency: let's use everything we have!

“…The uncontrolled innate immune response promotes a massive inflammatory reaction and causes irreversible tissue damage and mortality. 5,6 Our group recently published a review on how the various medical comorbidities (diabetes mellitus, hypertension, obesity, and cardiovascular disease) can affect the melatonergic pathway and its relationship with COVID-19. In addition, we suggest melatonin doses for treatment and prophylactic use.…”

“…In addition, we suggest melatonin doses for treatment and prophylactic use. 6 When a vaccine is developed, it may not be as effective in elderly patients. A limited immune response to vaccines has been previously reported in older patients due to immunosenescence.…”

“…7 Thus, adjuvant therapy to enhance vaccine efficacy in the elderly is urgently needed amidst the COVID-19 crisis and melatonin may be a suitable candidate. 6 Melatonin is an inexpensive product with scalable production. It has a long shelf life, the simplest mode of transportation, and can be self-administered orally in remote areas.…”