Results

NOTE: Clinicians must make decisions based on the clinical presentation of each person, ideally through a shared process that considers the person’s values and preferences with respect to the anticipated outcomes of the chosen option. Decisions may be constrained by the realities of a specific clinical setting and local resources, including, but not limited to, institutional policies, time limitations, and availability of treatments. For more information, please visit the CAN-PCC website.

Summary of reported criteria:

Reported age:

Reported gender:

Reported pregnancy status:

Reported PCC status:

Reported symptoms:

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Reported age:

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Reported gender:

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Reported pregnancy status:

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Reported PCC status:

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Reported symptoms:

Here are the CAN-PCC guidelines relevant to the information you selected:

Suggestions for drug therapy:

SUGGESTION FOR: Antihistamines
The CAN-PCC Collaborative suggests using antihistamines in adults who have or may have post COVID-19 condition and have symptoms of mast cell activation syndrome (MCAS).
(certainty of evidence: very low; recommendation strength: conditional)

SUGGESTION FOR: Ivabradine, beta-blockers, pyridostigmine, or midodrine as appropriate
The CAN-PCC Collaborative suggests using ivabradine, beta-blockers, pyridostigmine, or midodrine in adults who have or may have post COVID-19 condition and postural orthostatic tachycardia syndrome (POTS) or inappropriate sinus tachycardia (IST).
(certainty of evidence: low; recommendation strength: conditional)

SUGGESTION FOR: Ivabradine, beta-blockers, pyridostigmine, or midodrine as appropriate
The CAN-PCC Collaborative suggests using ivabradine, beta-blockers, pyridostigmine, or midodrine in adults who have or may have post COVID-19 condition and postural orthostatic tachycardia syndrome (POTS) or inappropriate sinus tachycardia (IST).
(certainty of evidence: low; recommendation strength: conditional)

SUGGESTION FOR: Melatonin (in addition to sleep hygiene advice)
The CAN-PCC Collaborative suggests using melatonin and good sleep habits to manage sleep problems in adults who have or may have post COVID-19 condition.
(certainty of evidence: very low; recommendation strength: conditional)

SUGGESTION FOR: Metformin
The CAN-PCC Collaborative suggests using metformin in adults who have or may have post COVID-19 condition and also have a new COVID-19 infection. (certainty of evidence: very low; recommendation strength: conditional)

SUGGESTION FOR: Nirmatrelvir/ritonavir, Remdesivir, Molnupiravir
The CAN-PCC Collaborative suggests using nirmatrelvir/ritonavir (Paxlovid), Molnupiravir or Remdesivir in adults with post COVID-19 condition and a new COVID-19 infection.
(certainty of evidence: very low; recommendation strength: conditional)

SUGGESTED PREFERENCE OF THERAPY: (i) nirmatrelvir/ritonavir, (ii) remdesivir, (iii) molnupiravir
The CAN-PCC Collaborative ranked these three treatments in order of preference (most to least preferred): (i) nirmatrelvir/ritonavir (Paxlovid); (ii) remdesivir; (iii) molnupiravir.
(certainty of evidence: not ranked; recommendation strength: conditional)

SUGGESTED PREFERENCE OF THERAPY: (i) metformin, (ii) nirmatrelvir/ritonavir (there is insufficient evidence to make a recommendation on the concurrent use of both drugs)
The CAN-PCC Collaborative ranked the two interventions in order of preference (most to least preferred): (i) metformin; (ii) nirmatrelvir/ritonavir (Paxlovid).
(certainty of evidence: not ranked; recommendation strength: conditional)

SUGGESTION FOR: Synbiotics and related health products (e.g., probiotics)
The CAN-PCC Collaborative suggests using synbiotics or similar products (e.g., probiotics) for children and teenagers who have or may have post COVID-19 condition.
(certainty of evidence: low; recommendation strength: conditional)

Suggestions for non-drug therapy:

SUGGESTION FOR: Rest/pacing
The CAN-PCC Collaborative suggests rest and pacing for adults with post COVID-19 condition who experience post-exertional malaise (also known as post-exertional symptom exacerbation).
(certainty of evidence: very low; recommendation strength: conditional)

SUGGESTION FOR: Activity, movement, or exercise-based interventions
The CAN-PCC Collaborative suggests activity, movement, or exercise therapies for adults with post COVID-19 condition who do not experience post-exertional malaise (also known as post-exertional symptom exacerbation).
(certainty of evidence: very low; recommendation strength: conditional)

SUGGESTION FOR: Smell training
The CAN-PCC Collaborative suggests the use of smell training in adults with loss of smell who have or may have post COVID-19 condition.
(certainty of evidence: very low; recommendation strength: conditional)

SUGGESTION FOR: Cognitive rehabilitation
The CAN-PCC Collaborative suggests using cognitive rehabilitation in adults who have or may have post COVID-19 condition and cognitive impairment (also known as brain fog).
(certainty of evidence: very low; recommendation strength: conditional)

SUGGESTION FOR: Cognitive behavioural therapy (in addition to pacing)
The CAN-PCC Collaborative suggests using cognitive behavioral therapy for adults who have or may have post COVID-19 condition and post-exertional malaise (also known as post-exertional symptom exacerbation).
(certainty of evidence: very low; recommendation strength: conditional)

SUGGESTION FOR: Mindfulness, relaxation, and breathing techniques
The CAN-PCC Collaborative suggests mindfulness, relaxation, and breathing techniques in adults who have or may have post COVID-19 condition.
(certainty of evidence: low; recommendation strength: conditional)

Suggestions/recommendations for health screening:

RECOMMENDATION FOR: Depression screening
The CAN-PCC Collaborative recommends screening for depression in adults who have or may have post-COVID-19 condition.
(certainty of evidence: moderate; recommendation strength: strong)

SUGGESTION FOR: Anxiety screening
The CAN-PCC Collaborative suggests screening for anxiety in adults who have or may have post COVID-19 condition.
(certainty of evidence: very low; recommendation strength: conditional)

SUGGESTION FOR: Mental health screening
The CAN-PCC Collaborative suggests mental health screening for children and teenagers who have or may have post COVID-19 condition.
(certainty of evidence: very low; recommendation strength: conditional)

SUGGESTION FOR: 10-minute standing test
The CAN-PCC Collaborative suggests the use of a 10-minute standing test for children and teenagers who have or may have post COVID-19 condition and dizziness.
(certainty of evidence: very low; recommendation strength: conditional)

Suggestions for treatment modalities:

SUGGESTION FOR: Virtual over in-person rehabilitation
The CAN-PCC Collaborative suggests virtual instead of in-person rehabilitation for adults who have or may have post COVID-19 condition with fatigue, brain fog, or post-exertional malaise (also known as post-exertional symptom exacerbation).
(certainty of evidence: low; recommendation strength: conditional)

SUGGESTION FOR: Care navigators
The CAN-PCC Collaborative suggests using care navigators for adults who have or may have post COVID-19 condition.
(certainty of evidence: Very low; recommendation strength: conditional)

SUGGESTION FOR: Programmes to improve self-care
The CAN-PCC Collaborative suggests the use of programs to improve self-care in adults who have or may have post COVID-19 condition.
(certainty of evidence: Very low; recommendation strength: conditional)

SUGGESTION FOR: Either in-person or virtual appointments to receive care
The CAN-PCC Collaborative suggests the use of either in-person or virtual appointments for adults who have or may have post COVID-19 condition.
(certainty of evidence: low; recommendation strength: conditional)

SUGGESTION FOR: Multidisciplinary workplace interventions
The CAN-PCC Collaborative suggests the use of a combination of workplace programs and supports for people who have or may have post COVID-19 condition who are unable to return to work.
(certainty of evidence: very low; recommendation strength: conditional)

SUGGESTION FOR: Individualized activity, movement, or exercise-based interventions
The CAN-PCC Collaborative suggests activity, movement, or exercise therapies for children and teenagers who have or may have post COVID-19 condition. It is important to use a cautious approach that is guided by the child or teen’s symptoms, abilities and energy level.
(certainty of evidence: very low; recommendation strength: conditional)

SUGGESTION FOR: Programmes to improve self-care
The CAN-PCC Collaborative suggests using self-care programs for children and teenagers who have or may have post COVID-19 condition.
(certainty of evidence: very low; recommendation strength: conditional)

Suggestions/recommendations against drug therapy:

SUGGESTION AGAINST: Low-dose naltrexone
The CAN-PCC Collaborative suggests not using low-dose naltrexone for people who have or may have post COVID-19.
(certainty of evidence: Very low; recommendation strength: conditional)

SUGGESTION AGAINST: Antihistamines
The CAN-PCC Collaborative suggests not using antihistamines in adults who have or may have post COVID-19 condition and do not have symptoms of mast cell activation syndrome (MCAS).
(certainty of evidence: very low; recommendation strength: conditional)

SUGGESTION AGAINST: Antiplatelets
The CAN-PCC Collaborative suggests not using antiplatelet drugs in adults who have or may have post COVID-19 condition. This is unless an individual has other conditions that need these drugs.
(certainty of evidence: very low; recommendation strength: conditional)

SUGGESTION AGAINST: Taurine supplementation
The CAN-PCC Collaborative suggests not using taurine supplementation for adults who have or may have post COVID-19 condition.
(certainty of evidence: Very low; recommendation strength: conditional)

SUGGESTION AGAINST: Nirmatrelvir/ritonavir, Remdesivir, Molnupiravir
The CAN-PCC Collaborative suggests not using nirmatrelvir/ritonavir, molnupiravir, remdesivir (paxlovid) in adults with post COVID-19 condition
(certainty of evidence: very low; recommendation strength: conditional)

SUGGESTION AGAINST: Intranasal, inhaled, or oral corticosteroids
The CAN-PCC Collaborative suggests not using corticosteroids for adults who have or may have post COVID-19 condition. This is unless an individual has other conditions that need these drugs.
(certainty of evidence: very low; recommendation strength: conditional)

SUGGESTION AGAINST: CNS stimulants
The CAN-PCC Collaborative suggests not using central nervous system (CNS) stimulants in adults who have or may have post COVID-19 condition and brain fog, with or without post exertional malaise (also known as post-exertional symptom exacerbation).
(certainty of evidence: very low; recommendation strength: conditional)

SUGGESTION AGAINST: Hyperbaric oxygen
The CAN-PCC Collaborative suggests not using hyperbaric oxygen therapy for adults who have or may have post COVID-19 condition and cognitive impairment.
(certainty of evidence: very low; recommendation strength: conditional)

SUGGESTION AGAINST: Cognitive screening tests
The CAN-PCC Collaborative suggests not using cognitive impairment screening tests for adults who have or may have post COVID-19 condition.
(certainty of evidence: very low; recommendation strength: conditional)

SUGGESTION AGAINST: SSRIs
The CAN-PCC Collaborative suggests not using selective serotonin reuptake inhibitors (SSRIs) for adults who have or may have post COVID-19 condition and brain fog. This recommendation does not apply to adults currently taking SSRIs for pre-existing conditions and/or co-morbid mood disorders.
(certainty of evidence: very low; recommendation strength: conditional)

RECOMMENDATION AGAINST: Cannabidiol (CBD)/hemp
The CAN-PCC Collaborative recommends not using cannabidiol (CBD) or related products for children and teenagers who have or may have post COVID-19 condition.
(certainty of evidence: very low; recommendation strength: strong)

SUGGESTION AGAINST: Creatine supplementation, L-arginine and Vitamin C supplementation, Omega 3 supplementation
The CAN-PCC Collaborative suggests not using creatine supplements, L-arginine and vitamin C supplements or omega 3 supplements for children and teenagers who have or may have post COVID-19 condition. 
(certainty of evidence: very low; recommendation strength: conditional)

SUGGESTION AGAINST: SSRIs
The CAN-PCC Collaborative suggests not using selective serotonin reuptake inhibitors (SSRIs) for children and teenagers who have or may have post COVID-19 condition and brain fog.
(certainty of evidence: very low; recommendation strength: conditional)

SUGGESTION AGAINST: Psychostimulants
The CAN-PCC Collaborative suggests not using psychostimulants for children and teenagers who have or may have post COVID-19 condition and brain fog.
(certainty of evidence: very low; recommendation strength: conditional)

For information on how to use these guidelines in your practice, visit the canpcc.ca site here: (and review the FAQ, “What do I need to know before implementing the guidelines”