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Melatonin
Melatonin has been shown to have an inhibitory two recent published papers proposing the use of
effect on the NLRP3 inflammasome. This has not gone melatonin as a therapeutic agent in the treatment of
83
unnoticed by the COVID-19 research community, with patients with COVID-19. 84,85
Intervention Melatonin
Suggested dose 5–20 mg qd
Mechanism(s) of action against non- Favorably modulate viral-induced pathological cellular processes
COVID-19 viruses 83,84 • Modulation of NLRP3 inflammasome activation 83,84
Outcomes data supporting their Research in progress
mitigating effects on illness from
other viral strains
Strength of evidence Conditional
Risk of harm 86-94 Mimimal

Vitamin A
Vitamin A is a micronutrient that is crucial for system and plays regulatory roles in cellular immune
maintaining vision, promoting growth and development, and responses and humoral immune processes through the
protecting epithelium and mucus integrity in the body. modulation of T helper cells, sIgA, and cytokine
Vitamin A is known as an anti-inflammation vitamin production. Vitamin A has demonstrated a therapeutic
because of its critical role in enhancing immune function. effect in the treatment of various infectious diseases. 95
Vitamin A is involved in the development of the immune

Intervention Vitamin A
Suggested dose Up to 10 000–25 000 IU/d
Mechanism(s) of action against Favorably modulate cellular defense and repair mechanisms:
non-COVID-19 viruses 95,96 • Modulation of helper T cells
• Modulation of sIgA
Favorably modulate viral-induced pathological cellular processes:
• Modulation of cytokine production
Outcomes data supporting their No data available
mitigating effects on illness from
other viral strains
Strength of evidence Conditional
Risk of harm 97-102 Mimimal, if does not exceed this dose; caution: pregnancy

Elderberry
Elderberry (Sambucus nigra) is seen in many storm.” However, these data were not confirmed when the
medicinal preparations and has widespread historical use same group performed similar studies, which were
as an anti-viral herb. Based on animal research, published in 2002. Therefore, these data suggest it is
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103
elderberry is likely most effective in the prevention of and highly implausible that consumption of properly prepared
early infection with respiratory viruses. One in-vitro elderberry products (from berries or flowers) would
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study reported an increase in TNF-alpha levels related to a contribute to an adverse outcome related to overproduction
specific commercial preparation of elderberry, leading of cytokines or lead to an adverse response in someone
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some to caution that its use could initiate a “cytokine with COVID-19.
Intervention Elderberry
Suggested dose 500 mg po qd (of USP standard of 17% anthocyanosides)
Mechanism(s) of action against Favorably modulate cellular defense and repair mechanisms
non-COVID-19 viruses 103,107-112 Favorably modulate viral-induced pathological cellular processes
Outcomes data supporting their No data available
mitigating effects on illness from
other viral strains
Strength of evidence Strong
Risk of harm 103,107,113,114 Mild; caution with autoimmune disease; uncooked/unripe plant parts toxic;
USDA GRAS

38 Integrative Medicine • Vol. 19, No. S1 • Epub Ahead of Print Evans—Virus-Specific Nutraceutical and Botanical Agents