Note: Information in this article was valid at the time of publication. Because information about the coronavirus infection changes quickly, we encourage you to visit the websites of the Centers for Disease Control & Prevention (CDC), World Health Organization (WHO), and your state and local government for the updates on COVID-19.
This article was prepared with the support of health care specialists from canadian-familypharmacy.com, a leading provider of high-quality pharmaceuticals and a medication expert.
COVID-19 is an infectious disease caused by the SARS-CoV-2 coronavirus. Discovered in China at the end of 2019, by May 15, it had affected 4.4 million people worldwide. Most of those with symptoms complain of high fever, cough and difficulty breathing.
In general, the WHO recommends the use of five drugs for the treatment of coronavirus. These drugs have shown high efficacy against coronavirus infection. According to the developers, patients with COVID-19 at risk who took these drugs were less likely to die and be hospitalized.
Each of these medications has individual side effects, contraindications, and instructions for use. However, many people self-medicate using unproven, i.e. dangerous, treatment regimens. In this article, we will review the five drugs currently approved for the COVID-19 treatment.
What is it? Paxlovid is Pfizer’s antiviral drug for the treatment of COVID-19 in adults who do not need supplemental oxygen and who are at risk of severe illness.
When it was authorized: December 2021.
Who can get it: The drug is intected for use in adults. Paxlovid is not suitable for the treatment of pregnant women, people with liver and kidney diseases. It is intended primarily for the treatment of people from risk groups. The medicine will be dispensed by prescription!
How you take it: The medication should be used at an early stage up to 5 days after the onset of symptomatic COVID-19 disease. It is released is tablets for oral administration. The active ingredients of Paxlovid are contained in two separate tablets, both of which will need to be taken at the same time twice a day for five days in a row.
Side effects: Possible side effects include diarrhea, vomiting, loss of taste and smell, high blood pressure, and muscle pain.
How it works: The drug significantly reduces the reproduction of viral particles in infected cells of the human body.
How well it works: Clinical trials of the drug showed that Paxlovid treatment significantly reduced the risks of hospitalization and death. One month after the start of treatment, 0.8% of patients who received Paxlovid were hospitalized (8 people out of 1039). Among those who received placebo, there were 6.3% of such patients (66 people out of 1046). Not a single patient died in the group that received the drug, and there were 12 such among those who received the placebo.
What else you should know: Paxlovid can only be used after infection with the virus. The drug significantly reduces the production of new viral particles in the cells of the human body. The medicine should not be taken on a daily basis in order to avoid infection.
The medicine is intended primarily for members of risk groups with a weakened immune system. Paxlovid can be used to treat mild forms of the disease. The medicine is not suitable for the treatment of pregnant women. Also, the patient should definitely not have problems with the kidneys and liver. This medicine should not be taken with other medicines. The decision on the treatment with Paxlovid must be made by a medical professional.
Paxlovid works more effectively the sooner it is started after the onset of symptoms of the disease. Therefore, the European Medicines Agency recommends that you start taking it no later than five days after the onset of symptoms.
According to reports, Paxlovid should be taken within 5 days after the onset of symptoms and the course of treatment is 5 days. In the event that the patient is already hospitalized, he or she is no longer treated with this medicine.
More information: FDA Paxlovid fact sheet for patients, parents, and caregivers.
What is it? Remdesivir is a medicine that fights viruses. It is used to prevent the virus that causes COVID-19 (SARS-CoV-2) from replicating. Medicines regulators have approved remdesivir for emergency use to treat people with COVID-19.
When it was authorized: October 2020 (for critically ill patients) and January 2022 (for non-hospitalized patients)
Who can get it: Remdesivir is indicated for use in adults and adolescents (12 years of age and older weighing at least 40 kg) for the treatment of COVID‑19 requiring hospitalization. In November 2020, the FDA granted an Emergency Use Authorization (EUA) for the combination of baricitinib with remdesivir for the treatment of suspected or laboratory-confirmed COVID-19 in hospitalized people aged two years or older who require supplemental oxygen, invasive mechanical ventilation, or extracorporeal membrane oxygenation. (ECMO).
How you take it: Recommended dosage for patients aged 12 years and over and weighing at least 40 kg: Day 1 – a single loading dose of remdesivir 200 mg intravenously; Day 2 and beyond – 100 mg once a day intravenously. The total duration of treatment is at least 5 days and not more than 10 days.
Side effects: The most common side effects in COVID‑19 studies of remdesivir include respiratory failure and organ damage, including low albumin, low potassium, low red blood cell count, low platelets needed for blood clotting, and yellowing of the skin (liver damage). Other reported side effects include gastrointestinal disturbances, elevated levels of liver transaminase enzymes, in the blood (impaired liver function), and infusion site reactions. Possible side effects of remdesivir directly upon administration include: lowering blood pressure, nausea, vomiting, sweating, and trembling.
How it works: Remdesivir is a direct-acting antiviral drug that inhibits the RNA-dependent RNA polymerase of the virus. As an analog of adenosine nucleoside triphosphate (GS-443902), the active metabolite of remdesivir interferes with the action of viral RNA-dependent RNA polymerase and eludes viral exoribonuclease (ExoN) verification, causing a decrease in viral RNA production. In some viruses, such as respiratory syncytial virus, it causes RNA-dependent RNA polymerase to shut down, but its predominant effect (as in the case of Ebola) is irreversible chain termination. Unlike many other chain terminators, this is not mediated by preventing the addition of the immediately following nucleotide, but instead occurs with a delay occurring after the addition of five additional bases to the growing RNA strand. For the RNA-dependent RNA polymerase of MERS-CoV, SARS-CoV-1, and SARS-CoV-2, RNA synthesis stops after the inclusion of three additional nucleotides. Thus, remdesivir is classified as a direct-acting antiviral agent that acts as a chain termination inhibitor.
How well it works: The drug does not have a significant effect on patients who are on ventilation, in the rest of the hospitalized, its administration reduces the risk of death or progression of the disease.
What else you should know: The use of Remdesivir is possible only in the conditions of inpatient medical care.
Existing clinical experience has not identified differences in response between older and younger patients. In patients over 65 years of age, dose adjustment is not required. In general, appropriate caution should be exercised when using remdesivir and elderly patients should be monitored, given the greater incidence of decreased liver, kidney or heart function, as well as the presence of concomitant diseases or other drug therapy.
The pharmacokinetics of remdesivir has not been studied in patients with renal insufficiency. Patients with an estimated GFR greater than or equal to 30 ml/min received remdesivir for the treatment of COVID-19 without dose adjustment. All patients should have their estimated GFR determined before initiation and when remdesivir is administered, in accordance with clinical guidelines.
The pharmacokinetics of remdesivir has not been evaluated in patients with hepatic impairment. In all patients, laboratory testing of liver function should be performed before starting the use of remdesivir and during treatment in accordance with clinical recommendations.
More information: Gilead remdesivir fact sheet for patients.
What is it? Molnupiravir is an orally active antiviral drug. It suppresses the replication of some RNA viruses. The medication is used to treat COVID-19 in individuals infected with SARS-CoV-2. This prodrug, based on the synthetic nucleoside derivative of N4-hydroxycytidine (also known as EIDD-1931), exerts its antiviral activity by introducing copy errors during viral RNA replication.
When it was authorized: December 2021.
Who can get it: Treatment of a new coronavirus infection (COVID-19) of mild or moderate course in adults, incl. with an increased risk of disease progression to a severe course, not requiring additional oxygen therapy.
How you take it: Therapy with molnupiravir oral tablets is prescribed no later than five days after the onset of symptoms of the disease, four tablets (800 mg total) twice a day for five days and is carried out under the supervision of a doctor. When prescribed as soon as possible after infection, the drug can help prevent hospitalization.
How it works: Molnupiravir inhibits viral reproduction by promoting the spread of mutations during viral RNA replication by RNA-directed RNA polymerase. It is metabolized to a ribonucleoside analogue resembling cytidine, β-D-N 4-hydroxycytidine 5′-triphosphate (also known as EIDD-1931 5′-triphosphate or NHC-TP). During replication, the viral enzyme incorporates NHC-TP into the newly created RNA instead of using the real cytidine.
Molnupiravir can switch between two forms (tautomers), one mimicking cytidine (C) and the other mimicking uridine (U). NHC-TP is not recognized as a mistake by virus-checking exonuclease enzymes, which can replace mutated nucleotides with corrected versions. When the viral RNA polymerase tries to copy the RNA containing molnupiravir, it sometimes interprets it as a C and sometimes as a U. This causes more mutations in all subsequent copies than the virus can survive, an effect called viral error catastrophe or lethal mutagenesis.
How well it works: The effectiveness against hospitalization is 30%.
Side effects: The most common adverse reactions are diarrhea, nausea, dizziness, and mild to moderate headache.
What else you should know: The use of molnupiravir is possible only under medical supervision.
The drug is not indicated for children, pregnant and breastfeeding women. Women using molnupiravir should use contraceptives, and health facilities should ensure that pregnancy testing and contraceptives are available at the point of care.
Contraindications for use are hypersensitivity to molnupiravir; pregnancy or pregnancy planning, breastfeeding period; children’s age up to 18 years.
During treatment, you should refrain from driving a car, as well as engaging in potentially hazardous activities that require increased concentration of attention and speed of psychomotor reactions.
More information: FDA molnupiravir fact sheet for patients and caregivers.
What is it? The Evusheld vaccine is a passive vaccine (antibodies) against coronavirus and is not intended to treat or prevent illness after exposure to a coronavirus patient.
When it was authorized: December 2021.
Who can take it: The drug is intended for adults and adolescents aged 12 years and older, with a body weight of 40 kg for the prevention of COVID 19 and is indicated for the following categories of the population:
- those having a moderate or severe decrease in immunity: due to a disease (rheumatological and systemic diseases, oncological diseases, chronic renal failure, HIV, etc.), the use of immunosuppressive drugs or therapy (prednisolone, methotrexate, chemotherapy, etc.), lack of an effective immune response to COVID-19 vaccination;
- persons who are not recommended to be vaccinated with available COVID-19 vaccines according to an approved schedule for various reasons;
- those who have any other justified contraindications to COVID-19 vaccination.
How you take it: This vaccine is given in two injections, one after the other.
Side effects: The most common side effects are headache, fatigue, cough. More rare, but rather unpleasant complications are serious allergic reactions and bleeding at the injection site.
How it works: The vaccine contains two long-acting monoclonal antibodies (tixagevimab and cilgavimab) against the coronavirus spike protein. Antibodies bind to the protein and neutralize the entry of the virus into cells, thereby reducing the risk of developing symptomatic disease. Tixagevimab and cilgavimab are two recombinant human IgG1K monoclonal antibodies. This combination of monoclonal antibodies binds to the spike protein, blocking its interaction with the human angiotensin-converting enzyme 2 (ACE2) receptor, which is required for viral attachment.
How well it works: This vaccine reduces severe morbidity and mortality from coronavirus by 83%.
What else you should know: This drug is not an alternative for people who are recommended to be vaccinated against SARS-CoV-2.
According to the FDA, this medication protects against coronavirus infection for six months. It cannot be used by already infected patients.
More information: FDA Evusheld fact sheet for patients, parents, and caregivers.
Bebtelovimab (No longer authorized)
What is it? Bebtelovimab is a drug that was developed on the basis of recombinant human antibodies, developed for the treatment of patients with a confirmed diagnosis of Covid-19. The drug was used in relation to persons who have a mild or moderate form of the course of the disease with an existing risk of spilling over into a more complex condition. Bebtelovimab was also prescribed in cases where other methods of therapy are not applicable to a particular patient or are not available. It was assumed that the drug was active against various strains of the virus, including Omicron and BA.2 Omicron.
On December 1, 2022 The U.S. Food and Drug Administration (FDA) said Eli Lilly’s coronavirus drug bebtelovimab is not currently approved for emergency use in the United States, citing it is not expected to neutralize the dominant omicron subvariants BQ.1 and BQ.1.1.1.
Note: If you are having symptoms of COVID-19 and think you need a medical treatment, you can visit the government Test-to-Treat Locator. You can use the site to search for places near you where you can fill a COVID-19 prescription or find sites that offer testing, medical care, and COVID-19 drugs.
Information provided in this article is for informative purposes only. No content in the articles should ever be used as a substitute for medical advice from your doctor or other health care provider. Always seek the medical advice of a medical professional with any questions you have regarding a medical condition.
Tags: coronavirus, COVID-19, infection, medications, treatment