From the Guidelines
Lagevrio (molnupiravir) should be considered for the treatment of symptomatic patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 5 days of the onset of symptoms and at a high risk for progressing to severe disease, as supported by the American College of Physicians 1.
Key Points
- The recommended dosage of Lagevrio is 800 mg (four 200 mg capsules) taken orally every 12 hours for 5 days.
- Lagevrio works by introducing errors into the viral RNA during replication, preventing the virus from multiplying effectively.
- It is not recommended for use during pregnancy due to potential fetal harm, and both men and women of childbearing potential should use effective contraception during treatment and for a period afterward (4 days for women, 3 months for men).
- Common side effects include diarrhea, nausea, and dizziness.
- Lagevrio is less effective than other COVID-19 treatments like Paxlovid and is generally considered when other options are not appropriate or available.
Considerations
- The use of Lagevrio should be based on individual patient risk factors and medical history.
- Patients should be closely monitored for adverse events and treatment efficacy.
- Lagevrio should not be used for pre-exposure or post-exposure prevention of COVID-19.
Evidence
The American College of Physicians recommends the use of molnupiravir for the treatment of COVID-19 in outpatient settings, as stated in their living, rapid practice points 1. The evidence suggests that molnupiravir can reduce the risk of severe disease and hospitalization in high-risk patients. However, it is essential to consider the potential risks and benefits of treatment and to closely monitor patients for adverse events.
From the Research
Lagevrio (Molnupiravir) Information
- Molnupiravir, also known as Lagevrio, is an oral antiviral medication used to treat mild to moderate COVID-19 in adults who are at risk for progression to severe disease 2, 3.
- The medication works by targeting the viral polymerase and causing lethal mutations within the virus during replication 2.
- Studies have shown that molnupiravir can significantly decrease severe outcomes, including hospitalizations and death, when started within the first 5 days of illness in persons at risk for complications due to COVID-19 2, 4.
Efficacy and Safety
- A comparative analysis of early COVID-19 treatment efficacy found that molnupiravir (MLP) and nirmatrelvir/ritonavir (NMV/r) were superior to other interventions, including sotrovimab (SOT) and remdesivir (RDV), in reducing hospitalization and death rates 5.
- Another study found that molnupiravir and nirmatrelvir/ritonavir demonstrated a greater risk reduction in hospitalization and death compared to placebo, with nirmatrelvir/ritonavir showing a greater risk reduction than molnupiravir 3.
- However, a real-world cohort study found that death or hospitalization did not differ among high-risk COVID-19 outpatients treated with currently available antivirals, including molnupiravir, nirmatrelvir/ritonavir, and remdesivir 4.
Comparison with Other Treatments
- A study comparing the efficacy and safety of nirmatrelvir/ritonavir, molnupiravir, and remdesivir in outpatients with COVID-19 at high risk of progression found that the composite endpoint of death or hospitalization was more frequent in patients treated with remdesivir compared to molnupiravir or nirmatrelvir/ritonavir 4.
- Another study found that nirmatrelvir/ritonavir demonstrated a greater risk reduction in hospitalization and death than molnupiravir compared to placebo 3.
Special Considerations
- Molnupiravir should not be used in children or pregnant persons due to concerns about potential toxicity, and reliable contraception should be used in persons of childbearing potential 2.
- Nirmatrelvir/ritonavir may cause significant drug-to-drug interactions that limit its use in persons taking certain medications metabolized by certain cytochrome P450 enzymes 2, 3.