What medications can be prescribed for COVID-19?

Medications for COVID-19 Treatment

For COVID-19 patients, remdesivir is the recommended first-line antiviral treatment for those requiring oxygen but not invasive mechanical ventilation, with dexamethasone strongly recommended for patients requiring oxygen support. 1

Antiviral Medications

Remdesivir

• Dosing: 200 mg IV loading dose on Day 1, followed by 100 mg IV daily from Day 2, for 5 days (can be extended to 10 days if no clinical improvement) 1
• Efficacy: May reduce mortality compared to standard care (odds ratio 0.61,95% CI 0.45-0.82) 1
• Monitoring:
  • Perform hepatic laboratory testing before starting and while receiving remdesivir 2
  • Consider discontinuing if ALT increases >10 times upper limit of normal 2
  • Discontinue if ALT elevation is accompanied by signs of liver inflammation 2

Nirmatrelvir/ritonavir

• First-line therapy for high-risk outpatients to reduce progression to severe disease 1
• Caution: Significant drug interactions with BTK inhibitors and BCL-2 inhibitors 1

Anti-inflammatory Medications

Corticosteroids

• Dexamethasone: 6 mg daily strongly recommended for patients requiring oxygen 1
• Efficacy: Reduces mortality from 26.2% to 23.3% in patients on oxygen therapy and from 41.4% to 29.3% in mechanically ventilated patients 1
• For rheumatic disease patients: Continue lowest effective dose possible to control underlying disease and avoid adrenal insufficiency 3

Immunomodulators

• Tocilizumab (anti-IL-6): Can be used in combination with dexamethasone for worsening disease with inflammation 1
• Alternatives: Sarilumab, anakinra, baricitinib/tofacitinib 1

Symptomatic Treatment

• Acetaminophen: Effective for fever management 4
• NSAIDs:
  • May be continued in patients without severe COVID-19 3
  • Should be stopped in patients with severe respiratory symptoms 3
• For respiratory symptoms:
  • Benzonatate and guaifenesin for cough 4
  • Albuterol MDIs for bronchospasm 4

Medications to Avoid

• Hydroxychloroquine/Chloroquine: Strongly discouraged due to lack of efficacy and potential harm 1
• Coadministration of remdesivir with chloroquine/hydroxychloroquine: Not recommended due to potential antagonistic effect 2
• Azithromycin: Discouraged unless bacterial infection is suspected 1
• Lopinavir-ritonavir: Strongly discouraged despite initial use 1

Treatment Considerations for Special Populations

Rheumatic Disease Patients

• Following COVID-19 exposure:
  • Hydroxychloroquine/chloroquine, sulfasalazine, and NSAIDs may be continued 3
  • Immunosuppressants, non-IL-6 biologics, and JAK inhibitors should be temporarily stopped 3
• With active COVID-19:
  • Hydroxychloroquine/chloroquine may be continued 3
  • Sulfasalazine, methotrexate, leflunomide, immunosuppressants, non-IL-6 biologics, and JAK inhibitors should be stopped 3
  • IL-6 receptor inhibitors may be continued in select circumstances 3

Pediatric Patients with Rheumatic Disease

• NSAIDs, hydroxychloroquine, and colchicine may be continued if necessary to control underlying disease 3
• IL-1 and IL-6 inhibitors may be continued even with symptomatic COVID-19 3
• Other biologics and targeted synthetic DMARDs should be temporarily delayed with symptomatic COVID-19 3

Immunocompromised Patients

• Monoclonal anti-SARS-CoV-2 antibodies recommended for pre-exposure prophylaxis in non-immunized patients 1

Non-Pharmacological Interventions

• High-flow nasal oxygen therapy or non-invasive CPAP for patients with acute hypoxemic respiratory failure 1
• Thromboprophylaxis with low molecular weight heparin for all hospitalized COVID-19 patients 1
• Non-drug treatments such as Tai Chi, breathing relaxation training, and mindfulness training may help with anxiety and mental health symptoms 3, 1

Important Clinical Considerations

• Start antiviral therapy as early as possible in the disease course for maximum benefit 1
• Lower respiratory symptoms and anxiety are often the most challenging to manage 4
• Monitor for potential drug-drug interactions, especially with nirmatrelvir/ritonavir 1
• Consider both COVID-19 severity and underlying conditions when making treatment decisions 1