Is there a medication for COVID-19 (Coronavirus Disease 2019) prophylaxis?

COVID-19 Prophylaxis Medications

There is currently no FDA-approved medication specifically for COVID-19 prophylaxis in the general population, though tixagevimab/cilgavimab (EVUSHELD) is authorized for pre-exposure prophylaxis in specific high-risk populations who may not mount an adequate immune response to COVID-19 vaccination. 1

Available Pre-Exposure Prophylaxis Options

EVUSHELD (Tixagevimab/Cilgavimab)

• FDA Emergency Use Authorization (EUA) status: Authorized for pre-exposure prophylaxis
• Target population: Limited to:
  • Individuals who may not mount an adequate immune response to COVID-19 vaccination
  • Individuals for whom COVID-19 vaccination is not recommended due to history of severe adverse reaction to vaccines or components
• Dosing: 300 mg of tixagevimab and 300 mg of cilgavimab administered as two separate consecutive intramuscular injections
• Administration frequency: Every 6 months
• Administration route: Intramuscular injection

Medications That Should NOT Be Used for COVID-19 Prophylaxis

The American College of Physicians explicitly recommends against using the following medications for COVID-19 prophylaxis in the general population 2:

• Chloroquine: No available evidence supporting prophylactic use
• Chloroquine + Azithromycin: No available evidence supporting prophylactic use
• Hydroxychloroquine: No available evidence supporting prophylactic use
• Hydroxychloroquine + Azithromycin: No available evidence supporting prophylactic use

Anticoagulants in COVID-19 Management

While not prophylaxis against COVID-19 infection itself, anticoagulants are recommended for thromboprophylaxis in hospitalized COVID-19 patients 2, 3:

• Standard dose anticoagulant thromboprophylaxis is recommended for hospitalized COVID-19 patients
• Low-molecular-weight heparin (LMWH) is preferred over unfractionated heparin
• Not recommended for outpatient prophylaxis or extended post-discharge use

Common Pitfalls and Caveats

1. Off-label use of unproven medications:

   • Despite early interest in hydroxychloroquine and chloroquine, there is no evidence supporting their use for COVID-19 prophylaxis 2
   • These medications carry significant cardiac risks including QT prolongation and torsades de pointes 2

2. Inappropriate anticoagulation:

   • Anticoagulants should not be used for COVID-19 prevention in non-hospitalized patients 2, 3
   • Antiplatelet agents are not recommended for VTE prevention in COVID-19 patients 2

3. Misunderstanding EVUSHELD's role:

   • EVUSHELD is not for general population use
   • It's specifically for immunocompromised individuals or those who cannot receive COVID-19 vaccines
   • There are no adequate alternatives to EVUSHELD for pre-exposure prophylaxis in eligible populations 1

Conclusion for Clinical Practice

When considering COVID-19 prophylaxis:

1. For general population: No medication is currently recommended or approved for COVID-19 prophylaxis
2. For immunocompromised individuals: Consider EVUSHELD if they meet eligibility criteria
3. For hospitalized patients: Standard thromboprophylaxis with LMWH is recommended but this prevents complications rather than infection

The medical community continues to await results from ongoing clinical trials for definitive prophylactic options against COVID-19 infection 4, 5, 6, 7, 8.