What medications can I use to manage COVID-19 symptoms?

Management of COVID-19 Symptoms: Medication Options

For mild COVID-19 symptoms, acetaminophen (Tylenol) and NSAIDs like ibuprofen (Advil, Motrin) are recommended as first-line treatments, while more severe cases may require specific antivirals, corticosteroids, or monoclonal antibodies depending on disease severity. 1, 2

First-Line Medications for Mild COVID-19 Symptoms

Fever Management

• Acetaminophen (Tylenol): Preferred first-line agent for fever management 1
  • Dosing: Regular adult dosing (650-1000mg every 4-6 hours, not exceeding 4000mg daily)
  • Continue only while symptoms persist
• NSAIDs (ibuprofen, naproxen): Can be used for fever and pain 2, 3
  • Despite early concerns, studies show no association between ibuprofen use and increased mortality or respiratory complications in COVID-19 patients

Cough Management

• Honey: For patients over 1 year of age 1
• Codeine-containing preparations: For persistent, troublesome cough 1
  • Codeine linctus or codeine phosphate tablets
  • Start with lowest effective dose to minimize side effects
  • Monitor for respiratory depression, especially in elderly

Breathlessness Management

• Albuterol inhalers: Reported as highly efficacious (>80% effectiveness) 4
  • For patients with or without asthma experiencing respiratory symptoms
• Benzonatate: Commonly used for respiratory symptoms (83.9% of providers report using) 4
• Guaifenesin: For mucus thinning and productive cough 4

Moderate to Severe COVID-19 Treatment

Antiviral Medications

• Remdesivir: For moderate COVID-19 requiring oxygen with saturation >90% 1
• Nirmatrelvir/ritonavir (Paxlovid): For non-hospitalized patients at high risk for progression 1

Anti-inflammatory Medications

• Dexamethasone: 6mg daily for 10 days for patients requiring oxygen support 1
  • Avoid in patients not requiring oxygen
• IL-6 inhibitors (tocilizumab, sarilumab): Consider for worsening despite dexamethasone with COVID-19-related inflammation 5
• IL-1 inhibitors (anakinra): Alternative immunomodulator option 5

Monoclonal Antibodies

• Anti-SARS-CoV-2 monoclonal antibodies: For high-risk unvaccinated or vaccine non-responders 5, 1
  • Recommended for post-exposure prophylaxis in high-risk patients 5

Treatment Algorithm Based on Severity

Mild COVID-19 (Outpatient Management)

1. Symptomatic treatment:

   • Acetaminophen for fever and pain
   • NSAIDs for myalgia, arthralgia, or headache
   • Cough suppressants as needed
   • Maintain hydration (not exceeding 2L/day) 1

2. Non-pharmacological approaches:

   • Controlled breathing techniques
   • Sitting upright to increase ventilation
   • Avoiding lying on back to improve cough effectiveness 1

Moderate COVID-19 (Requiring Oxygen)

1. Continue symptomatic treatment as above
2. Add dexamethasone: 6mg daily for 10 days 1
3. Consider remdesivir 1
4. Thromboprophylaxis: Low molecular weight heparin 1

Severe COVID-19 (Critical Illness)

1. Dexamethasone: Continue as above 1
2. Consider second immunosuppressant if COVID-19-related inflammation is present:
   • Anti-IL-6 (tocilizumab, sarilumab)
   • Anti-IL-1 (anakinra)
   • JAK inhibitors (baricitinib/tofacitinib) 5

Important Considerations

• Avoid unnecessary antibiotics: There is no justifiable rationale for antimicrobials in uncomplicated COVID-19 6
• Thromboprophylaxis: All hospitalized COVID-19 patients should receive thromboprophylaxis with LMWH 1
• Monitor for complications: Pneumonia, acute respiratory distress syndrome, and cardiovascular manifestations 7

Caution

• Avoid premature discharge before clinical improvement is established 1
• Lower respiratory symptoms and anxiety are reported as the most challenging symptoms to manage 4
• Consider higher doses of thromboprophylaxis for patients with additional risk factors (high BMI, history of VTE, active cancer) 1

By following this evidence-based approach to COVID-19 symptom management, you can effectively address symptoms while minimizing complications and optimizing outcomes.