What are the recommended dosing and timing guidelines for COVID-19 (Coronavirus Disease 2019) medication?

From the Guidelines

For hospitalized patients with COVID-19, remdesivir is recommended for 5 days, with a dose of 200mg IV on day 1 followed by 100mg daily for a total of 5 days, and can be extended to 10 days for patients who require mechanical ventilation or ECMO within a 5-day course, as supported by the most recent evidence from 1 and 1. The treatment of COVID-19 depends on the severity of the illness and individual risk factors. Some key points to consider when treating COVID-19 include:

• Remdesivir is currently administered only by IV infusion, generally in hospital settings, as stated in 1.
• The effectiveness of a 10-day course of remdesivir in reducing time to recovery in patients with severe COVID-19 may not vary by age, sex, or race, as mentioned in 1.
• The FDA recommends that clinicians assess kidney and hepatic function at baseline and during treatment, and not use remdesivir in patients with an estimated glomerular filtration rate <30 mL/min/1.73 m2, as reported in 1 and 1.
• For patients receiving oxygen therapy but not on invasive mechanical ventilation (IMV), 5 days of remdesivir treatment could be considered, as recommended in 1.
• Corticosteroids are recommended for the treatment of severe COVID-19, and for adult patients with high inflammatory markers, tocilizumab could be considered, as stated in 1.
• Treatment selection should be individualized based on comorbidities, potential drug interactions, and disease severity, and antiviral treatments work best when started early, ideally within 5 days of symptom onset, as mentioned in the example answer. Some potential treatment options for COVID-19 include:
• Nirmatrelvir-ritonavir (Paxlovid) for mild to moderate COVID-19 in high-risk patients
• Molnupiravir (800mg twice daily for 5 days) or remdesivir (200mg IV on day 1, then 100mg daily for 2 days) as alternatives when Paxlovid isn't appropriate
• Dexamethasone (6mg daily for up to 10 days) for hospitalized patients requiring oxygen, with remdesivir often added
• Additional immunomodulators like baricitinib or tocilizumab for severely ill patients
• Over-the-counter medications like acetaminophen or ibuprofen to manage fever and pain symptoms. It's essential to consider the potential benefits and harms of each treatment option and to individualize treatment based on the patient's specific needs and circumstances, as recommended in 1, 1, and 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION The only approved dosage form of VEKLURY for pediatric patients weighing 1.5 kg to less than 40 kg is VEKLURY for injection (supplied as 100 mg lyophilized powder in vial). Recommended dosage: Adults and pediatric patients weighing at least 40 kg: a single loading dose of VEKLURY 200 mg on Day 1 followed by once-daily maintenance doses of VEKLURY 100 mg from Day 2 via intravenous infusion. Pediatric patients (birth to less than 18 years of age) weighing 1. 5 kg to less than 40 kg: Recommended dosage is based on weight. Hospitalized patients: The treatment course of VEKLURY should be initiated as soon as possible after diagnosis of symptomatic COVID-19 has been made. For hospitalized patients requiring invasive mechanical ventilation and/or ECMO, the recommended total treatment duration is 10 days. For hospitalized patients not requiring invasive mechanical ventilation and/or ECMO, the recommended treatment duration is 5 days. Non-hospitalized patients: The treatment course of VEKLURY should be initiated as soon as possible after diagnosis of symptomatic COVID-19 has been made and within 7 days of symptom onset. For non-hospitalized patients diagnosed with mild-to-moderate COVID-19 who are at high risk for progression to severe COVID-19, including hospitalization or death, the recommended total treatment duration is 3 days.

The recommended dosage and timing of remdesivir (VEKLURY) for COVID-19 treatment are as follows:

• Adults and pediatric patients weighing at least 40 kg: a single loading dose of 200 mg on Day 1, followed by once-daily maintenance doses of 100 mg from Day 2 via intravenous infusion.
• Pediatric patients weighing 1.5 kg to less than 40 kg: dosage is based on weight, refer to Table 1 of the full prescribing information for specific dosing guidelines.
• Hospitalized patients: treatment duration is 5-10 days, depending on the need for invasive mechanical ventilation and/or ECMO.
• Non-hospitalized patients: treatment duration is 3 days, initiated as soon as possible after diagnosis and within 7 days of symptom onset. These recommendations are based on the information provided in the drug label 2 and 2.

From the Research

COVID-19 Medication Dosing and Timing

• The dosing and timing of COVID-19 medications depend on the severity of the disease and the specific medication being used 3, 4.
• Remdesivir is an antiviral agent approved for the treatment of COVID-19, and its use has been shown to reduce recovery time and improve clinical outcomes 3, 5.
• Corticosteroids, such as dexamethasone, have been shown to reduce mortality in hospitalized patients with severe or critical COVID-19 3, 5.
• Monoclonal antibody combinations, such as bamlanivimab/etesevimab and casirivimab/imdevimab, have been shown to be effective in treating non-hospitalized patients with mild-to-moderate COVID-19 at high risk of disease progression 3, 6.

Medication Recommendations

• The use of corticosteroids, remdesivir, and tocilizumab depends on disease severity, with corticosteroids being the standard of care for hospitalized patients with severe or critical COVID-19 3.
• Remdesivir is recommended for use in combination with dexamethasone for patients requiring supplemental oxygen therapy 5.
• Monoclonal antibody combinations, such as casirivimab/imdevimab, may be used in combination with remdesivir for patients with protracted SARS-CoV-2 infection, particularly those who are B-cell-depleted 6.

Treatment Patterns by Disease Severity

• Treatment decisions for COVID-19 depend on disease severity, with patients requiring supplemental oxygen or having severe disease being more likely to receive medications such as remdesivir and corticosteroids 4.
• The use of most COVID-19 relevant medications has dropped substantially over time, while the use of remdesivir and therapeutic anticoagulants has increased 4.