What medications can I use for COVID-19 symptoms?

Medications for COVID-19 Symptoms

For symptomatic relief of mild COVID-19, use acetaminophen (paracetamol) for fever and pain, maintain adequate hydration (no more than 2 liters daily), and use simple linctus or honey for cough; if you are high-risk (elderly, immunocompromised, or have significant comorbidities), initiate nirmatrelvir-ritonavir within 5 days of symptom onset to prevent progression to severe disease. 1, 2, 3

Symptomatic Treatment for Mild COVID-19

Fever and Pain Management

• Acetaminophen (paracetamol) is the preferred antipyretic and analgesic for managing fever and associated symptoms in COVID-19 patients 2, 3
• Use antipyretics only while fever and associated symptoms persist, not solely to reduce body temperature 2
• NSAIDs (ibuprofen, naproxen) can also be used for symptom control, though acetaminophen is generally preferred 3, 4

Cough Management

• Use simple linctus or honey for symptomatic relief of cough 2, 3
• Reserve codeine linctus, codeine phosphate tablets, or morphine sulfate oral solution only if cough is distressing and not controlled by simpler measures 2, 5

Hydration

• Advise regular fluid intake to prevent dehydration, limiting to no more than 2 liters daily 2, 5

Antiviral Therapy for High-Risk Patients

If you have risk factors for severe COVID-19 (age >65, obesity, diabetes, heart disease, lung disease, immunosuppression), you need antiviral therapy within 5 days of symptom onset, not just symptomatic treatment. 1, 2, 3

First-Line Antiviral: Nirmatrelvir-Ritonavir (Paxlovid)

• Nirmatrelvir-ritonavir is the preferred first-line antiviral for high-risk patients with mild COVID-19 1, 3, 6
• Dosage: 300 mg nirmatrelvir (two 150 mg tablets) with 100 mg ritonavir (one 100 mg tablet), taken together twice daily for 5 days 6
• Must be initiated within 5 days of symptom onset 1, 6
• Take at approximately the same time each day, with or without food 6
• Complete the full 5-day course even if feeling better 2

Critical drug interaction warning: Nirmatrelvir-ritonavir includes ritonavir, a strong CYP3A inhibitor that can cause potentially severe, life-threatening, or fatal interactions with many common medications 6. Review all current medications before prescribing, including supplements and herbal products 2, 6.

Dose Adjustments for Kidney Disease

• Moderate renal impairment (eGFR 30-60 mL/min): 150 mg nirmatrelvir with 100 mg ritonavir twice daily for 5 days 6
• Severe renal impairment (eGFR <30 mL/min): 300 mg nirmatrelvir with 100 mg ritonavir once on day 1, then 150 mg nirmatrelvir with 100 mg ritonavir once daily on days 2-5 6

Alternative Antiviral: Molnupiravir

• Molnupiravir should be considered only when nirmatrelvir-ritonavir is contraindicated or unavailable 1, 3
• Molnupiravir is less effective than nirmatrelvir-ritonavir and should be used with caution only if no other therapeutic options are acceptable 7

Alternative Antiviral: Remdesivir

• Remdesivir (3-day course) can be considered for high-risk outpatients within 7 days of symptom onset, particularly when drug interactions preclude nirmatrelvir-ritonavir use 2, 7

What NOT to Use

Corticosteroids

Do not use corticosteroids (dexamethasone, prednisone) for mild COVID-19 unless you already take them for another condition. 2, 3, 5 Corticosteroids are harmful in patients not requiring oxygen and should be reserved only for those with hypoxemia 2, 5.

Ineffective or Harmful Medications

• Do not use hydroxychloroquine - it increases risk of death and invasive mechanical ventilation without improving outcomes 1, 2, 5
• Do not use ivermectin - no evidence of benefit 1, 3
• Do not use sotrovimab - not effective against current variants 1, 3
• Do not use lopinavir-ritonavir - no clinical benefit and high adverse event rate 2, 5

Antibiotics

• Do not use antibiotics unless bacterial superinfection is suspected based on clinical worsening, elevated inflammatory markers, or new infiltrates 3
• Azithromycin should not be used in the absence of bacterial infection 2

When to Seek Emergency Care

Seek immediate medical attention if you develop: 2

• Severe breathlessness or difficulty breathing
• Persistent chest pain or pressure
• New confusion or inability to stay awake
• Blue lips or face
• Oxygen saturation <94% on pulse oximetry

Special Considerations for Elderly Patients (Age >80)

• Reduce all COVID-19 medication doses to 1/2 of standard adult doses due to deteriorated liver and kidney function 5
• Consider early high-titer convalescent plasma therapy, which significantly reduces severe conversion rates in elderly patients 5
• Monitor aggressively for secondary bacterial infections and thromboembolic complications 5