Coronavirus Disease 2019 (COVID-19) Medication

Updated: Feb 25, 2021
  • Author: David J Cennimo, MD, FAAP, FACP, AAHIVS; Chief Editor: Michael Stuart Bronze, MD  more...
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Medication

Medication Summary

Remdesivir was the first drug approved by the FDA for treating the SARS-CoV-2 virus. It is indicated for treatment of COVID-19 disease in hospitalized adults and children aged 12 years and older who weigh at least 40 kg. [20]  The broad-spectrum antiviral is a nucleotide analog prodrug. Full approval was preceded by the US FDA issued an EUA (emergency use authorization) on May 1, 2020 to allow prescribing of remdesivir for severe COVID-19 (confirmed or suspected) in hospitalized adults and children prior to approval. [155]  Upon approval of remdesivir in adults and adolescents, the EUA was updated to maintain the ability for prescribers to treat pediatric patients weighing 3.5 kg to less than 40 kg or children younger than 12 years who weigh at least 3.5 kg. [21]   

Investigational treatments include other antiviral agents, immunomodulators, monoclonal antibodies, convalescent plasma, and antithrombotics. Several vaccines are nearing conclusion of phase 3 clinical trials. 

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Antiviral Agents

Class Summary

Remdesivir is the first drug approved by the FDA for COVID-19.

Remdesivir (Veklury)

Adenosine nucleotide prodrug that distributes into cells, where it is metabolized to form the pharmacologically active nucleoside triphosphate metabolite. Inhibits SARS-CoV-2 RNA-dependent RNA polymerase (RdRp), which is essential for viral replication. It is indicated. It is indicated for treatment of COVID-19 disease in hospitalized adults and children aged 12 years and older who weigh at least 40 kg. An EUA is approved for pediatric patients weighing 3.5 kg to less than 40 kg or children younger than 12 years who weigh at least 3.5 kg. 

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Corticosteroids

Class Summary

NIH guidelines for COVID-19 recommends use of dexamethasone to reduce mortality in hospitalized patients who are mechanically ventilated or those requiring supplemental oxygen without mechanical ventilation. [420]  These recommendations are based on results of the RECOVERY trial. [212]  

If dexamethasone is unavailable, use alternant glucocorticoids (eg, prednisone, methylprednisolone, or hydrocortisone). [420]  

Dexamethasone

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes (PMNs) and reducing capillary permeability; stabilizes cell and lysosomal membranes.

Prednisone (Deltasone)

Consider use if dexamethasone is unavailable. Available as oral formulation. 

Methylprednisolone (A-Methapred, DepoMedrol, Medrol)

Consider use if dexamethasone is unavailable. Available as IV formulation.

Hydrocortisone

Consider use if dexamethasone is unavailable. Available as oral or IV formulations.

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Monoclonal Antibodies

Class Summary

Recombinant neutralizing human IgG1-kappa monoclonal antibodies (mAb) exert their effect by binding to various sites on the SARS-CoV-2 spike protein. All are indicated for mild-to-moderate COVID-19 disease in adults and adolescents who are at high risk for progressing to severe COVID-19 and/or hospitalization.

Casirivimab/imdevimab

FDA granted EUA November 21, 2020. Casirivimab and imdevimab IV solution are each supplied in individual single-dose vials and are admixed in the same IV bag.

Bamlanivimab

FDA granted EUA November 9, 2020. Bamlanivimab can be used alone or together with etesevimab.

Etesevimab

FDA granted EUA February 9, 2021. Etesevimab can only be used with bamlanivimab by admixing each dose within the same IV bag. Etesevimab and bamlanivimab bind to different but overlapping epitopes in the receptor-binding domain of the S-protein; using both antibodies together is expected to reduce the risk of viral resistance. In clinical trials, bamlanivimab and etesevimab administered together resulted in fewer treatment-emergent variants relative to bamlanivimab administered alone.

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