Rapid Reference

COVID Therapeutics

February 1, 2022
Sam Ashoo, MD

The following table represents a list of therapeutics known to be effective against the Omicron variant of COVID-19, and currently authorized or approved by the FDA in the U.S.. Further detailed information is available at the NIH COVID Treatment Guidelines. Additionally, the CDC maintains a list of high risk medical conditions.

Category

Drug

Dose

Notes

Antiviral

Molnupiravir

800 mg q12hr x 5 days

  • Age > 18

  • At least one high risk factor

  • Must be within 5 days of symptom onset

  • Not in pregnancy

  • Males must use barrier protection for 3 months

    Reduced unvaccinated death and hospitalization 9.7% -> 6.8%

  • FDA EUA

Antiviral

Paxlovid

  • 300 mg nirmatrelivir + 100 mg ritonavir q12hr x 5 days

  • eGFR ≥30 to <60 mL/min 150 mg nirmatrelivir + 100 mg ritonavir q12hr x 5 days

  • eGFR <30 mL/min, not recommended

  • Age > 12 (at least 40kg)

  • At least one high risk factor

  • Must be within 5 days of symptom onset

  • Reduced unvaccinated death and hospitalization 6% -> 0.8%

    Multiple CYP450 medication interactions. Free interaction checker here. 

  • FDA EUA

Antiviral

Remdesivir

(Veklury)

3.5 kg-40 kg 5mg/kg IV day 1, then 2.5 mg/kg daily



>40 kg 200mg IV day 1, then 100 mg IV daily

  • Peds and Adult

  • Hospitalized OR At least one high risk factor

  • Non-hospitalized- must be within 7 days of symptoms, 3 day course of treatment

  • Hospitalized- duration 5 days, increase to 10 days for ventilated or ECCMO.

  • (Outpatient) Reduced unvaccinated death and hospitalization 5.3% -> 0.7%

  • FDA Authorization and EUA

Monoclonal Antibody

Bebtelovimab

175 mg IV, once

  • Age > 12 (at least 40kg)

  • At least one high risk factor

  • Must be within 7 days of symptom onset

  • Data is limited. Primary studied effect was a reduction in viral load by day 5, and resolution of symptoms in 5 days vs 8 days in unvaccinated. 

  • For non-hospitalized AND those not requiring oxygen only.

  • FDA EUA

Monoclonal Antibody*

Evusheld

Tixagevimab

300 mg IM

AND 

Cilgavimab

300 mg IM

  • For PRE-Exposure prophylaxis of COVID-19 only. May not be used for Post-exposure prophylaxis or treatment.*

  • Age > 12 (at least 40kg)

  • Must have moderate to severe immune compromise OR have severe adverse reactions and cannot be vaccinated.

  • Wait at least 2 weeks after vaccination before administering Evusheld.

  • FDA EUA

  • FDA EUA dosing revision 

Anti-inflammatory

Dexamethasone

6 mg daily x 10 days

  • Only for patients requiring supplemental oxygen

  • Studied in adults, but recommended in peds by NIH.

  • NIH guidelines

Bamlanivimab and Etesevimab (administered together) and REGEN-COV (casirivimab and imdevimab) authorization for use in the U.S. was rescinded by the FDA due to a lack of efficacy against the Omicron variant of COVID-19. Additionally, as of 4/5/2022, the use of Sotrovimab is also no longer authorized by the FDA due to evidence of reduced efficacy against the Omicron sub-variant BA.2. Lastly, the dosing for Pxalovid was updated on 4/14/2022 to reflect recommendations for renal dosing.

The U.S. Department of Health & Human Services has two websites available to help find government distributed medications for the treatment of COVID-19:

  • COVID-19 Therapeutics Locator– includes a U.S. map of locations receiving Paxlovid, Molnupiravir, and Evusheld
  • Therapeutics Distribution– includes a U.S. map of sites receiving monoclonal antibodies but has not been updated since Oct 2021, and does not include Sotrovimab.

Last Updated on January 25, 2023

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