Covid-19 Treatments

By Peter Galvin, MD

The Covid-19 pandemic has thankfully ended, save for a few cases here and there in people at increased risk to develop it, but few, if any, deaths are occurring anymore. There was and is a dizzying array of medications to treat Covid. Some were approved by the FDA, some were not. Others received emergency use approval, only to have it subsequently withdrawn. The FDA uses emergency use authorization for products or medications that may be useful during a crisis but that have not yet fully undergone the extensive testing usually required for formal approval of use. Most of the fully approved medications are antiviral medications, so let’s look at them first. They include:

• Nirmatrelvir-Ritonavir (Paxlovid) – pill taken twice a day for five days. Approved for use in those aged 18 years and over, and emergency use authorization for those aged 12 to 17 years. Not recommended for those with serious liver or kidney disease.
• Remdesivir (Veklury) – given intravenously for three days. Reserved for those who cannot take Paxlovid.
• Molnupiravir (Lagevrio) – used only for those who cannot take Paxlovid or Veklury. Not recommended for those younger than 18 years, pregnant, or about to become pregnant.
• Ivermectin, which is used to treat parasites in animals and humans, was used for a while during the pandemic. It has no antiviral properties and was never approved for use by the FDA. Ivermectin can have serious, severe side-effects.
• Hydroxychloroquine and chloroquine are both used to treat malaria. They also have no antiviral properties. They did receive emergency use authorization from the FDA, but this was withdrawn when they were found to be ineffective.
• Dexamethasone, a potent steroid (glucocorticoid), has potent anti-inflammatory properties. Since inflammation, especially of the lungs, is a significant factor in coronavirus infections, dexamethasone is used mostly on hospitalized, critically ill patients who are usually on ventilators.

The remainder of approved anti-Covid medications are biologicals, or anti-viral antibodies. They include:

• Baricitinib (Olumiant) – a pill that also reduces inflammation.
• Tocilizumab (Actemra) – given by injection, also an anti-inflammatory.
• Vilobelimab (Gohibic) – approved for use in April 2023. Used for hospitalized patients on ventilators.
• Anakinra (Kineret) – same as Gohibic.

Antivirals, especially Paxlovid and Veklury, work best if taken early in the course of Covid. They also substantially decrease the risk of hospitalization. Most patients improve within several days to two weeks after starting these medications. Those with weakened immune systems who have prolonged symptoms and persistently test positive for Covid-19 may need to take longer courses of these medications.

For more information go to:

www.cdc.gov, www.dhhs.gov, or www.mayoclinic.org

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