Updated June 7, 2022
The COVID-19 pandemic has been with us for more than two years. While vaccination has proved an effective means of preventing hospitalizations and death from SARS-CoV-2 infection, many are still susceptible due to poorly functioning immune systems, an inability to respond to or safely get vaccinated against COVID-19, and vaccine refusal. Seven medications and a few other treatments are available for treating COVID, but they are only for specific people in a few situations.
Recommended Use of Medication Is Restricted
Medications that can affect COVID-19 are now available, but most are limited to specific situations. To understand why there are a few things to understand.
There is a difference between using medications to treat a disease vs to prevent a disease.
- When treating a disease the expectation is that the medication will cure or control that disease enough for the body to finish the job. In many cases with viral infections, there is a “window of opportunity” for effective treatment. For influenza, this is needing to start antiviral medication within two days of flu symptoms appearing. For most COVID-19 treatments this is when the symptoms are mild to moderate, usually 5-7 days.
- Preventing a disease involves receiving a vaccine or medication while you are well to protect you from catching the disease. Examples of preventative medications include post-exposure emtricitabine/tenofovir for HIV/AIDS or anti-malaria drugs to prevent the disease when traveling in endemic areas. For COVID-19, vaccination is the best option.
Most medications are approved for a specific use such as for a specific disease or symptom, a certain stage of a disease, a specific age range, and/or a specific gender. These uses are determined by clinical trials in people with similar demographics and level of disease or symptoms. Medications are usually only approved for people that have the same characteristics as those in the study. When used outside those limits, it is called “off-label use.” Some drugs used for COVID-19 are being used “off-label.”
The Federal Drug Administration (FDA) is primarily responsible for approving drugs/vaccinations and their uses. While most drugs and vaccinations have been fully approved by the FDA, they can also receive emergency use authorization (EUA). EUA is typically used during public health emergencies and allows the use of unapproved drugs/vaccines or unapproved uses of approved ones.
- In many cases, the use of medications approved by EUA can be more restrictive than ones that are fully approved. The drugs used for COVID-19 are reserved for treating people who are hospitalized or those with mild-to-moderate symptoms who have a positive result on a direct SARS-CoV-2 viral testing and are at high risk for progressing to severe disease, hospitalization, or death — especially those with immunosuppressive disease or receiving immunosuppressive treatment of a medical of condition, such as:
- Moderate to severe primary immunodeficiency or advanced and untreated HIV;
- Being on immunosuppressive medications, such as high-dose corticosteroids, treatments for solid-tumor and hematological malignancies, or transplants, chimeric antigen receptor T cell therapy; and/or
- Being unable to get vaccinated with any available COVID-19 vaccine due to a history of severe adverse reaction to a COVID-19 vaccine or vaccine component or whose immune systems have not mounted responses to one of the three COVID-19 vaccines available in the U.S.
- In most cases the drugs have been well studied, but may still be undergoing testing.
COVID-19 came upon us so quickly that most vaccines and medications for COVID-19 began with or still have EUA. Currently, the Moderna and Pfizer-BioTech vaccines and the antiviral medication remdesivir are approved for use in people with COVID-19; all others have only emergency authorization.
The monoclonal antibody medications sotrovimab, bamlanivimab/etesevimab, and casirivimab/imdevimab previously had EUA for post-exposure prevention or treatment of COVID-19, but are not effective against the Omicron variant and the authorization was revoked.
Approved or Authorized Medication for COVID
The Moderna and Pfizer-BioTech mRNA vaccines are now approved for the prevention of Covid infection. The Johnson & Johnson vaccine is authorized for emergency use if the mRNA vaccines cannot be tolerated.
Tixagevimab/cilgavimab (Evusheld) is a monoclonal antibody drug that has emergency use authorization to be used for pre-exposure prophylaxis in people 12 years old or older and weigh at least 88 pounds that are moderately to severely immunocompromised. A single dose of Evusheld is given intravenously (IV) and is only available at IV infusion centers.
The following antiviral medications are reserved for the treatment of people with mild-to-moderate COVID-19 symptoms who are at high risk for progressing to severe disease, hospitalization, or death. They should be started as soon as possible — up to five days — after symptoms begin.
Nirmatrelvir/ritonavir (Paxlovid) is an experimental oral drug that has emergency use authorization (EUA) as the initial treatment of COVID-19 in adults and adolescents (12 years old and older) weighing at least 40 kg (88 lbs) at high risk for severe COVID-19. Paxlovid is taken orally twice a day for five days. It has been shown to decrease the risk of hospitalization or death from COVID-19 by about 90% when taken within five days of symptom onset. Although there are limited amounts of nirmatrelvir/ritonavir available, Pfizer — the manufacturer has recently increased production.
Molnupiravir (Lagevrio) is an experimental drug that has EUA as an alternate treatment for COVID-19 in adults. Molnupiravir is taken orally twice a day for five days. It has been shown to decrease the risk of hospitalization or death from COVID-19 by about 30% when taken within five days of symptom onset.
Remdesivir (Veklury) is approved to treat COVID-19 in adults and children down to 28 days old. It is currently recommended as a second treatment option for non-hospitalized people 12 years old and older. However, remdesivir is the only antiviral medication approved for use in hospitalized patients. It is usually given intravenously once per day for 3 days for people in outpatient settings or 5-10 days for hospitalized patients. It has been shown to decrease the risk of hospitalization or death from COVID-19 by about 87% when taken within seven days of symptom onset. The effect of remdesivir on hospitalized patients is variable.
Monoclonal antibodies are manufactured medications that help your immune system recognize and defend against COVID-19.
Bebtelovimab is an experimental drug that has EUA for the treatment of COVID-19 in adults and adolescents (12 years old and older) weighing at least 40 kg (88 lbs). It is given once intravenously and is only available at IV infusion centers. It is authorized for treating people with mild-to-moderate COVID-19 symptoms who have a positive result on a direct SARS-CoV-2 viral testing and are at high risk for progressing to severe disease, hospitalization, or death. Effectiveness is not currently known.
Tocilizumab (Actemra) is a monoclonal antibody drug used for treating rheumatoid arthritis and other autoimmune diseases that has EUA to be used “off-label” for the treatment of adults and children 2 years old and older hospitalized with COVID-19. Up to two doses can be given intravenously, depending on the response to the first dose.
Tocilizumab is authorized for the treatment of COVID-19 patients who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). Tocilizumab lowers the risk of death due to COVID-19 and is most effective when used within 10 days of developing symptoms.
Baricitinib (Olumiant) is an immunosuppressant drug used for treating rheumatoid arthritis that has EUA to be used “off-label” for the treatment of adults and children 2 years old and older hospitalized with COVID-19. Baricitinib is taken orally once a day for 14 days or until discharge from the hospital, whichever comes first.
Baricitinib is authorized for the treatment of COVID-19 of patients who require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). It has been shown to lower the risk of death due to COVID-19.
COVID-19 convalescent plasma
COVID-19 convalescent plasma is authorized for the treatment of COVID-19 in people with immunosuppressive disease or receiving immunosuppressive treatment in either inpatient or outpatient settings. COVID-19 convalescent plasma is the liquid part of the blood that is collected from eligible people that have fully recovered from a documented COVID infection and have antibodies (infection fighting proteins) to COVID-19.
COVID-19 convalescent plasma is most effective when used early on in the illness. Additional doses may be given if there is little to no clinical response. It may not benefit everyone. The World Health Organization (WHO) no longer recommends COVID-19 convalescent plasma to treat COVID-19.
Continuous renal replacement therapy or blood purification
Treatment with continuous renal replacement therapy (dialysis) and blood purification devices may be effective for some patients with confirmed COVID-19 that is damaging their organs. It may work by reducing various pathogens, cytokines, and other inflammatory mediators — small active proteins in the bloodstream that control a cell’s immune response — by filtering the blood and returning the filtered blood to the patient.
Despite information available to the contrary, there are no other medications — approved or otherwise — that are effective against COVID. See BeMedWise blogs Ivermectin, the New Hydroxychloroquine for COVID-19 and Next Up for Anti-vaxxers – Iodine
There are no direct treatments for Long COVID.
While there is one theory that some of the symptoms of Long COVID are caused by the COVID-19 virus persisting in the body, most recent evidence suggests that is primarily the result of:
- Damage to the body during the active infection — such as brain/nerve or other organ damage;
- Persistent overactivity of the immune system attacking parts of the body; and/or
- Ongoing problems with small blood clots.
Since most of the symptoms of Long COVID are unrelated to active COVID-19 virus, the medications for the virus described above are not effective for treatment. Treatments for Long COVID are confined to ways to relieve individual symptoms, such as counseling, antidepressant and antianxiety medications, pulmonary rehabilitation, cardiovascular treatments, and physical therapy.
While there is one drug to prevent COVID disease, convalescent plasma and six medications to treat documented COVID-19 infections, their use is limited to those with severe disease or at risk for severe disease. Most of the treatments have age restrictions and are not available to young children. The bottom line is that medical treatment of SARS-CoV-2 infections is not available to most people who have COVID-19, which is another reason to get vaccinated.
Test to Treat is a federal program that makes it faster and easier for people with COVID-19 to obtain treatment. The Test to Treat web-based locator can be used to locate the nearest Test to Treat site. This information is also available in English, Spanish, and more than 150 other languages by calling 800-232-0233.
For more information about possible coronavirus therapies currently being investigated visit the FDA’s Coronavirus Treatment Acceleration Program (CTAP) website.