I've heard several drugs mentioned as possible treatments for COVID-19. What are they and how do they work?
Answer From Daniel C. DeSimone, M.D.
COVID-19 medicine can help people who are at risk of, diagnosed with, or have symptoms of coronavirus disease 2019 (COVID-19). The medicine helps manage symptoms, stop the virus that causes COVID-19 from spreading in the body, and manage the body's immune system response.
Many people with COVID-19 recover at home without needing medicine given to them by a healthcare professional. Symptoms may be helped by:
- Fever reducers.
- Pain relievers such as ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others).
- Cough medicine.
Medicines to prevent COVID-19
Some medicine can help people who are at high risk of serious illness avoid getting sick. The monoclonal antibody pemivibart (Pemgarda) is a prevention medicine. The U.S. Food and Drug Administration (FDA) authorized this treatment to prevent COVID-19 in some people with weakened immune systems.
Medicines to treat COVID-19
Your healthcare professional may suggest certain medicines if you test positive for COVID-19 and are at high risk of serious illness. These medicines keep mild illness from getting worse. They can include nirmatrelvir-ritonavir (Paxlovid), remdesivir (Veklury) or molnupiravir (Lagevrio).
Nirmatrelvir-ritonavir
Paxlovid combines two medicines. The first, called nirmatrelvir, blocks the activity of an enzyme the COVID-19 virus needs to copy itself, also called replicate. The second medicine, called ritonavir, helps slow the breakdown of nirmatrelvir. Paxlovid is approved to treat mild to moderate COVID-19 in people age 12 and older who are at higher risk of serious illness. The medicine is taken by mouth as a pill.
Remdesivir
Remdesivir is a medicine that blocks the virus that causes COVID-19 from spreading in the body. It's used to treat COVID-19 in people age 12 and older. It's given through a needle into a vein, known as intravenously (IV).
Molnupiravir
The FDA has authorized an antiviral drug called molnupiravir. Molnupiravir treats mild to moderate COVID-19 in adults at higher risk of serious illness who can't take other treatments. The medication is taken by mouth as a pill.
For people with COVID-19 who are in the hospital
People in the hospital with serious COVID-19 may get remdesivir. Another option is a corticosteroid, such as dexamethasone. That medicine helps lower inflammation.
Other medicines include baricitinib (Olumiant) and tocilizumab (Actemra).
Baricitinib, a pill, seems to treat COVID-19 as an antiviral medicine and by lowering inflammation. Tocilizumab is a shot, also called an injection, that seems to work against the COVID-19 virus by lowering inflammation. Healthcare professionals may use these medicines for people in the hospital with COVID-19 who need supplemental oxygen or machines to help them breathe.
The FDA has authorized the immune system suppression drug anakinra (Kineret) for people who need supplemental oxygen. And vilobelimab (Gohibic), a monoclonal antibody, was authorized by the FDA for people receiving mechanical ventilation or extracorporeal membrane oxygenation, called ECMO.
Convalescent plasma
The FDA also has authorized COVID-19 convalescent plasma therapy with high antibody levels to treat COVID-19. Convalescent plasma comes from blood donated by people who've recovered from COVID-19. It may be used to help people diagnosed with COVID-19 who have weakened immune systems.
Medicine that doesn't treat or prevent COVID-19
Early in the COVID-19 pandemic, no treatments for COVID-19 existed. Researchers tested medicines based in the idea that the drugs could treat or prevent COVID-19.
As research has grown, health agencies such as the FDA have authorized or approved the medicines that work and are safe. Researchers also have found out which medicines don't work to treat or prevent COVID-19.
Some medicines stop working because the virus that causes COVID-19 changes.
Examples are bebtelovimab and the combination tixagevimab-cilgavimab (Evusheld). These medicines were based on proteins the body naturally creates to block the COVID-19 virus. But when the virus changed over time, the proteins in the medicine no longer matched up to the virus and stopped working.
Another example is an HIV medicine. It's a combination of two drugs, lopinavir and ritonavir, tested in clinical trials to treat COVID-19. But the trials failed to show a benefit, and the combination is no longer an option to treat COVID-19.
Other examples are ivermectin, hydroxychloroquine or chloroquine.
Claims that ivermectin, hydroxychloroquine or chloroquine can treat COVID-19 are false. These medicines are still useful for treating other illness. But only medicines approved or authorized by the FDA to treat COVID-19 are useful for that illness.
Ivermectin treats or prevents parasites in animals and in humans, not viruses. Taking large doses of this drug can cause serious harm.
Hydroxychloroquine and chloroquine are malaria medicines. Early in the pandemic, the FDA authorized these medicines for emergency use. But the FDA later withdrew that authorization. Clinical information showed that the medicines weren't effective for treating COVID-19. They also can cause serious heart problems.
If you want to try medicine, supplements or herbal products that you've heard might treat or prevent COVID-19, talk with your healthcare professional first. Some of these options have serious side effects. Others are only for people at high risk of serious illness or who are very ill. Your healthcare professional can help you weigh the risks and benefits. That way, you get the treatment that's best for you.
With
Daniel C. DeSimone, M.D.
Show References
- Interim clinical considerations for COVID-19 treatment in outpatients. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/outpatient-treatment-overview.html. Accessed Jan. April 19, 2024.
- Emergency use authorizations for drugs and non-vaccine biological products. U.S. Food and Drug Association. https://www.fda.gov/drugs/emergency-preparedness-drugs/emergency-use-authorizations-drugs-and-non-vaccine-biological-products. Accessed April 19, 2024.
- COVID-19 treatment and preventive medication. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/your-health/treatments-for-severe-illness.html. Access April 19, 2024.
- Know your treatment options for COVID-19. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/know-your-treatment-options-covid-19. Accessed April 19, 2024.
- AskMayoExpert. COVID:19 Drug regimens and other treatment options. Mayo Clinic. 2023.
- Emergency use authorization. U.S. Food and Drug Administration. https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-use-authorization#coviddrugs. Accessed April 19, 2024.
- Coronavirus (COVID-19) drugs. U.S. Food and Drug Administration. https://www.fda.gov/drugs/emergency-preparedness-drugs/coronavirus-covid-19-drugs. Accessed April 19, 2024.
- Beware of fraudulent coronavirus tests, vaccines and treatments. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/beware-fraudulent-coronavirus-tests-vaccines-and-treatments. Accessed April 19, 2024.
- FDA cautions against use of hydroxychloroquine or chloroquine for COVID-19 outside of the hospital setting or a clinical trial due to risk of heart rhythm problems. U.S. Food and Drug Administration. https://www.fda.gov/drugs/drug-safety-and-availability/fda-cautions-against-use-hydroxychloroquine-or-chloroquine-covid-19-outside-hospital-setting-or. Accessed April 19, 2024.
- Antiviral agents, including antibody products. National Institutes of Health. https://www.covid19treatmentguidelines.nih.gov/therapies/antivirals-including-antibody-products/summary-recommendations/. Accessed April 19, 2024.
Original article: https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/coronavirus-drugs/faq-20485627