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.
Although there is only one approved by the U.S. Food and Drug Administration (FDA) to treat coronavirus disease 2019 (COVID-19), many medications are being tested.
The FDA has approved an antiviral drug called remdesivir (Veklury) to treat COVID-19 in adults and children who are age 12 and older. Remdesivir may be prescribed for people who are hospitalized with COVID-19. It’s given through a needle in the skin (intravenously).
The FDA has granted an emergency use authorization for the rheumatoid arthritis drug baricitinib (Olumiant) to treat COVID-19 in some cases. Baricitinib is a pill that seems to work against COVID-19 by reducing inflammation and having antiviral activity. The FDA states baricitinib may be used in people who are hospitalized with COVID-19 who are on mechanical ventilators or need supplemental oxygen.
Researchers are studying other potential treatments for COVID-19, including:
- Antiviral drugs. In addition to remdesivir, other antiviral drugs being tested include favipiravir and merimepodib. Studies have found that the combination of lopinavir and ritonavir isn’t effective.
Dexamethasone. The corticosteroid dexamethasone is one type of anti-inflammatory drug that researchers are studying to treat or prevent organ dysfunction and lung injury from inflammation. Studies have found that it reduces the risk for deaths by about 30% for people on ventilators and by about 20% for people who needed supplemental oxygen.
The U.S. National Institutes of Health has recommended this drug for people hospitalized with COVID-19 who are on mechanical ventilators or need supplemental oxygen. Other corticosteroids, such as prednisone, methylprednisolone or hydrocortisone, may be used if dexamethasone isn’t available. Dexamethasone and other corticosteroids may be harmful if given for less severe COVID-19 infection.
In some cases, the drugs tocilizumab or baricitinib may be given with dexamethasone in hospitalized people who are on mechanical ventilation or need supplemental oxygen. Remdesivir may be given with dexamethasone in hospitalized people who need supplemental oxygen or who are on mechanical ventilation.
- Anti-inflammatory therapy. Researchers study many anti-inflammatory drugs to treat or prevent dysfunction of several organs and lung injury from infection-associated inflammation.
Immune-based therapy. Researchers study the use of a type of immune-based therapy called convalescent plasma. The FDA has granted emergency use authorization for convalescent plasma therapy to treat COVID-19. Convalescent plasma is blood donated by people who’ve recovered from COVID-19. Convalescent plasma with high antibodies may be used to treat some hospitalized people ill with COVID-19 who are either early in their illness or who have weakened immune systems.
Researchers also study other immune-based therapies, including mesenchymal stem cells and monoclonal antibodies. Monoclonal antibodies are proteins created in a lab that can help the immune system fight off viruses.
Several monoclonal antibody medications are available. These include sotrovimab and a combination of two antibodies called casirivimab and imdevimab. These drugs are used to treat mild to moderate COVID-19 in people who have a higher risk of developing serious illness due to COVID-19. Treatment consists of a single intravenous infusion given in an outpatient setting. To be most effective, these medications need to be given soon after COVID-19 symptoms start and prior to hospitalization.
The FDA has also authorized the use of casirivimab and imdevimab as a treatment for people at higher risk of serious illness who have recently been exposed to the COVID-19 virus or who are at high risk of exposure. For example, people at high risk of exposure may include those living in nursing homes or prisons where others have recently been infected with the COVID-19 virus. This treatment is for people who aren’t fully vaccinated, or who are fully vaccinated but have a weakened immune system.
- Drugs being studied that have uncertain effectiveness. Researchers study amlodipine and losartan. But it’s not yet known how effective these drugs may be in treating or preventing COVID-19. Famotidine isn’t likely to be beneficial in treating COVID-19.
- Ivermectin. Ivermectin isn’t a drug for treating viruses and the FDA hasn’t approved use of this drug to treat or prevent COVID-19. Taking large doses of this drug can cause serious harm. Don’t use medications intended for animals on yourself.
- Hydroxychloroquine and chloroquine. These malaria drugs were authorized for emergency use by the FDA during the COVID-19 pandemic. However, the FDA withdrew that authorization when data analysis showed that the drugs are not effective for treating COVID-19. They can also cause serious heart problems.
- Drugs to prevent COVID-19. Researchers are studying drugs to prevent COVID-19 before and after exposure to the virus.
It’s not known if any of these will prove to be effective against COVID-19. It’s critical to complete medical studies to determine whether any of these medications are effective against COVID-19.
Don’t try these medications without a prescription and your doctor’s approval, even if you’ve heard that they may have promise. These drugs can have serious side effects. They’re reserved for people who are seriously ill and under a doctor’s care.
Daniel C. DeSimone, M.D.
- How do COVID-19 antibody tests differ from diagnostic tests?
Aug. 31, 2021
- Information for clinicians on investigational therapeutics for patients with COVID-19. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/therapeutic-options.html. Accessed April 21, 2020.
- 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 Aug. 18, 2021.
- AskMayoExpert. COVID-19: Inpatient evaluation, management, and treatment. Mayo Clinic; 2020.
- Kim AY, et al. Coronavirus disease 2019 (COVID-19): Management in adults. https://www.uptodate.com/contents/search. Accessed April 21, 2020.
- Giudicessi JR, et al. Urgent guidance for navigating and circumventing the QTc-prolonging and torsadogenic potential of possible pharmacotherapies for coronavirus disease 19 (COVID-19). Mayo Clinic Proceedings. 2020; doi:10.1016/j.mayocp.2020.03.024.
- Coronavirus disease 2019 (COVID-19) treatment guidelines. National Institutes of Health. https://covid19treatmentguidelines.nih.gov/introduction/. Accessed Aug. 30, 2021.
- Coronavirus disease 2019 (COVID-19) frequently asked questions. U.S. Food and Drug Administration. https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/coronavirus-disease-2019-covid-19-frequently-asked-questions. Accessed April 23, 2020.
- Zhang L, et al. Calcium channel blocker amlodipine besylate is associated with reduced case fatality rate of COVID-19 patients with hypertension. Medrxiv. 2020; doi:10.1101/2020.04.08.20047134.
- Marshall WF III (expert opinion). Mayo Clinic. Nov. 23, 2020.
- Q&A: Dexamethasone and COVID-19. World Health Organization. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-dexamethasone-and-covid-19. Accessed June 30, 2020.
- Horby P, et al. Effect of dexamethasone in hospitalized patients with COVID-19: Preliminary report. medRxiv. 2020; doi:10.1101/2020.06.22.20137273.
- Janowitz T, et al. Famotidine use and quantitative symptom tracking for COVID-19 in non-hospitalised patients: A case series. Gut. 2020; doi:10.1136/gutjnl- 2020- 321852.
- Why you should not use ivermectin to treat or prevent COVID-19. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/why-you-should-not-use-ivermectin-treat-or-prevent-covid-19. Accessed Aug. 30, 2021.
See more Expert Answers