Antivirals for COVID-19

Pavithra Srinivas; Gretchen L. Sacha; Christine Koval

doi:10.3949/ccjm.87a.ccc030

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TABLE 1

Antiviral agents under investigation for COVID-19

Drug	Mechanism of action	FDA-approved indication(s)	Dosage	Adverse reactions/contraindications	Comments
Remdesivir	Adenosine analogRNA polymeraseinhibitor	Not currentlyapproved	200 mg IV on day 1,then 100 mg IV daily× 9 additional days	Safety not fullyestablished	Currently undergoingseveral phase III clinicaltrials in the US forCOVID-19
Lopinavir/ritonavir(Kaletra)	Protease inhibitor	HIV	HIV: varies based onconcomitant medications,typically lopinavir/ritonavir400 mg/100 mg twice daily	Adverse reactions: QTc prolongation, weightgain, fat redistribution,hepatotoxicity, increasedcholesterol, hyperglycemia,pancreatitis, skin rash,gastrointestinal effects Caution/avoid use: Lopinavir and ritonavirare strong CYP3A4inhibitors and thus mayhave many druginteractions	Clinical trials ongoingin the US andinternationally
Oseltamivir(Tamiflu)	Neuraminidaseinhibitor	Influenza A/Bfor treatmentor prophylaxis	Influenza: 75 mg twice dailyInfluenza prophylaxis:75 mg once dailyAdjust doses for renalfunction	Adverse reactions: Vomiting, nausea,headache	Two randomizedclinical trials currentlyongoing in China
Favipiravir(Avigan)	Purine nucleotideRNA polymeraseinhibitor	Not currentlyapproved	Varies based on clinical trial	Safety not fullyestablished	Currently undergoingclinical trial evaluationfor COVID-19 inChina and US
Umifenovir(Arbidol)	Viral envelopemembrane fusioninhibitor viaS-protein/ ACE2interaction	Not currentlyapproved	Varies based on clinical trial	Safety not fullyestablished	Pending further clinicaltrial evaluation forCOVID-19

ACE2 = angiotensin-converting enzyme 2 gene; FDA = US Food & Drug Administration; HIV = human immunodeficiency virus; IV = intravenous; QTc = corrected QT interval; RNA = ribonucleic acid; US = United States