COVID-19 Therapeutics
This webpage is for healthcare professionals and focuses on common antiviral treatments that can be used in the outpatient setting.
In brief, COVID-19 therapeutics are indicated for symptomatic patients with mild to moderate COVID-19 who are at increased risk for progression to severe disease. COVID-19 antiviral therapy has been shown to prevent worsening illness, and COVID-19-related hospitalizations and deaths. Drug therapy needs to be started quickly after the onset of symptoms. Use of these medications is considered a recommended practice for patients.
Summary Table of Food and Drug Administration (FDA) Approved and/or Authorized Treatments for High-Risk Patients
| Antiviral Medication | Use | How is it given? | Key Highlights | When is it given? | |
| First line treatment | Paxlovid for Adults (≥ 18 years) (Nirmatrelvir/ ritonavir) Paxlovid for children (ages 12 through 17) - under FDA EUA Paxlovid for patients with moderate renal impairment (reduced dose) | For treatment of mild-moderate COVID-19 in patients ≥ 12 years of age who are at increased risk for severe COVID-19 | Oral tablets | • Paxlovid has many potential drug-drug interactions • Need complete medication list from patient • Suggest use University of Liverpool drug interaction checker • Consult Paxlovid prescribing information and/or EUA Fact Sheet • Renal dosing with Paxlovid | Within 5 days of symptoms starting |
| Second Line Treatment | Remdesivir (Veklury) | For treatment of COVID-19 (inpatient or outpatient) | IV | • FDA approved for children and adults • Must be administered over 3 consecutive days | Within 7 days of symptoms starting |
| Third line Treatment | Molnupiravir (Lagevrio) | For treatment of mild-moderate COVID-19 in adults (≥ 18 years of age). Medical providers are strongly encouraged to consult prescribing information before using the medication | Oral capsule | • Lagevrio continues to be under an FDA EUA (EUA Fact Sheet) • Be sure to review EUA Fact Sheet before prescribing. There are mandatory requirements for administration of this drug • Only authorized for use in adults • Per EUA, Lagevrio is a drug of last resort | Within 5 days of symptoms starting |
| Antivrial medication | Use | How is it given? | Key highlights | When is it given? |
| Pemivibart (Pemgarda) | COVID-19 pre-exposure prophylaxis (PrEP) | 60 minute IV infusion | • Drug is under FDA Emergency Use Authorization (EUA); it is not FDA approved • Drug is a monoclonal antibody •Indicated for: - People age ≥ 12 years -Weight ≥ 40 kg (~88 lbs) -People with moderate to severe immunocompromise -People who do not have COVID-19 or who have not been in recent contact with someone who has COVID-19 -People who are not expected to mount an adequate response to COVID-19 vaccination • Drug carries black box warning about risk of anaphylaxis • Be sure to consult before using drug EUA Fact Sheet • Drug is meant to be given over 60 minutes by IV infusion • Drug is NOT indicated for COVID-19 treatment • Drug is NOT indicated as a substitute for COVID-19 vaccine | Drug should be given at least TWO WEEKS after a person has had a COVID-19 vaccination Otherwise, the drug can be given anytime to a person who meets the EUA indication criteria |
Patients who are uninsured or underinsured can access medical care, including COVID-19 treatment. To find treatment:
- Treatment Locator (search for Test to Treat sites)
- Local Health Department
- Federally Qualified Health Center (FQHC)
- Free Clinic
Patient assistance programs are available to help lower out-of-pocket costs for COVID-19 treatment medications:
Therapeutics Guidelines
- CDC Interim Clinical Considerations for COVID-19 Treatment in Outpatients
- IDSA: Therapeutics
- University of Liverpool COVID-19 Drug Interaction Checker
Paxlovid (nirmatrelvir/ritonavir)
Lagevrio (Molnupiravir)
Veklury (remdesivir)
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