Table 1.

Potential therapies for monkeypox.

Therapy	Mechanism of Action	Dosing	Formulation	FDA Approval Status	Adverse Event
Cidofovir	Competitive blocking of DNA polymerase effectively blocks viral DNA synthesis	Every other week, provide a dose of 5 mg/kg (with the concomitant probenecid)	Intravenous; non-approved: topical; intravesicular	AIDS-related CMV retinitis [47] (1996)	Neutropenia, incidences of nephrotoxicity, low intraocular pressure, nausea, and vomiting
Brincidofovir	Cidofovir lipid-conjugate prodrug	Four milligrams per kilogram of body weight, twice weekly (maximum of two hundred milligrams each dose)	Oral	Smallpox (2021) [48]	Increased liver transaminases, bilirubin, as well as abdominal pain, nausea, vomiting, and diarrhea
Tecovirimat	Stops replication and spread inside the host, VP37 activity is inhibited. This stops the protein from being able to form contagious particles called viruses that can replicate outside of a host cell	35 to <120 kg: 200 mg IV q12 hr	Two routes of administration are available: intravenous (IV) and oral (off-label topical)	Smallpox (2018) [49]	Extravasation, discomfort, edema at the site of infusion,. Headache, nausea, and vomiting after oral administration.
VIGIV	Smallpox vaccine recipients’ pooled plasma with antibodies specific to OPXVs provides passive protection	up to 9000 units/kg in a dose, or 6000 units/kg. According to the severity of the symptoms, the dosage can be increased	IV	Varicella vaccination side effects (developing vaccinia, significant widespread vaccinia, etc.) (2005) [50]	Reaction during infusion; response at the injection location.

Abbreviations: AIDS, acquired immunodeficiency syndrome; CMV, cytomegalovirus; DNA, deoxyribonucleic acid; FDA, US Food and Drug Administration; IgA, immunoglobulin A; IV, intravenous; max, maximum; VIGIV, vaccinia immunoglobulin intravenous. The registered drugs are shown in Table 2.