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. 2020 Apr 23;728:138914. doi: 10.1016/j.scitotenv.2020.138914

Table 1.

FDA and WHO recommended drugs for the treatment of COVID-19.

Name of drug Working root Risk Factors Overall efficacy
Chloroquine
(Antimalarial)
  • In vitro activity against SARS-CoV-2 and may have immunomodulating properties.

  • Inhibition of viral enzymes or processes such as viral DNA and RNA polymerase, viral protein glycosylation, virus assembly, new virus particle transport, and virus release.

  • ACE2 cellular receptor inhibition, acidification at the surface of the cell membrane inhibiting fusion of the virus, and immunomodulation of cytokine release.

  • Risk of cardiac arrhythmias (e.g., QT prolongation)

  • Risk of retinal damage, especially with long term use

  • Caution in patients with G6PD deficiency

  • Caution in diabetics

  • Significant drug interactions

In vitro and limited clinical data suggest potential benefit.
Hydroxychloroquine
(Antimalarial)
Same as above Same as above Same as above
Lopinavir; Ritonavir
(HIV Protease Inhibitor)
  • In vitro and animal model studies show potential activity for other coronaviruses (SARS-CoV and MERS-CoV).

Lopinavir and ritonavir may bind to Mpro, a key enzyme for coronavirus replication. This may suppress coronavirus activity.
  • Risk of cardiac arrhythmias (e.g., QT prolongation)

  • Caution in patients with hepatic disease or hepatitis

  • Significant drug interactions

Role in the treatment of COVID-19 is unclear. Preclinical data suggested potential benefit; however, more recent data has failed to confirm.
Remdesivir
(Investigational Nucleoside Analogue)
  • Act as a broad-spectrum antiviral with in vitro activity against coronaviruses.

  • Acts as an inhibitor of RNA-dependent RNA polymerases (RdRps).

  • Remdesivir-TP competes with adenosine-triphosphate for incorporation into nascent viral RNA chains.

  • Once incorporated into the viral RNA at position i, RDV-TP terminates RNA synthesis at position i + 3.

  • Because RDV-TP does not cause immediate chain termination (i.e., 3 additional nucleotides are incorporated after RDV-TP), the drug appears to evade proofreading by viral exoribonuclease (an enzyme thought to excise nucleotide analog inhibitors).

Investigational and available only through expanded access and study protocols; several large clinical trials are underway.
Azithromycin
(Macrolide Antibacterial)
  • It may prevent bacterial superinfection, and macrolides may have immunomodulatory properties to work as adjunct therapy.

  • It may have immunomodulatory properties in pulmonary inflammatory disorders.

  • They may downregulate inflammatory responses and reduce the excessive cytokine production associated with respiratory viral infections; however, their direct effects on viral clearance are uncertain.

  • Immunomodulatory mechanisms may include reducing chemotaxis of neutrophils (PMNs) to the lungs by inhibiting cytokines (i.e., IL-8), inhibition of mucus hypersecretion, decreased production of reactive oxygen species, accelerating neutrophil apoptosis, and blocking the activation of nuclear transcription factors.

  • Risk of cardiac arrhythmias (e.g., QT prolongation)

  • Significant drug interactions

Used in some protocols based on theoretical mechanism and limited preliminary data as adjunct therapy.
Tocilizumab
(Interleukin-6 (IL-6) Receptor-Inhibiting Monoclonal Antibody)
  • Cytokine release syndrome may be a component of severe disease in COVID-19 patients.

  • Inhibits IL-6-mediated signaling by competitively binding to both soluble and membrane-bound IL-6 receptors. IL-6 is a proinflammatory cytokine that is involved in diverse physiological processes such as T-cell activation, immunoglobulin secretion induction, hepatic acute-phase protein synthesis initiation, and hematopoietic precursor cell proliferation and differentiation stimulation. IL-6 is produced by various cell types, including T- and B-cells, lymphocytes, monocytes, and fibroblasts.

  • Risk of GI perforation

  • Risk of hepatotoxicity

  • Caution in patients with thrombocytopenia and neutropenia

  • Infusion-related reactions

Immunomodulating agent used in some protocols based on theoretical mechanism and limited preliminary data as adjunct therapy.
COVID-19 convalescent plasma
(Plasma collected from persons who have recovered from COVID-19 that may contain antibodies to CoV-19)
  • Clinical trials are being conducted to evaluate the use of COVID-19 convalescent plasma to treat patients with severe or immediately life-threatening COVID-19 infections. COVID-19 convalescent plasma is not intended for prevention of the infection.

  • Awaiting as clinical trials are on it are going on.

Investigational use is being studied.
Corticosteroid therapy
  • Corticosteroid therapy is not recommended for viral pneumonia; however, use may be considered for patients with refractory shock or acute respiratory distress syndrome.

  • Normal corticosteroid administration issues along with cardiac arrest problem.

Not recommended for viral pneumonia; however, use may be considered for patients with refractory shock or acute respiratory distress syndrome.

The table is prepared after Smith et al. (2020), an open access article with common creative attribution.