Table 7.
Treatment options for COVID-19.
| Drug | Proposed dose for COVID-19 | Mechanism of action | Target diseases | Route of administration | Safety concerns and toxicities |
|---|---|---|---|---|---|
| Ritonavir + Lopinavir (Kaletra) (Repurposed agent) | 500 mg once, twice a day, 2 weeks | Protease inhibitors Inhibits coronavirus replication |
HIV infection | Oral | Elevated risk of cardiac arrhythmias, pancreatitis, cardiac conduction abnormalities, and hepatotoxicity Caution in cases with liver disease, hemophilia, cardiovascular disease, and pancreatitis Potential drug interactions Common side effects: diarrhea, gastrointestinal intolerance, nausea, vomiting, |
| Ribavirin (Repurposed agent) | 500 mg each time, 2 to 3 times/day in combination with IFN-α or lopinavir/ritonavir | Nucleoside inhibitor (Interfering with the synthesis of viral mRNA) | Hepatitis C, SARS, MERS | Oral or intravenous infusion | Elevated risk of anemia Is a contraindicated and teratogen in pregnancy Leads to severe dose-dependent hematologic toxicity |
| Chloroquine phosphate, chloroquine (Repurposed agent) | 500 mg each time, 2 times/day for 5–10 days (300 mg for chloroquine) | Increasing endosomal pH Autophagy inhibitors Inhibits viral RNA polymerase Immunomodulating Probably inhibit ACE2 cellular receptor |
Antimalarial agent, autoimmune disease | Oral | Elevated risk of cardiac arrhythmias, hypoglycemia, retinal damage, particularly with long time use Caution in cases with G6PD deficiency and diabetes Potential drug interactions Common side effects: Abdominal cramps, anorexia, vomiting, nausea, diarrhea |
| Hydroxychloroquine sulphate (Repurposed agent) | 400 mg each time, 2 times/day in first day, then 200 mg 2 times/day for 4 days (Alternative dose: 400 mg daily for 5 days or 200 mg 3 times/day for 10 days) | Has same mechanism as Chloroquine | Antimalarial agent, autoimmune disease | Oral | Side effects are similar to chloroquine but less common |
| Arbidol (umifenovir) (Repurposed agent) | 200 mg each time, 3 times/day | S protein/ACE2, membrane fusion inhibitor Inhibits the replication of coronavirus in vitro |
Influenza infection | Oral | Safety and efficacy not established Common side effects: allergic reaction, gastrointestinal intolerance, increased liver enzymes |
| Favipiravir (T-705) (Investigational agent) | 1600 mg*2/first day followed by 600 mg*2/day | Nucleoside analogue (RNA polymerase inhibitor) | Influenza A (H1N1), Ebola | Oral | Increased risk for embryotoxicity and teratogenicity Common side effects: diarrhea, increased liver enzymes, hyperuricemia, decreased neutrophil count |
| Remdesivir (GS-5734) (Investigational agent) | 200 mg on day 1, then 100 mg on days 2–10 | Nucleoside analogue (terminates RNA synthesis) Interfering with virus post-entry |
SARS, Ebola, and MERS | Intravenous infusion | Safety and efficacy not established Common side effects: increased liver enzymes (reversible), kidney injury |
| Interferon alpha (IFN-α) (Adjunctive/Supportive therapy) | 5 million U, 2 times/day | Increase cellular immunity, Inhibits viral replication |
Broad-spectrum antiviral | Oral or injectable | Failed to suppress viral replication and had some side effects when prescribe later |
| Tocilizumab (Actemra) (Adjunctive/Supportive therapy) | 400 mg IV or 8 mg/kg × 1–2 doses Next dose 8–12 h after the first dose if insufficient response |
Inhibits IL-6-mediated signaling (also reduce cytokine storm) | Rheumatoid arthritis | Intravenous infusion | Caution in patients with neutropenia a (<500 cells/μL) or thrombocytopenia (<50,000/μL) Safety in pregnancy is unknown and may cause harm to the fetus Increased risk of URTI, hepatotoxicity, hypersensitivity reactions, infections, nasopharyngitis, hematologic effects, gastrointestinal problem Common side effects: hypertension, headache, increased AST level |
Note: Most of these drugs should not be used for more than 10 days.
ACE2 (angiotensin-converting enzyme 2), AST (aspartate aminotransferase), G6PD (glucose-6-phosphate dehydrogenase), HIV (human immunodeficiency viruses), IL-6 (interleukin 6), IV (intravenous therapy), MERS (middle east respiratory syndrome), SARS (severe acute respiratory syndrome), URTI (upper respiratory tract infection).