Table 1.
Class/Drug | Dose | Rationale | Trials |
---|---|---|---|
Antivirals | |||
Lopinavir/ritonavir (LPV/RTV) | i. LPV 400 mg/RTV 100 mg BID PO x 14 d ii. LPV 400 mg/RTV 100 mg PO BID x 21 d iii. LPV 400 mg/RTV 100 mg PO x 14 d ± ribavirin (loading dose 4 g, 1.2 g x 8 hourly PO) |
HIV protease inhibitor In vitro activity vis-à-vis SARS-CoV and NERS-CoV No data vis-à-vis SARS-CoV-2 |
Randomized trial: not effective A cohort study and anecdotal experience: results inconsistent |
Remdesivir | i. 200 mg IV x d1; 100 mg IV x d2–5 ii. 200 mg IV x d1; 100 mg IV x d2–10 iii. 200 mg IV x d1; 100 mg IV x daily up to 10 days |
Nucleoside analogue Broad-spectrum antiviral against coronaviruses |
Shortens the time to recovery in adults with no effect on mortality |
Favipiravir (Avigan) | 200 mg tablets (1200 mg PO first dose; 400 mg PO x d1; 400 mg BID PO xd2–5) | Activity against RNA viruses and indicated in influenza resistant to Tamiflu It has a teratogenic effect |
Chinese non-randomized trial-effective |
Antimalarials | |||
Chloroquine (CQ) | 500 mg BID PO x 10 d | Immunomodulatory effect and reduce the production of cytokines. In vitro antiviral activity vis-à-vis SARS-CoV-2; HCQ is more potent and less toxic |
Chinese and French trials; non-randomized; results inconclusive Anecdotal reports Included for treatment and prophylaxis in protocols. Preliminary report from large scale randomized trial did not show any significant reduction in 28-day mortality. HCQ also show no beneficial effect in post-exposure prophylaxis against COVID-19 |
Hydroxychloroquine (HCQ) | i. 400 mg BID PO x d1; 200 mg BID PO x d2–5 ii. 200 mg TID PO x 10 days (French trial) iii. 400 mg BID PO x d1; 400 mg PO once weekly x 3–7 wk (ICMR, prophylaxis) |
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Antihypertensive drug | |||
Losartan | 50 mg QID POi | Hypothetical: may block ACE2 receptors and inhibit virus binding Can also upregulate ACE2, which may harm host |
Clinical trial underway |
Immunosuppressive drugs | |||
Tocilizumab | IV infusion: 4-8 mg/kg x 60 min; if needed repeat at 12 hr (max dose 800 mg) | Recombinant humanized monoclonal antibody against IL-6 receptor To treat cytokine storm syndrome |
Case study and series, rapid improvement in cytokine-related symptoms |
Corticosteroids | Parenteral | Anti-inflammatory to treat extended cytokine response; treatment for ARDS and sepsis | Dexamethasone 6 mg once daily lowered 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support. Treat shock and/or ARDS |
Antibiotic | |||
Azithromycin | i. 500 mg QID PO x d1; 250 mg QID PO x d2–5 ii. 500 mg PO QID x 7 days iii. 500 mg PO x QID 5 days |
Macrolide and antibacterial immunomodulators downregulate inflammatory response; reduce cytokine production and inhibit cytokine actions No antiviral effect is known |
French trial as an adjunct to HCQ MERS-CoV: large retrospective analysis – no advantage |
Convalescent plasma | Plasma from recovered COVI-19 patients | Convalescent COVID-19 patients may have high titre antibodies (titre > 1:320). | Trials to treat severe/life-threatening disease (not allowed for prevention) |