Table 4.
Expected PK of the antivirals used to treat COVID-19 with extracorporeal support treatments
| Name of antiviral | Effects on pharmacokinetic parameters | Protein binding (%) | ||
|---|---|---|---|---|
| RRT | ECMO | Extracorporeal systemic inflammatory responsea | ||
| Remdesivir | NA | NA | NA | NA |
| Chloroquine | – | Likelyb | Alterations in cytochrome metabolism | 40–60 [25, 31] |
| Lopinavir | – | Likelyb | Alterations in cytochrome metabolism | 98–99 [101] |
| Ritonavir | – | Likelyb | Alterations in cytochrome metabolism | 99 [102] |
| Favipiravir | – | Increases Vd | Alterations in cytochrome metabolism | 54 [32] |
| Ribavirin | – | Increases Vd | – | 0 [26] |
| Arbidol (Umifenovir) | – | – | Alterations in cytochrome metabolism | NA |
| Hydroxychloroquine | – | Likelyb | Alterations in cytochrome metabolism | 40–60 [25, 31] |
| PegIFN-α2β | – | – | – | NA |
| IFN-α1β | – | – | – | NA |
| IFN-α | – | – | – | NA |
RRT renal replacement therapies, ECMO extracorporeal membrane oxygenation, NA not available, Vd volume of distribution, IFN interferon
aFor example, systemic inflammatory response syndrome (SIRS) caused by extracorporeal life support system
bSequestration of drug to the ECMO oxygenator is likely, but is unlikely to affect dosing needs