Table 3.
Drugs used in the course of COVID-19 disease, classification, primary indication and main metabolic pathways.
| Drugs | Classification | Primary indication | Substrate of (enzyme/transporter)b | Inhibitor of | Inducer of |
|---|---|---|---|---|---|
| ACE Inhibitors, Angiotensin II Receptor Blockers (ARBs) | Renin angiotensin aldosterone system (RAAS) inhibitor | High blood pressure and heart failure | – | – | – |
| CYP2C9 | – | – | |||
| Alteplase | Plasmin activator | Acute ST elevation myocardial infarction (STEMI), pulmonary embolism | – | – | – |
| Anakinra | Disease modifying anti-rheumatic agent | RA | – | – | – |
| Ascorbic acid | Vitamin C | Vitamin C deficiency | – | – | – |
| Atazanavir | HIV protease inhibitors | HIV infection | CYP3A4 | CYP3A4 | – |
| Azithromycin | Macrolides | Multiple bacterial infections | – | – | – |
| Baloxavir | Antiviral | Influenza | – | – | – |
| Baricitinib | Disease-modifying anti-rheumatic agent | Moderate to severe RA | CYP3A4 | – | – |
| Bevacizumab | IgG1 antibody | Various cancer types | – | – | – |
| Chloroquine phosphate | Antimalarial (4-aminoquinoline derivative) | Malaria | CYP2C8, CYP3A4 | CYP2D6 | – |
| Colchicine | Antigout agents | Gout | CYP3A4, P-gp | – | – |
| Darunavir/cobicistat | HIV protease inhibitors | HIV infection | CYP3A | – | – |
| Emapalumab | Anti-interferon gamma | hemophagocytic lymphohistiocytosis | – | ||
| Famotidine | Histamine H2 antagonists | Peptic ulcer disease, gastroesophageal reflux disease, Zollinger-Ellison syndrome | – | ||
| Favipiravir | Antiviral | Influenza | Aldehyde oxidase | – | – |
| Fingolimod | Immunosuppressant | Multiple sclerosis | Sphingosine kinase, CYP4F2 | – | – |
| HMG-CoA reductase inhibitors (statins) | Antilipemic agent | Reduce risk of heart attack or stroke | CYP3A4, CYP3A5 | – | – |
| Hydroxychloroquine sulfate | Antimalarial (4-aminoquinoline derivative) | Malaria, auto-immune diseases (lupus, rheumatoid arthritis) | CYP3A4 | CYP2D6 | – |
| Inhaled prostacyclins (e.g. epoprostenol, iloprost) | Vasodilating agents | Pulmonary arterial hypertension | – | – | – |
| Interferon beta 1a | Interferon | Multiple sclerosis | – | – | – |
| Ivermectin | Anthelmintic | Multiple parasitic infections | P-gp | – | – |
| Lopinavir | HIV protease inhibitor | HIV infection | CYP3A | CYP3A4 | – |
| Methylprednisolone | Corticosteroid | Multiple conditions | 11beta-hydroxysteroid dehydrogenases and 20-ketosteroid reductases | – | – |
| N-acetylcysteine | Antioxidant | Acetaminophen overdose | – | – | – |
| Niclosamide | Anthelmintic | Tapeworm infestations | CYP1A2, UGT1A1 | – | – |
| Nitazoxanide | Antiprotozoal | GIT infections | – | – | – |
| Nitric oxide (inhaled) | Vasodilating Agent | Neonatal respiratory failure | – | – | – |
| NSAIDS (e.g. ibuprofen, indomethacin) | Nonsteroidal anti-inflammatory agent | Pain, fever, inflammation | CYP2C8/9, CYP2C19, UGT2B7 | – | – |
| Oseltamivir | Neuraminidase inhibitor | Influenza | Esterases | – | – |
| Peg-interferon alpha 2b | Interferon | Hepatitis C and melanoma | – | – | – |
| Remdesivir | Antiviral | *COVID-19 | CYP2C8, CYP2D6, CYP3A4 | – | – |
| Ribavirin | Hepatitis C | Adenosine kinase | |||
| Ritonavir | HIV protease inhibitors | HIV infection | CYP3A/CYP2D6 | CYP3A4, P-gp | – |
| Ruxolitinib | Antineoplastic Agents | Bone marrow disorders | CYP3A4 | P-gp | – |
| Sarilumab | Disease modifying anti -rheumatic agent | Moderate to severe RA in adults | – | – | – |
| Sildenafil | PDE5 inhibitor | Erectile dysfunction, pulmonary arterial hypertension | CYP3A4/CYP2C9 | – | – |
| Siltuximab | Monoclonal antibody | Multicentric Castleman's disease | – | – | – |
| Sirolimus | Immunosuppressive agent (mTOR inhibitor | Prevent rejection of kidney transplant | CYP3A4 | – | – |
| Tocilizumab | Disease-modifying antirheumatic agent | Moderate to severe rheumatoid arthritis (RA) in adults, systemic juvenile idiopathic arthritis-SJIA, other rheumatological conditions | Proteolytic enzymes | – | – |
| Umifenovir | Antiviral | Influenza | CYP3A4, UGT1A9, UGT2B7 | – | – |
*
FDA and EMA emergency use authorization.
b
Metabolizing enzymes information collected from Drugbank and product information, drug list data obtained from https://www.ashp.org/COVID-19.