Table 3. Pharmacological treatment for COVID-19.

Agent	Mechanism of action	Dose	Adverse effects
Remdesivir	Inhibition of viral RNA polymerase	Adult and pediatric patients >40 kg NOT on invasive mechanical ventilation: 200 mg IV on Day 1 followed by 100 mg IV on Days 2-5 Pediatric patients <40 kg NOT on invasive mechanical ventilation: 5 mg/kg IV on Day 1 followed by 2.5 mg/kg IV on Days 2-5 Patients ON mechanical ventilation and/or ECMO and patients with no clinical improvement after 5 days of treatment: extend the duration of therapy to 10 days Administration: IV infusion over 30-120 minutes	Transient elevations in transaminases, acute kidney injury, gastrointestinal symptoms (nausea, vomiting) Not recommended for patients with GFR <30 mL/min/1.73 m2 or patients on dialysis or those with increased plasma concentrations of alanine aminotransferase or aspartate aminotransferase (>5 times the upper limit of normal)
Lopinavir/ritonavir	Inhibition of 3-chymotrypsin-like protease	Lopinavir 300 mg/m2 (max. 400 mg) plus ritonavir 75 mg/m2    (max. 100 mg) PO twice daily for up to 14 days	Gastrointestinal effects (nausea, vomiting, diarrhea), transaminase elevation, prolongation of QTc interval, torsades de pointes, PR interval prolongation
Chloroquine phosphate/hydroxychloroquine sulfate	Blocks viral entry by inhibition of glycosylation of the cellular angiotensin-converting enzyme 2 receptor, proteolytic processing, and endosomal acidification. Immunomodulatory effects: inhibits the production of cytokines, autophagy, and lysosome activity	Adults and adolescents ≥50 kg:500 mg of chloroquine phosphate PO every 12-24 h for 5-10 days (500 mg of chloroquine phosphate =300 mg of chloroquine base) 400 mg of hydroxychloroquine sulfate PO every 12 h on Day 1, then 200 mg PO every 12 h for 4 days (200 mg of hydroxychloroquine sulfate=155 mg hydroxychloroquine base) Children: 5-10 mg/kg/day of chloroquine base for 5-10 days	Abdominal cramps, diarrhea, nausea, vomiting, prolongation of QTc interval (additive effect with azithromycin and fluoroquinolones), hemolysis (especially in patients with G6PD deficiency), hypoglycemia, retinal toxicity, neuropsychiatric and central nervous system effects, idiosyncratic reactions
Azithromycin	Reduction of viral replication by induction of interferon-stimulated genes. Stimulation of neutrophil activation and attenuation of inflammatory cytokines in epithelial cells and airway smooth muscle cells	10 mg/kg (max. 500 mg) PO on Day 1 followed by 5 mg/kg (max. 250 mg) PO on Days 2-5	Gastrointestinal symptoms (diarrhea, nausea, vomiting), hepatotoxicity, prolongation of the QTc interval (additive effect with chloroquine/hydroxychloroquine)
Convalescent plasma	Plasma containing antibodies to SARS-CoV-2 may help suppress the virus and modulate the inflammatory response	Adults: Transfusion of 200-500 mL of convalescent plasma (ABO-compatible, preferentially)	Transfusion-associated circulatory overload, transfusion-related acute lung injury, allergic reactions, transmission of infectious pathogens, and red cell alloimmunization
Dexamethasone	Anti-inflammatory effects, suppression of cytokine-related lung injury	Adults: 6 mg/day IV or PO for up to 10 days	Hyperglycemia, hypertension, secondary infections, psychiatric disorders, adrenal insufficiency, myopathy (particularly if used with neuromuscular blockers)
Tocilizumab	IL-6 inhibition, reduction of cytokine storm	400 mg or 8 mg/kg IV, 1-2 doses; second dose 8-12 h after the first dose, if inadequate response.Administration: IV infusion over 60 minutes	Increased aspartate aminotransferase, neutropenia, thrombocytopenia, risk for serious infections (including tuberculosis), hypertension, hypersensitivity reactions