Types of Coronavirus Disease 2019 (COVID-19) Medications

The deadly coronavirus disease (COVID-19) pandemic prompted medical science to marshal existing medications and technologies as well as develop new ones. These drugs combat the virus itself through convalescent and monoclonal antibodies, antiviral drugs and vaccines. Corticosteroids and other drugs help manage inflammatory response and other symptoms caused by the virus.

Coronavirus disease 2019 (COVID-19) medications are drugs used in the treatment of COVID-19, a respiratory disease caused by a coronavirus identified in 2019. The virus is now known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

COVID-19 medications include vaccines that protect against SARS-CoV-2 infection, and medications that treat the symptoms and complications caused by the viral infection. As of February, 2021, the only drug approved by FDA to treat COVID-19 is remdesivir, an antiviral drug.

FDA has also granted Emergency Use Authorization (EUA) for a few other medications and vaccines. An Emergency Use Authorization is a mechanism by which the FDA facilitates the availability and use of unapproved medical products, or unapproved use of approved medical products during public health emergencies, such as the current COVID-19 pandemic.

An EUA usually remains in effect until the health emergency declaration is withdrawn. In some cases, the EUA may be revoked. For example, the FDA revoked the EUA for hydroxychloroquine and chloroquine after it was determined that scientific data does not support their use in COVID-19 treatment, and their potential risks outweigh potential benefits. 

Medications made available with EAU for COVID-19 treatment include:

• Bamlanivimab, a monoclonal antibody (MAB)
• Baricitinib, a small molecule drug, in combination with remdesivir
• Combination of two MABs, casirivimab and imdevimab

Typically vaccines require years of research, but spurred on by the COVID-19 pandemic, scientists from all over the world cooperated to develop vaccines in record time. Barely a year after the first SARS-CoV-2 human infection in China, FDA granted EUA to two COVID-19 vaccines:

• Pfizer-BioNTech COVID-19 vaccine
• Moderna COVID-19 vaccine

Several more vaccines and therapeutic medications targeting the SARS-CoV-2 virus were under investigation as of February, 2021. The types of therapeutic drugs include antiviral medications, immunomodulators and antibodies, which can reduce viral load, ease symptoms and improve recovery.

Coronavirus disease 2019 is a highly infectious respiratory illness caused by SARS-CoV-2, a type of coronavirus. Coronaviruses are a large family of viruses which cause illnesses ranging from a mild cold to severe respiratory distress syndromes. The SARS-CoV-2 has mutated over time, and more infectious strains have emerged.

The SARS-CoV-2 is a single strand of genetic material known as RNA, which uses the host’s cellular mechanism to replicate itself. The viral RNA is encased in an envelope with spikes of protein molecules on the surface.

The spike protein helps the virus attach to an enzyme known as angiotensin-converting enzyme 2 (ACE2) present on the surface of many types of cells including lungs, heart and intestines, and fuse with the  cell membrane and allows the viral RNA to enter and replicate the virus.

According to current understanding, COVID-19 is transmitted by droplets released by infected persons, even if the person is asymptomatic, when they exhale, talk, cough or sneeze. 

Because of this characteristic of the virus, wearing a mask and physical distancing are effective in limiting transmission of the disease to a great extent but not 100%..

Approximately 50% of people who contract COVID-19 may experience no symptoms. About 80% of the people who develop symptoms from COVID-19 do not require hospitalization, 15% require oxygen, and 5% need intensive care.

People older than 60, or those who have underlying conditions such as diabetes, cancer, heart or lung diseases have a higher risk for severe symptoms and complications.

As of February 8, 2021, more than 106 million people worldwide tested positive for COVID-19, and over 2.32 million people had died from the disease. Also, at least two different SARS-CoV-2 strains have developed to date that cause similar symptoms. The effect of currently available drug treatments and vaccines is being rapidly investigated.

The most common symptoms of COVID-19 are:

• Fever
• Dry cough
• Fatigue

Less common symptoms include:

• Loss of taste and/or smell
• Red eyes (conjunctivitis)
• Nasal congestion
• Sore throat
• Headache
• Chills
• Dizziness
• Muscle and joint pain
• Nausea and/or vomiting
• Diarrhea
• Skin rashes

Symptoms of severe COVID-19 include:

• Shortness of breath
• Loss of appetite
• Pain or pressure in the chest
• Confusion
• High temperature
• Complications

Complications from COVID-19 include:

• Acute respiratory distress syndrome (ARDS)
• Respiratory failure
• Blood vessel block from blood clots (thromboembolism)
• Sepsis
• Multiorgan failure
• Neurological complications such as:
  • Delirium
  • Strokes
  • Brain inflammation
  • Nerve damage

The long-term effects of COVID-19 are not entirely clear, but some people are reported to have continuing fatigue, respiratory and neurological symptoms after recovery from the disease.

Treatments for COVID-19 depend on the severity of the illness. People with mild symptoms may be able to recover at home with appropriate care, after testing for COVID-19 and consulting with a doctor. It is essential to take necessary precautions to avoid infecting others.

People who develop severe COVID-19 symptoms must seek medical care immediately. Treatments for hospitalized patients are individualized based on the patient’s condition. The treatments for hospitalized COVID-19 patients may include the following:

• Supplemental oxygen to raise blood oxygen level.
• Mechanical ventilation for patients who are unable to breathe on their own.
• Intravenous administration of fluids, drugs and biologic products.
• Extracorporeal membrane oxygenation (ECMO), an artificial process in which carbon dioxide is removed from the blood and oxygen is infused, bypassing the lungs.
• Continuous renal replacement therapy (CRRT), a type of slow dialysis for patients with kidney damage. The device removes toxins and fluid from the blood and infuses it with sterile fluid and electrolytes.

Researchers are studying many types of medications that target the ability of SARS-CoV-2 to infect, survive and multiply. The types of medications approved or granted EUA by FDA to treat COVID-19 include the following:

• Vaccines
• Antivirals
• Monoclonal antibodies
• JAK inhibitors
• Convalescent plasma
• Continuous renal replacement therapy (CRRT) solutions
• Anticoagulants
• Sedative medication

In addition, corticosteroids are used in certain hospitalized patients. Clinical trials continue to evaluate many more types of medications that can relieve symptoms and treat complications. Types of medications under investigation include the following:

• Vaccines
• Antivirals
• Immunomodulators which regulate immune response to the virus
• Antibody therapies which can help attack the virus
• Postexposure prophylaxis to prevent disease progression after exposure to the virus

Vaccines

Vaccines activate the immune system to produce antibodies to specific pathogens. It usually takes a few weeks for the body to develop antibodies to the virus. Currently, two vaccines have received EUA from the FDA, 67 COVID-19 vaccines are in clinical trials and at least 89 are in pre-clinical investigation globally.

Typically vaccines consist of weakened or inactive particles of a virus, but newer vaccine technologies have evolved. Some of the new vaccines use genetic particles known as messenger RNA (mRNA), without any viral material in it -- the first vaccines of their kind in history.

The injected mRNA particles fuse with cells in our body. The mRNA has the code for the SARS-CoV-2 spike proteins, which the fused cells start producing. The immune system attacks the spike proteins in the fused cells, spurring development of antibodies, which can recognize and attack the actual SARS-CoV-2 spike proteins if exposure occurs.

FDA has granted EUA for the following two mRNA COVID-19 vaccines:

• Pfizer-BioNTech COVID-19 vaccine (BNT-162b2) for individuals 16 or older. A clinical trial has shown this vaccine to have 95% efficacy in preventing COVID-19.
• Moderna COVID-19 vaccine (mRNA-1273) for individuals 18 or older. Moderna vaccine clinical trial has shown 94.1% efficacy in COVID-19 prevention.

Antivirals

Antiviral medications stop the virus from replicating itself. The only FDA-approved antiviral drug for COVID-19 is:

Remdesivir (Veklury) for hospitalized adults and children who are 12 or older and weigh at least 40 kg. The EUA for use in children under 12 remains in place currently.

Several more antiviral medications and other drugs with antiviral properties are in clinical trials, which include the following:

• Molnupiravir
• Favipiravir
• Nitazoxanide
• Ivermectin
• Niclosamide

Monoclonal antibodies

Monoclonal antibodies are lab-engineered proteins that bind to the spike protein of the virus, and prevent the virus from attaching and entering into human cells. The FDA has granted EUA for use of monoclonal antibodies in adults and children of age 12 or older, weighing at least 40 kg, who have mild or moderate COVID-19, and at risk for progressing to severe disease.

Monoclonal antibodies granted EUA by the FDA are:

• Bamlanivimab
• Casirivimab and imdevimab combined (REGEN-COV)

JAK inhibitors

Janus kinase (JAK) inhibitors are tiny particles (small molecule drugs) which inhibit the activity of an enzyme known as Janus kinase, and suppress the release of inflammatory proteins (cytokines) by immune cells. This helps prevent hyper-inflammatory response to the virus causing what is known as a cytokine storm.

The JAK inhibitor granted EUA by the FDA for use in COVID-19 patients who require supplemental oxygen, mechanical ventilation or ECMO is:

• Baricitinib (Olumiant) for adults and children of age two or older.

Convalescent plasma

Convalescent plasma is obtained from people who have recovered from COVID-19. Convalescent plasma contains antibodies to SARS-Cov-2 and can help others fight the virus. FDA has granted EUA for use of convalescent plasma for hospitalized COVID-19 patients.

Continuous renal replacement therapy (CRRT) solutions

CRRT filters the toxins out of the blood and replaces electrolytes in COVID-19 patients with kidney injury. The FDA has granted EUA for use of the following solutions for CRRT:

• Fresnius Medical, multiFiltrate PRO system and multiBic/multiPlus Solutions

Anticoagulants

Anticoagulants prevent blood clotting in patients while they undergo CRRT. Anticoagulant granted EUA by the FDA for use in COVID-19 patients undergoing CRRT is:

• REGIOCIT replacement solution

Sedative medication

Sedative medication is used in patients on mechanical ventilation in the ICU. Medication that the FDA has granted EUA for sedation of patients older than 16 is:

• Fresnius Kabi Propoven 2%

Corticosteroids

Corticosteroids have anti-inflammatory and immunosuppressive properties. The COVID-19 treatment guidelines published by the National Institute of Health recommends the use of the corticosteroid dexamethasone in severely ill COVID-19 patients who require supplemental oxygen, mechanical ventilation or ECMO.

• Please visit our medication section of each drug within its class for more detailed information.
• If your prescription medication isn’t on this list, remember to look on MedicineNet.com drug information or discuss with your healthcare provider and pharmacist.
• It is important to discuss all the drugs you take with your doctor and understand their effects, possible side effects and interaction with each other.
• Never stop taking your medication and never change your dose or frequency without consulting with your doctor.