Currently, only one medication has been approved to treat COVID-19. No cure is available for COVID-19. Antibiotics aren't effective against viral infections such as COVID-19. Researchers are testing a variety of possible treatments. The FDA has approved the antiviral drug remdesivir (Veklury) to treat COVID-19 in hospitalized adults and children who are age 12 and older in the hospital. Remdesivir may be prescribed for people who are hospitalized with COVID-19 and need supplemental oxygen or have a higher risk of serious illness. It's given through a needle in the skin (intravenously). The FDA has authorized a drug called Paxlovid that includes nirmatrelvir – a drug that blocks the activity of a specific enzyme needed for the virus that causes COVID-19 to replicate – and an antiviral drug called ritonavir that helps slow the breakdown of nirmatrelvir. Paxlovid is authorized to treat mild to moderate COVID-19 in people age 12 and older who are at higher risk of serious illness. The medications are taken by mouth as pills. The FDA has authorized another drug called molnupiravir to treat mild to moderate COVID-19 in adults who are at higher risk of serious illness and who aren't able to take other treatment options. The medication is taken by mouth as a pill. The FDA has authorized the rheumatoid arthritis drug baricitinib (Olumiant) to treat COVID-19 in some cases. Baricitinib is a pill that seems to work against COVID-19 by reducing inflammation and having antiviral activity. Baricitinib may be used in people who are hospitalized with COVID-19 who are on mechanical ventilators or need supplemental oxygen. The U.S. National Institutes of Health has recommended the corticosteroid dexamethasone for people hospitalized with severe COVID-19 who are on supplemental oxygen or need mechanical ventilation. Other corticosteroids, such as prednisone, methylprednisolone or hydrocortisone, may be used if dexamethasone isn't available. In some cases, the drugs remdesivir, tocilizumab or baricitinib may be given with dexamethasone in hospitalized people who are on mechanical ventilation or need supplemental oxygen. The FDA has also authorized convalescent plasma therapy with high antibody levels to treat COVID-19. Convalescent plasma is blood donated by people who've recovered from COVID-19. Convalescent plasma with high antibodies may be used to treat some hospitalized people ill with COVID-19 who are either early in their illness or who have weakened immune systems. Monoclonal antibodies aren't effective against treating COVID-19 caused by the omicron variant. These drugs were previously used to treat mild to moderate COVID-19 in people who had a higher risk of developing serious illness due to COVID-19. Many people with COVID-19 may have mild illness and can be treated with supportive care. Supportive care is aimed at relieving symptoms and may include: Pain relievers (ibuprofen or acetaminophen) Cough syrup or medication Rest Fluid intake.

1. Treatment options for Corona Virus
Year 3 “CVS & Respiration Module” 2022
Department of
Pharmacology
Fazaia Ruth Pfau
Medical College
1
DR AWAIS IRSHAD

2. Department of
Pharmacology
Fazaia Ruth Pfau
Medical College
2

3. Department of
Pharmacology
Fazaia Ruth Pfau
Medical College
3

4. Department of
Pharmacology
Fazaia Ruth Pfau
Medical College
4

5. Clinical presentation
Asymptomatic
Mild
Moderate
Severe
Critical
Multi-organ
dysfunction
Shock
Department of
Pharmacology
Fazaia Ruth Pfau
Medical College
5

6. Management
• No specific treatment is
required for
asymptomatic & mild
forms.
• Moderate disease patients
needs supportive care &
assessed for Cytokine
Release Syndrome (CRS)
with following
Investigations
Department of
Pharmacology
Fazaia Ruth Pfau
Medical College
6

7. Treatment options
Supportive
Moderate
CRS
• Oxygen (HFNC, CPAP)
• Prone position
• Antibiotics
• Anticoagulation
• Remdesivir
• Convalescent plasma
• Steroids
• Tocilizumab
Department of
Pharmacology
Fazaia Ruth Pfau
Medical College
7
Hydroxychloroquine &
Chloroquine
NO LONGER INDICATED

8. Department of
Pharmacology
Fazaia Ruth Pfau
Medical College
8

9. Department of
Pharmacology
Fazaia Ruth Pfau
Medical College
9

10. Department of
Pharmacology
Fazaia Ruth Pfau
Medical College
10

11. REMDESIVIR
• Broad-spectrum Antiviral Remdesivir is used for filoviruses
(Ebola viruses, Marburg virus), coronaviruses (SARS-
CoV, MERS-Co-V, SARS-CoV-2), paramyxoviruses
(parainfluenza type III virus, Nipah virus, Hendra
virus, measles, and mumps virus),
and Pnemoviridae (Respiratory Syncytial Virus)
• First and only FDA approved for clinical use in suspected or
laboratory-confirmed COVID-19.
• It acts as a nucleoside analog and inhibits the RNA-
dependent RNA polymerase (RdRp) of coronaviruses
into the growing RNA product and allows for addition of three
more nucleotides before RNA synthesis stalls.
Department of
Pharmacology
Fazaia Ruth Pfau
Medical College
11

12. LOPINAVIR & RITONAVIR
• The antiretroviral drug lopinavir is a protease inhibitor,
which is widely used in treatment of HIV and is a
potential candidate for the treatment of COVID-19.
• Lopinavir is formulated in combination with another
protease inhibitor, ritonavir.
• Ritonavir inhibits the metabolising enzyme cytochrome
P450 3A and therefore increases the half-life of lopinavir
Department of
Pharmacology
Fazaia Ruth Pfau
Medical College
12
https://www.cebm.net/covid-19/lopinavir-ritonavir-a-rapid-review-of-the-evidence-for-effectiveness-in-treating-covid/

13. IVERMECTIN
• An antiparasitic drug with effective pharmacological
activity towards viruses and anticancer activity
• It act as an inhibitor of nuclear transport mediated by
the importin α/β1 heterodimer, responsible for the
translocation of various viral species proteins (HIV-1,
SV40), indispensable for their replication.
Department of
Pharmacology
Fazaia Ruth Pfau
Medical College
13
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7251046/

14. Department of
Pharmacology
Fazaia Ruth Pfau
Medical College
14

15. TOCILIZUMAB
• Recombinant humanized monoclonal antibody which is
directed against interleukin-6 (IL-6) receptor.
• Disease Modifying Antirheumatic (DMARD)
• FDA issued an emergency use authorization (EUA) for the
treatment of hospitalized adults and pediatric patients 2
years of age and older with COVID-19 who are receiving
systemic corticosteroids and require supplemental
oxygen, non-invasive or invasive mechanical ventilation,
or extracorporeal membrane oxygenation (ECMO).
• Caution: Risk of severe infections
Department of
Pharmacology
Fazaia Ruth Pfau
Medical College
15
https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30173-9/fulltext

16. BARICITINIB
• Oral selective & reversible inhibitor of Janus
Kinases (JAKs) - an intracellular enzyme of tyrosine-
protein kinase family which modulates signals from
cytokines & growth factor receptors involved in immune
cell function
• JAK phosphorylate transcription proteins (STATs) &
activate intracellular activity, including
gene transcription, of inflammatory mediators leading to
an autoimmune response.
• Caution: Risk of severe infections
Department of
Pharmacology
Fazaia Ruth Pfau
Medical College
16
https://www.ncbi.nlm.nih.gov/books/NBK572064/

17. Department of
Pharmacology
Fazaia Ruth Pfau
Medical College
17

18. Department of
Pharmacology
Fazaia Ruth Pfau
Medical College
18

19. Department of
Pharmacology
Fazaia Ruth Pfau
Medical College
19

20. Department of
Pharmacology
Fazaia Ruth Pfau
Medical College
20

21. Department of
Pharmacology
Fazaia Ruth Pfau
Medical College
21

22. Department of
Pharmacology
Fazaia Ruth Pfau
Medical College
22

23. References...
1. Basic & Clinical pharmacology by Katzung 15th edition.
2. Rang & Dale Pharmacology 9th edition
3. Lippincott Pharmacology 6th edition
4. WHO handouts
5. As on slides
6. For queries a.mehdi@frpmc.edu.pk