You'll hear buzz about molnupiravir, an oral antiviral to treat COVID-19.
Molnupiravir incorporates into the RNA of the SARS-CoV-2 virus and introduces "errors" in the code...causing the virus to mutate to death.
It's 4 capsules bid for 5 days...and seems well tolerated.
Evidence suggests molnupiravir reduces hospital admissions...like injectable COVID-19 monoclonal antibodies, or "MAbs" (Regen-COV, etc).
But it has downsides. For example, there's a concern molnupiravir may lead to more viral variants...because of its mechanism of action.
Plus animal studies suggest molnupiravir may cause birth defects. It isn't recommended for use during pregnancy or breastfeeding...and has contraception precautions for men or women of reproductive potential.
Don't be surprised if molnupiravir isn't added to your formulary. It is NOT authorized for patients hospitalized due to COVID-19...since it doesn't seem to shorten recovery time.
Instead, expect it to be used in high-risk adult OUTpatients unable to receive another COVID-19 treatment...such as COVID-19 MAbs or the other authorized oral antiviral, nirmatrelvir/ritonavir (Paxlovid).
Stay tuned for our review of nirmatrelvir/ritonavir and its place in therapy in a future Letter.
And see our chart, Treatments of Interest for COVID-19, for more details about these oral antivirals.
- N Engl J Med. 2021 Dec 16. doi: 10.1056/NEJMoa2116044
- https://www.fda.gov/media/155054/download (1-5-22)
- https://www.covid19treatmentguidelines.nih.gov/therapies/statement-on-therapies-for-high-risk-nonhospitalized-patients/ (1-5-22)