COVID Medication Run Down

We are very fortunate at this stage in the pandemic to have several medications that can prevent COVID-19 or prevent an infection from getting worse. Knowing who’s best suited to receive each and when can be complex. Here’s a rundown of the medications that are available now and the details surrounding each.

The best medicines are those that prevent infection and serious disease. The most widely available preventive medications are the vaccines. People as young as 5 can get a vaccine and greatly decrease their risk of serious illness. Please get vaccinated and boosted as soon as you are eligible.  For most people, vaccines are the only COVID-related pharmaceutical they will ever need.

The very highest risk patients—like cancer patients, people who have had an organ transplant, and people with HIV or a similar immune-suppressed condition—are eligible to receive a special medication before they are infected or exposed to COVID. Given in advance of infection, it is designed to provide more protection than vaccines alone. It’s called EVUSHELD™ by AstraZeneca, and it is a long-acting monoclonal antibody combination for patients who are at least 12 years old and who are not expected to have mounted an adequate immune response to vaccination. It is given through two intramuscular injections, and it is available in limited quantities to outpatients at SVHC’s COVID Resource Center now. Talk to your doctor, if you think you are eligible.

For very high-risk patients, including some pregnant women who are exposed to COVID and those who are high-risk for a serious infection and test positive but who don’t need overnight hospital care, there are monoclonal antibody treatments. They are given intravenously, by shot, or under the skin during an appointment at the hospital’s infusion center. They work best when they are given before or shortly after symptoms begin, and they help prevent symptoms from getting worse. Be sure to let your doctor know if you test positive or have symptoms, so you can get this treatment if you qualify for it.

Oral antivirals, like molnupiravir and paxlovid, received FDA authorization in late December and early January, respectively. Much like the monoclonal antibody treatments, these are for people at high risk after testing positive for SARS-CoV-2. They are far more convenient and less expensive than the infusion type of monoclonal antibody treatment, because they come in pill form and are available in limited quantities at local pharmacies. You can take them at home, rather than having to come to the hospital for an infusion.

Hospitalized patients are eligible to receive remdesivir, an antiviral infusion delivered intravenously to adults and kids who are hospitalized with COVID. It has been available since October 2020. In order to work, it must be used early in the patient’s inpatient stay.

A few medications typically used for people with rheumatoid arthritis—including the janus kinase (JAK) inhibitor baricitinib, known by the brand name olumiant, and a biologic called tocilizumab, known as actemra, help control COVID symptoms in the hospital. All of these agents are only available in limited quantities. 

Finally, dexamethasone is a corticosteroid medication that is given orally or intravenously to hospitalized patients who need more oxygen.

All of these medications have been studied and proven both safe and effective. Be particularly cautious if you hear about an alternative treatment to those authorized by the Food and Drug Administration. If they worked and were safe, they would be authorized. Taking unauthorized medications can cause harm.

Doctors are grateful to have these new treatment options for people at high risk for a serious case of COVID. Please get vaccinated with the hope that you will never need to use them.

Marie George, MD, is the infectious disease specialists at SVMC Infectious Disease, part of Southwestern Vermont Medical Center and Southwestern Vermont Health Care in Bennington.