Remdesivir: An Intravenous Antiviral
Remdesivir is an antiviral medication and one of the first treatments for COVID-19. It is administered intravenously, meaning it must be given as an infusion in a hospital or clinic over several days. This is because it is not well-absorbed when taken orally. Remdesivir works by interfering with the virus's ability to copy its genetic material. It has been shown to help hospitalized patients recover faster. Although a three-day course can benefit high-risk outpatients, the need for IV administration makes it less practical than taking a pill at home.
Oral Antivirals for COVID-19
For high-risk patients who don't need hospitalization, oral antiviral medications provide a more convenient option. The main ones are Paxlovid and molnupiravir.
Paxlovid (Nirmatrelvir/Ritonavir)
Paxlovid is an oral treatment combining nirmatrelvir and ritonavir. It is considered a highly effective oral antiviral for COVID-19 in high-risk outpatients. Nirmatrelvir works by stopping viral replication, while ritonavir boosts its levels. Paxlovid is authorized for those 12 and older at high risk of severe illness. Common side effects include an altered taste and diarrhea. Due to potential drug interactions with ritonavir, a doctor must review a patient's full medication list.
Lagevrio (Molnupiravir)
Molnupiravir (Lagevrio) is another oral antiviral option for high-risk adults who cannot take Paxlovid, such as due to drug interactions. It works by causing errors in the virus's genetic code, making it unable to function correctly. Molnupiravir has shown lower efficacy in reducing hospitalization or death compared to Paxlovid. It is authorized for adults 18 and older and is not recommended during pregnancy or breastfeeding.
Choosing the Right Antiviral Treatment
Selecting the appropriate treatment involves considering a patient's health, risk factors, and other medications. Oral antivirals are convenient for home use, whereas IV remdesivir is given in healthcare settings. For high-risk outpatients, Paxlovid is often preferred if drug interactions are not a concern. Molnupiravir serves as an alternative when Paxlovid isn't suitable.
Comparison of COVID-19 Antiviral Treatments
| Feature | Remdesivir (Veklury) | Paxlovid (Nirmatrelvir/Ritonavir) | Molnupiravir (Lagevrio) |
|---|---|---|---|
| Route of Administration | Intravenous (IV) infusion | Oral tablets | Oral capsules |
| Mechanism of Action | Inhibits RNA-dependent RNA polymerase (RdRp) | Inhibits viral protease (Mpro) | Induces lethal mutations in viral RNA |
| Primary Use | Hospitalized patients; some high-risk outpatients | High-risk, non-hospitalized patients | High-risk, non-hospitalized adults when Paxlovid isn't an option |
| Efficacy | Shortens recovery time and reduces hospitalization risk | High efficacy in reducing hospitalization and death | Lower efficacy compared to Paxlovid |
| Drug Interactions | Fewer significant drug interactions | Significant drug interactions due to ritonavir | Few to no known drug interactions |
| Common Side Effects | Nausea, allergic reactions | Altered taste, diarrhea | Diarrhea, dizziness, nausea |
New Research and the Future of Oral Remdesivir
While no oral remdesivir is currently available, research into oral prodrugs like VV116 has shown promise in trials. VV116 has demonstrated good oral absorption and comparable results to Paxlovid in some studies with potentially fewer drug interaction concerns. However, these are not yet approved for use in many countries. Research continues, but currently, Paxlovid and molnupiravir are the available oral treatments.
Conclusion
To answer the question, what is the oral version of remdesivir?—there isn't one; remdesivir is an IV treatment. The closest oral alternatives for eligible, high-risk individuals with COVID-19 are Paxlovid and molnupiravir. Paxlovid is generally preferred due to higher efficacy but requires careful consideration of drug interactions. Molnupiravir is a valuable alternative when Paxlovid isn't suitable. Consulting a healthcare provider promptly after a COVID-19 diagnosis is crucial to determine the best treatment plan. For further details, refer to {Link: AMA website https://www.ama-assn.org/public-health/infectious-diseases/what-doctors-wish-patients-knew-about-covid-19-oral-antivirals} or {Link: CDC's resources https://www.cdc.gov/covid/hcp/clinical-care/outpatient-treatment.html}.
