Updated February 24, 2022
The following treatment recommendations are intended to assist Orange County providers in making COVID-19 treatment decisions.
The National Institutes of Health (NIH) COVID-19 Treatment Guidelines remains the recommended source for current guidance on the treatment and the use of COVID-19 therapeutics and prophylaxis.
Availability of Therapeutics
COVID-19 therapeutics are widely available. Providers and patients should continue to use the Therapeutic Distribution Locator to identify local availability.
On January 26, 2023, the FDA announced that had it withdrawn authorization for Evusheld. Subsequently the NIH treatment guidelines regarding use of Evusheld were revised to align with the FDA’s announcement.
Recommendations for Treatment of Nonhospitalized patients with COVID-19: NIH Guidelines
The National Institutes of Health (NIH) COVID-19 Treatment Guidelines Panel is regularly updating its recommendations for Therapeutic Management of Nonhospitalized Adults With COVID-19. The panel recommends using one of the following therapeutics (listed in order of NIH preference, with the NIH panel’s comments on each product included):
- Nirmatrelvir 300 mg with ritonavir 100 mg (Paxlovid) - For information on dosing, administration, and safety, including information on drug interactions for Paxlovid review the FDA Fact Sheet for Healthcare Providers Emergency Use Authorization (EUA) of PAXLOVID.
- Ritonavir-boosted nirmatrelvir (Paxlovid) has significant and complex drug-drug interactions, primarily due to the ritonavir component of the combination.
- Before prescribing ritonavir-boosted nirmatrelvir (Paxlovid), clinicians should carefully review the patient’s concomitant medications, including over-the-counter medications and herbal supplements, to evaluate potential drug-drug interactions. See the Panel’s statement on the drug-drug interactions for ritonavir-boosted nirmatrelvir (Paxlovid) for details.
- For those with moderate renal impairment (eGFR ≥30 to <60 mL/min) a 150 mg Nirmatrelvir with 100 mg ritonavir dose pack is now available.
- Remdesivir (Veklury) - For information on dosing administration and safety and use of remdesivir for both pediatric and adult populations review the FDA approved package insert.
- Remdesivir should be administered in a setting where severe hypersensitivity reactions, such as anaphylaxis, can be managed. Patients should be monitored during the infusion and observed for at least 1 hour after infusion.
- Molnupiravir (Legevrio) - For information on administration, dosing, and safety of Molnupiravir (Legevrio) review the Fact Sheet for Healthcare Providers: Emergency Use Authorization (EUA) for Legevrio (molnupiravir).
- The FDA EUA states that molnupiravir (Legevrio) is not recommended for use in pregnant patients due to concerns of fetal toxicity observed during animal studies. However, when other therapies are not available, pregnant people with COVID-19 who are at high risk of progressing to severe disease may reasonably choose molnupiravir (Legevrio) therapy after being fully informed of the risks, particularly those who are beyond the time of embryogenesis (i.e., >10 weeks’ gestation). The prescribing clinician should document that a discussion of the risks and benefits occurred and that the patient chose this therapy.
- There are no data on the use of molnupiravir (Legevrio) in patients who have received COVID-19 vaccination, and the risk-to-benefit ratio is likely to be less favorable because of the lower efficacy of this drug.