Molnupiravir

Brand name:Lagevrio

use

Molnupiravir is a product that the FDA is allowing to be given for emergency use to treat
COVID-19.

It is used by adults 18 years of age and older who have recently tested positive for coronavirus,
have had mild to moderate symptoms for no more than 5 days and are not hospitalized.

To receive this product you must also be at high risk for COVID-19 complications due to older
age, obesity, or ongoing medical conditions (such as lung or heart disease or diabetes, among
others.

Mechanism of Action

Orally bioavailable prodrug of nucleoside analogue beta-D-N4-hydroxycytidine (NHC)

Metabolized to cytidine nucleoside analogue, NHC, which distributes into cells where NHC is
phosphorylated to form the pharmacologically active ribonucleoside triphosphate (NHC-TP)

NHC-TP incorporation into SARS-CoV-2 RNA by the viral RNA polymerase results in an
accumulation of errors in the viral genome, leading to inhibition of replication

Dosing & Uses

capsule

 200mg

800 mg PO q12hr for 5 days

Take orally, with or without food

Initiate as soon as possible after COVID-19 diagnosis and within 5 days of symptom onset

Completing the full 5-day treatment course and continuing to isolate in accordance with public
health recommendations are important to maximize viral clearance and minimize viral
transmission

If patient is hospitalized due to severe or critical COVID-19 after starting treatment with
molnupiravir, completion of the full 5-day treatment is at the healthcare provider’s discretion

Missed dose

 <10 hours: Take missed dose as soon as possible, and resume normal dosing schedule
 >10 hours: Skip dose, and take the next dose at the regularly scheduled time
 Do not double dose to make up for missed dose

Dosage Modifications

Renal impairment

 Mild or moderate (eGFR >30 mL/min): No dosage adjustment necessary

 Severe (eGFR <30 mL/min), end-stage renal disease, or patients on dialysis:
Pharmacokinetics not evaluated; not expected to have a significant effect on NHC (N4-
hydroxycytidine) exposure

Hepatic impairment

 Mild to severe (Child-Pugh Class A to C): No dosage adjustment required

 Preclinical data indicate that hepatic elimination is not expected to be a major route of
NHC elimination

Adverse Effects
1-10%

Diarrhea (2%)

Nausea (1%)

Dizziness (1%)
≤2%

 Selected Grade 3 and 4 laboratory abnormalities in chemistry (ALT, AST, creatinine, and
lipase) and hematology (hemoglobin, platelets, and leukocytes)

Limitations of use

 Not authorized for use in patients aged <18 years

 Not authorized for initiation of treatment in patients requiring hospitalization owing to COVID-
19
 Not authorized for use for >5 consecutive days
 Not authorized for preexposure or postexposure prophylaxis for prevention of COVID-19

Use in pregnancy is not recommended.[4] There are no human data on use during pregnancy to assess
the risk of adverse maternal or fetal outcomes. [4] Based on animal data, the drug may cause fetal harm.

Price and effectiveness

700$ in USA 624 p in eygpt

“Molnupiravir” is the first oral coronavirus treatment for adults at high risk, the
authority explained, cutting the threat of hospitalization and death by half for mild to
moderate cases.