Pharmacology Treatment for COVID-19

In this blog, we will discuss the pharmacological treatment for COVID-19 based on the severity of the disease.

Asymptomatic

• No medication is required in this case 

Mild 

• (No SOB, RR < 24, SpO2 > 94%)
• Anti-pyretic
• Anti-tussive
• Inhalational budesonide (800 mcg BD for 5 days)

Moderate

• (SOB, RR 24- 30, SpO2 90- 93%)
• Oxygen support (to maintain SpO2 above 92%)
• Steroids (if SpO2 is less than 92%) 
• Prophylactic anticoagulants
• Other therapies, depending upon investigation

Also read: Details Of Enzymatic Receptors

Severe

• (SOB, RR > 30, SpO2 < 90%)
• Oxygen support (to maintain SpO2 above 90%)
• Steroids
• Prophylactic anticoagulants
• Other therapies, depending upon investigations

Steroids

Steroids are the only mortality-reducing drug. Harmful in asymptomatic and mild cases Recommended dose:

• Dexamethasone 6 mg OD
• MPS 32 mg OD
• Prednisolone 40 mg OD
• Hydrocortisone 50 mg TDS

They decrease immunity and thus increase the risk of infections like mucormycosis. They cause hyperglycemia, so monitoring blood sugar levels is very important.

• Life-threatening condition
• DOC is L-AMB by IV route
• Oral drugs: Posaconazole and Isuvaconazole
• A solution of L-AMB is made in 5% dextrose

Also read: Frequently Asked Question in General Pharmacology

Remdesivir

• Not recommended for mild cases
• Only FDA-approved drug for COVID-19

Indications: Selected cases of moderate to severe COVID-19 patients, hospitalized patients, On oxygen therapy. Should be used within 10 days of disease onset; after that, it won't provide any benefits

Mechanism of Action (Moa)

• Inhibits RdRP
• Monitoring of KFT, LFT and PT is required
• Avoid if eGFR < 30 ml/min or ALT > 5 times
• Can be combined with Baricitinib

Adverse Effects

• Anaphylaxis
• Infusion-related reactions
• Nausea

Tocilizumab

• MAb against IL-6: Used for Cytokine Release syndrome
• Indications:
  • Only in severe to critically ill patients
  • No improvement of oxygen requirement after 24-48 hrs of steroids
  • Raised CRP > 75 mg/L
  • No bacterial, fungal or TB infections are present
• Dose: 8 mg/kg (max) by IV route
• Avoided in:
  • Immunosuppressive patients
  • Liver disease
  • High risk of GIT perforation
  • ANC < 500 cells/mcL
  • Platelet count < 50000 cells/mcL

Also read: Important One-liners in Pharmacology

Monoclonal Antibodies

• Drugs included:
  • Bamlanivimab
  • Bamlanivimab + Etesevimab
  • Casirivimab + Imdevimab
• These are MAb against Spike protein
• Given EUA by FDA
• Given IV for OPD patients
• Not given to hospitalized patients

Baricitinib

• JAK inhibitor
• Dose adjustment is required in renal and hepatic diseases
• Increased risk of thromboembolism
• Used along with Remdesivir (when steroids cannot be used)

Anticoagulants

• Drugs include:
  • UFH
  • LMWH
  • Fondaparinux
• They act by activating antithrombin
• So inhibit factor 10a and 2a

Also read: Pharmacology Important Questions for NEET PG/FMGE 2025

2-Deoxy-D-Glucose

• Approved by DCGI and developed by DRDO
• It is a glucose molecule in which the 2 hydroxyl groups have been replaced by hydrogen so that it cannot undergo further glycolysis
• So it acts by inhibiting glycolysis at the 2nd step
• Given EUA by DCGI for moderate to severe cases, as an adjunct to reduce oxygen requirement

Therapies Not Recommended Now

• Chloroquine / HCQ
• Ivermectin
• Azithromycin
• Colchicine

Important MCQS 

Q. Which of the following is true about the novel antiviral drug Remdesivir?

A. Was developed during the MERS outbreak in 2012

B. An adenosine analog interferes with the action of viral RNA-dependent RNA polymerase and causes decrease in viral RNA production

C. Drug of choice for the treatment of pneumonia caused by SARS-CoV-2

D. It is an FDA-approved drug for COVID-19

Answer: B

Solution: Remdesivir

• Novel antiviral agent developed by Gilead Sciences
• First developed as an antiviral against Ebola virus during the 2014 outbreak in West Africa.
• Adeosine analog
• Interferes with the action of the vial RNA dependent RNA polymerase
• Evades proof reading by the viral exoribonuclease causing decrease in viral RNA production.
• Promising results in animal studies for MERS-CoV and SARS, suggesting it may have some effects in patients with COVID-19.
• The dose being studied is 200mg IV on day one followed by 100mg IV once daily for 4 to 9 days.
• Currently Remdesivir has received investigational new drug (IND) status and several clinical trials are ongoing on patients with SARS-CoV-2 infection.

Also read: Introduction to Adrenergic drugs

Q. WHO declared COVID- 19 as Global pandemic on:

A. 11th Feb 2020

B. 11th March 2020

C. 30th Jan 2020

D. 15th March 2020

Answer: B

Solution:

• Origin- Wuhan, China
• 1st Dec, 2019- 1st case was reported
• 1st Jan, 2020- Wuhan seafood market was closed
• 7th Jan, 2020- Chinese health authority identifies Novel Corona virus
• 30th Jan, 2020- 1st case reported in India (Kerala); WHO declared it as Health emergency of international concern
• 11th Feb, 2020- Name COVID-19 by WHO
• 11th March, 2020- WHO declared COVID- 19 as global pandemic 

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