Coronavirus Disease 2019 (COVID-19) Drug Summary

Drug	Dosage	Remarks
Molnupiravir	Adult: 800 mg PO 12 hourly x 5 days	Adverse Reactions GI effects (diarrhea, nausea); Other effect (dizziness) Special Instructions Not to be used >5 consecutive days or as pre- and post-exposure prophylaxis Not recommended in patients <18 years old, lactating during treatment and for 4 days after the final dose Use with caution in women with childbearing potential as it may cause adverse maternal and fetal outcomes including pre-eclampsia, eclampsia, preterm birth, premature membrane rupture, VTE and fetal death
Nirmatrelvir/Ritonavir	300 mg Nirmatrelvir PO with 100 mg Ritonavir PO 12 hourly x 5 days	Adverse Reactions GI effects (dysgeusia, diarrhea, abdominal pain, nausea/vomiting); Hypersensitivity effects (anaphylaxis, serious skin reactions [including toxic epidermal necrolysis Stevens-Johnson syndrome]); Hepatic effects (hepatic transaminase elevations, clinical hepatitis, jaundice); Other effects (headache, hypertension, malaise) Special Instructions Administer within 5 days of symptom onset Not recommended in patients with severe renal impairment (eGFR <30 mL/min), severe hepatic impairment (Child-Pugh Class C) Use with caution in patients with renal and hepatic impairment, pre-existing liver diseases, liver enzyme abnormalities, hepatitis, uncontrolled or undiagnosed HIV-1 infection Co-administration with drugs highly dependent on CYP3A for clearance, drugs for which elevated concentrations are associated with serious and/or life-threatening reactions, and drugs that are strong CYP3A inducers are contraindicated
Remdesivir	Adult & children ≥12 years old: 200 mg IV infusion as a single dose on day 1 followed by 100 mg IV infusion 24 hourly from day 2 onwards Treatment duration: Mild-moderate COVID-19 with high risk of hospitalization: Up to 3 days Patient on ECMO or invasive mechanical ventilation: Up to 10 days Patient not on ECMO or invasive mechanical ventilation: Up to 5 days or until 10 days if no symptomatic improvement is observed	Adverse Reactions Significant effects (increased transaminase levels, infusion-related and anaphylactic reactions including angioedema, diaphoresis, dyspnea, bradycardia or tachycardia, hypotension, nausea/vomiting, rash, shivering, wheezing); Metabolic effect (hyperglycemia); Renal effects (increased serum creatinine, decreased eGFR or CrCl, acute kidney injury); Other effects (anemia, fever, headache) Special Instructions Use with caution in patients with renal and hepatic impairment Recent US FDA update in July 2023 allows Remdesivir to be used without dose adjustment in patients with an eGFR of <30 mL/min including patients on dialysis Not recommended for term newborns (7-28 days) with serum creatinine levels ≥1 mg/dL; patients with ALT levels ≥5 times the upper limit of normal range Perform LFT and hematology test at baseline and daily during therapy Determine eGFR and serum creatinine prior to initiation and daily during therapy

Drug	Dosage	Remarks
Tocilizumab	Adult hospitalized and receiving systemic corticosteroids that require supplemental oxygen or mechanical ventilation: 8 mg/kg 60-minute IV infusion If after first dose clinical signs and symptoms worsen or do not improve, give additional dose of 8 mg/kg at least 8 hours after initial infusion	Adverse Reactions Hepatic effect (increased transaminase levels); GI effects (constipation, diarrhea, nausea); Renal effect (urinary tract infection); CV effect (hypertension); Neurologic effects (anxiety, insomnia); Other effect (hypokalemia) Special Instructions For individuals weighing >100 kg, doses exceeding 800 mg per infusion are not recommended ALT/AST should be monitored

Drug	Dosage	Remarks
COVID-19 mRNA vaccine (Andusomeran)	Children 6 months to 4 years old with prior vaccination or known history of SARS-CoV-2 infection: 0.25 mL IM at least 3 months after the most recent dose of COVID-19 vaccine Children 6 months to 4 years old without prior vaccination and no known history of SARS-CoV-2 infection: 2 doses of 0.25 mL IM Administer second dose 28 days after the first dose Children 5-11 years old with or without prior vaccination: 0.25 mL IM at least 3 months after the most recent dose of COVID-19 vaccine Adult and children ≥12 years old with or without prior vaccination: 0.5 mL IM at least 3 months after the last prior dose of a COVID-19 vaccine	Adverse Reactions Dermatologic effects (injection site pain, redness, urticaria and swelling, rash); GI effects (diarrhea, nausea/vomiting); Other effects (lymphadenopathy, decreased appetite, irritability/crying, headache, sleepiness, myalgia, arthralgia, fatigue, chills, pyrexia) Special Instructions Not recommended in patients with known history of severe hypersensitivity reaction (eg anaphylaxis) to any of the components of the vaccine Postpone vaccination in individuals suffering from acute severe febrile illness or acute infection Use with caution in individuals receiving anticoagulant therapy or those with thrombocytopenia or any coagulation disorder (eg hemophilia) and are immunocompromised
COVID-19 mRNA vaccine (mRNA-1273)	Adult ≥18 years old: 0.5 mL IM x 2 doses Administer second dose 1 month after the first dose	Adverse Reactions Dermatologic effects (injection site pain, redness and swelling, axillary swelling/tenderness); Other effects (fatigue, headache, muscle or joint pain, nausea/vomiting, chills, fever) Special Instructions Not recommended in patients with known history of severe hypersensitivity reaction (eg anaphylaxis) to any of the component of the vaccine There is increased risk of myocarditis and particularly within 7 days following second dose based on postmarketing data thus use with caution in patients with history of myocarditis or pericarditis Syncope or fainting may occur thus measures to avoid injury from fainting should be implemented
COVID-19 mRNA vaccine (nucleoside modified)	25 mcg Elasomeran/25 mcg Davesomeran: Adult and children ≥12 years old who have previously received at least a primary vaccination course against COVID-19: 0.5 mL IM at least 3 months after the last prior dose of a COVID-19 vaccine	Adverse Reactions Dermatologic effects (injection site pain, redness and swelling, rash); GI effects (diarrhea, nausea/vomiting); Other effects (lymphadenopathy, decreased appetite, irritability/crying, headache, sleepiness, myalgia, arthralgia, fatigue, chills, pyrexia) Special Instructions Not recommended in patients with known history of severe hypersensitivity reaction (eg anaphylaxis) to any of the components of the vaccine Postpone vaccination in individuals suffering from acute severe febrile illness or acute infection Use with caution in individuals receiving anticoagulant therapy or those with thrombocytopenia or any coagulation disorder (eg hemophilia) and are immunocompromised
COVID-19 mRNA vaccine (Raxtozinameran)	Children 5-11 years old: 10 mcg/0.3 mL IM as single dose Adult and children ≥12 years old: 30 mcg/0.3 mL IM as single dose Individuals previously vaccinated with COVID-19: Administer at least 3 months after most recent dose of COVID-19 vaccine	Adverse Reactions Dermatologic effects (injection site pain, redness and swelling, erythema multiforme); GI effects (nausea/vomiting, diarrhea); CV effects (myocarditis, pericarditis); Other effects (fatigue, headache, lymphadenopathy, arthralgia, chills, fever) Special Instructions Not recommended in patients with known history of severe hypersensitivity reaction (eg anaphylaxis) to any of the components of the vaccine Postpone vaccination in individuals suffering from acute severe febrile illness or acute infection Use with caution in individuals receiving anticoagulant therapy or those with thrombocytopenia or any coagulation disorder (eg hemophilia) and immunocompromised
COVID-19 mRNA vaccine (Tozinameran)	Children 6 months - 4 years old: 0.2 mL (3 mcg) IM x 3 doses Give second dose 3 weeks after the first dose Give third dose ≥8 weeks after second dose Children 5-11 years old: (10 mcg) IM x 2 doses given 3 weeks apart Adult and children ≥12 years old: 0.3 mL (30 mcg) IM x 2 doses Administer second dose 3 weeks after the first dose	Adverse Reactions Dermatologic effects (injection site pain, redness and swelling); Other effects (fatigue, headache, muscle or joint pain, chills, fever) Special Instructions Not recommended in patients with known history of severe hypersensitivity reaction (eg anaphylaxis) to any of the components of the vaccine Postpone vaccination in individuals suffering from acute severe febrile illness or acute infection Use with caution in individuals receiving anticoagulant therapy or those with thrombocytopenia or any coagulation disorder (eg hemophilia) and immunocompromised
SARS-CoV-2 recombinant spike protein vaccine (Adjuvanted)	Adult and children ≥12 years old: 0.5 mL IM x 2 doses Administer second dose 3 weeks after the first dose	Adverse Reactions Dermatologic effects (injection site tenderness, redness and swelling); Other effects (fatigue, malaise, nausea/vomiting, headache, muscle or joint pain, chills, fever) Special Instructions Not recommended in patients with known history of severe hypersensitivity reaction (eg anaphylaxis) to any of the components of the vaccine Use with caution in individuals receiving anticoagulant therapy or those with thrombocytopenia or any coagulation disorder (eg hemophilia) and immunocompromised Monitor for myocarditis and pericarditis; avoid strenuous physical activities for 2 weeks after vaccination Postpone vaccination in individuals suffering from acute severe febrile illness or acute infection
SARS-CoV-2 virus vaccine (Inactivated)	Adult and children ≥5 years old: 0.5 mL IM x 2 doses Administer second dose 28 days after the first dose	Adverse Reactions Dermatologic effects (injection site pain, swelling, induration); Respiratory effects (cough, rhinorrhea, oropharyngeal pain); Other effects (fatigue, headache, nausea) Special Instructions Not recommended in patients with known history of severe hypersensitivity reaction (eg anaphylaxis) to any of the components of the vaccine Contraindicated in patients with uncontrolled severe chronic diseases and severe neurological conditions (eg transverse myelitis, Guillain-Barré syndrome, demyelinating diseases) Avoid exposing vaccine to disinfectant during use

All dosage recommendations are for non-pregnant and non-breastfeeding women and non-elderly adults with normal renal and hepatic function unless otherwise stated. 
Not all products are available or approved for above use in all countries. 
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs. 
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.