Table 1.

Drugs used to treat COVID-19: doses, eligibility criteria and contraindications or cautions

DexamethasoneOral or IV6 mg OD for up to 10 daysPCR-confirmed infection.
Features of severe or critical COVID-19 (Fig 1).
Avoid live virus vaccines.
Systemic infection (unless specific therapy is given).
Use with caution in a patient with coexisting heart failure, diabetes mellitus, diverticulitis, epilepsy, glaucoma, steroid myopathy, tuberculosis, hypertension, hypothyroidism, peptic ulcers, psychiatric reactions, recent intestinal anastomosis, recent myocardial infarction, severe affective disorders, thromboembolic disorders or ulcerative colitis.
TocilizumabIV8 mg/kg (max dose 800 mg) stat doseHypoxaemia with evidence of inflammation but not yet critically ill requiring respiratory support and CRP >75 ng/mL.
Within 48 hours of respiratory support (high-flow nasal oxygen, CPAP, NIV or IMV) regardless of CRP level.
Children aged under 12 years old.
Patients weighing less than 40 kg.
Known hypersensitivity reaction to tocilizumab.
Caution if:
  • co-existing infection which might be worsened by IL-6 inhibitor therapy

  • baseline ALT or AST >5 times the upper limit of normal

  • pre-existing condition or treatment resulting in immunosuppression.

Not to be used in pregnancy unless clinically necessary.
SarilumabIV400 mg stat doseAs per tocilizumab.
To be considered if tocilizumab is not available.
As per tocilizumab plus:
  • platelets <150 x 109/L

  • known hypersensitivity reaction to sarilumab.

BaricitinibOral4 mg OD for up to 14 daysRequiring respiratory support (high-flow nasal oxygen, CPAP, NIV or IMV).
To be given as an alternative to tocilizumab or sarilumab.
Lymphocyte count <0.5 x 109/L.
Neutrophil count <1 x 109/L.
Haemoglobin less than 8 g/dL.
Active tuberculosis.
RemdesivirOral200 mg loading dose followed by 100 mg OD for 3 days with mild–moderate disease and for 5 days with severe disease.Onset of symptoms within 7 days (outpatient) or 10 days (hospitalised due to COVID-19).
On low-flow supplemental oxygen.
Children aged under 12 years.
Patients weighing less than 40 kg.
eGFR <30 mL/min (unless known end-stage renal failure or dialysis).
ALT >5 times the upper limit of normal.
PaxlovidOral300 mg nirmatrelvir (PF-07321332) and 100 mg ritonavir BD for 5 daysAdults who do not require supplemental oxygen and are at increased risk for progression to severe COVID-19.
Onset of symptoms within 5 days.
Children aged under 18 years.
Severe renal or hepatic impairment.
Hypersensitivity to the active substances (nirmatrelvir (PF-07321332) or ritonavir).
Concomitant use of drugs highly dependent on CYP3A for clearance or potent inducers of CYP3A, eg amiodarone, apixaban, rivaroxaban, dabigatran, warfarin, clopidogrel, simvastatin, rosuvastatin, digoxin and phenytoin.
MolnupiravirOral800 mg BD for 5 daysAged ≥18 years.
PCR-confirmed infection within 5 days.
Onset of symptoms within 5 days.
Member of the ‘highest-risk’ group.
Breastfeeding (to be interrupted during treatment and resumed 4 days after last dose).
SotrovimabIV500 mg stat dosePCR-confirmed infection within 5 days.
Onset of symptoms within 5 days.
Member of the ‘highest-risk’ group
Children aged under 12 years.
Patients weighing less than 40 kg.
A pattern of illness that suggests recovery rather than risk of deterioration.
Likely to require hospitalisation in the next 24 hours.
Requiring supplemental oxygen for the management of COVID-19 symptoms or increase in baseline oxygen flow rate due to COVID-19.
Known hypersensitivity reaction to sotrovimab.
  • ALT = alanine transaminase; AST = aspartate aminotransferase; BD = twice daily; CPAP = continuous positive airways pressure; CRP = C-reactive protein; eGFR = estimated glomerular filtration rate; IL = interleukin; IMV = invasive mechanical ventilation; IV = intravenous; NIV = non-invasive ventilation; OD = once per day.