Type of therapy	Mechanism of action	Therapeutic considerations
Oral antivirals
Nirmatrelvir/ritonavir (Paxlovid)56,57	Protease inhibitor that cleaves two viral polyproteins combined with a cytochrome P450 3A4 (CYP3A4) inhibitor to increase the therapeutic effect	Start within five days of symptom onset Five-day course of pills Because of the CYP3A4 inhibitor, numerous drug-drug interactions exist, including statins, opioids and anticoagulants, and medications for HIV-1 treatment, and may require dose adjustments58–60 Dose adjustments are required in the setting of renal impairment (eGFR < 60 mL per minute per 1.73 m2), and it is contraindicated for severe renal impairment (eGFR < 30 mL per minute per 1.73 m2) COVID-19 rebound,61 a recurrence of symptoms or a new positive viral test after having tested negative, has been observed after completion of treatment with nirmatrelvir/ritonavir; symptoms are expected to be mild and improved or resolved within a median of three days; patients should be instructed to isolate again; cases should be reported to the drug company
Molnupiravir (Lagevrio)62,63	Mutagen that disrupts viral RNA-dependent RNA polymerases	Start within five days of symptom onset Five-day course of pills Recommended when other treatments are not available Not recommended in pregnant patients; contraception should be used or abstinence should be practiced during therapy and the four days following therapy; individuals of reproductive potential who are sexually active with individuals of childbearing potential should abstain from sex or use a reliable method of contraception for at least three months after the last dose
Antivirals (IV)
Remdesivir (Veklury)64	Adenosine analog that interrupts viral RNA transcription	Start within seven days of symptom onset Three-day course of IV therapy, with each treatment administered over the course of 30 to 120 minutes U.S. Food and Drug Administration approved Can be used in children weighing ≥ 3.5 kg (7.7 lb)
Corticosteroids (oral or IV)
Dexamethasone	Corticosteroids mitigate the systemic inflammatory response, reducing injury and dysfunction of multiple organs May cause harm in hospitalized patients not requiring oxygen; should not be used in outpatients not requiring oxygen support	Administer to hospitalized patients requiring supplemental oxygen (6 mg IV or orally once daily for up to 10 days or until hospital discharge)