Indications for and selection of COVID-19-specific therapy for adult outpatients

COVID-19: coronavirus disease 2019; eGFR: estimated glomerular filtration rate; IV: intravenous; NIH: National Institutes of Health.

* The authorized time window for administration of various COVID-19-specific therapies varies by agent. We encourage treatment initiation as soon as possible after symptom onset to try to optimize efficacy.

¶ Drug interaction resources include:

• Lexicomp Interact tool
• University of Liverpool interaction tool
• US Food and Drug Administration PAXLOVID Patient Eligibility Screening Checklist Tool for Prescribers
• United States National Institutes of Health COVID-19 Treatment Guidelines

Δ Approach to alternative options vary. This algorithm reflects the approach of the contributors to the UpToDate content on management of COVID-19 in outpatients. They do not use the antiviral agent molnupiravir (Lagevrio), because the benefit is unproven and studies do not consistently demonstrate efficacy against hospitalization or death. However, the NIH COVID-19 Treatment Guidelines list molnupiravir as an alternative when nirmatrelvir/ritonavir or remdesivir are not options and do not suggest convalescent plasma as an alternative; the approach of some other UpToDate contributors is similar to the NIH guidelines.

Monoclonal antibodies are no longer recommended for treatment, because prevalent Omicron subvariants escape neutralization and render this intervention ineffective.

◊ Observational studies have described safe use of reduced doses (eg, nirmatrelvir 300 mg-ritonavir 100 mg once on day 1 followed by nirmatrelvir 150 mg-ritonavir 100 mg once daily for the next 4 days) in patients with eGFR <30 mL/min, including those on dialysis. Refer to other UpToDate content for details on potential dosing in such situations.