IDStewardship

  • Home
  • Articles
  • LEARN ANTIBIOTICS
  • Study Guide
  • Resources
  • Q&A
  • #ASPchat
  • Contributors
  • About

Molnupiravir (Lagevrio)

Molnupiravir photo

Photo source: Merck


Last updated 26 December 2021. Information on this topic is rapidly changing and may render the following incomplete or inaccurate.


KEY POINTS

  • Molnupiravir (Lagevrio, MK-4482, EIDD-2801) is a ribonucleoside analog antiviral medication that inhibits the replication of SARS-CoV-2
    • Molnupiravir is a prodrug that is metabolised to the ribonucleoside analogue N-hydroxycytidine (NHC) which distributes into cells where it is phosphorylated to form the pharmacologically active ribonucleoside triphosphate (NHC-TP). NHC-TP acts by a mechanism known as viral error catastrophe. NHC-TP incorporation into viral RNA by the viral RNA polymerase, results in an accumulation of errors in the viral genome leading to inhibition of replication.
  • Molnupiravir was approved for use in the UK on 4 November 2021 to treat mild to moderate coronavirus disease 2019 (COVID-19) in adults with a positive SARS-COV-2 diagnostic test and who have at least one risk factor for developing severe illness
  • Molnupiravir gained FDA Emergency Use Authorization on 23 December 2021 for treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adults with positive results of direct SARS-CoV-2 viral testing who are at high risk for progressing to severe COVID-19, including hospitalization or death, and for whom alternative COVID-19 treatment options authorized by FDA are not accessible or clinically appropriate.
    • FDA held an Advisory Committee Meeting to Discuss Merck and Ridgeback’s EUA Application for COVID-19 Oral Treatment
      • Voted 13 yes, 10 no to move forward with EUA release
  • Should be administered as soon as possible after a diagnosis of COVID-19 has been made and within 5 days of symptom onset
    • Dosed as 800 mg BID x5 days
      • Comes in a 200 mg capsules, so is 4 pills per dose and 40 pills per course
      • No renal or hepatic dose adjustment required
      • May be taken with or without food, should not be crushed
  • Under FDA EUA may be continued if patient hospitalized during treatment
  • Under FDA EUA may be initiated in a hospitalized person who is not in the hospital for COVID-19 (see FAQ)
  • No drug-drug interactions known
  • Has warnings for embryo-fetal toxicity as well as bone and cartilage toxicity
    • Pregnancy data is lacking, use during pregnancy is not recommended
      • There is a pregnancy surveillance program
    • Note FDA only for persons 18 years and older
  • The most commonly reported adverse reactions have been diarrhea (3%), nausea (2%), dizziness (1%) and headache (1%)
  • See HCP Fact Sheet for more details

RESOURCES

  • Molnupiravir Fact Sheet for Healthcare Providers
  • Molnupiravir Fact Sheet for Patients and Caregivers
  • FDA’s Frequently Asked Questions on the Emergency Use Authorization for Molnupiravir for Treatment of COVID-19
  • US HHS Public Health Emergency Webpage on Molnupiravir
  • US HHS ASPR Frequently Asked Questions – Molnupiravir
  • FDA Letter of Emergency Use Authorization for Molnupiravir
  • Regulatory approval of Lagevrio (molnupiravir) – UK Government Website
  • November 30, 2021: Antimicrobial Drugs Advisory Committee Meeting Announcement – FDA
  • Unmet need for COVID-19 therapies in community settings – Lancet ID
  • β-D–N4-hydroxycytidine Inhibits SARS-CoV-2 Through Lethal Mutagenesis But Is Also Mutagenic To Mammalian Cells – JID
  • COVID antiviral pills: what scientists still want to know – NATURE news explainer
  • Merck and Ridgeback’s Molnupiravir, an Oral COVID-19 Antiviral Medicine, Receives First Authorization in the World News Release
  • Merck and Ridgeback’s Investigational Oral Antiviral Molnupiravir Reduced the Risk of Hospitalization or Death by Approximately 50 Percent Compared to Placebo for Patients with Mild or Moderate COVID-19 in Positive Interim Analysis of Phase 3 Study News Release



 

Free Antibiotic Cheat Sheet

Study Guide

  • Pharmacotherapy Study Guide
  • Acyclovir
  • Albendazole
  • Amikacin
  • Aminoglycosides
  • Amphotericin B
  • Amoxicillin
  • Amoxicillin-Clavulanic Acid
  • Ampicillin
  • Ampicillin-sulbactam
  • Anidulafungin
  • Artesunate
  • Atovaquone
  • Azithromycin
  • Aztreonam
  • Bacitracin
  • Baloxavir marboxyl (Xofluza)
  • Bamlanivimab
  • Baricitinib
  • Bebtelovimab
  • Bezlotoxumab
  • Brincidofovir
  • Casirivimab and Imdevimab
  • Caspofungin
  • Cefazolin
  • Cefepime
  • Cefiderocol
  • Ceftaroline
  • Ceftazidime
  • Ceftazidime-avibactam
  • Ceftolozane-Tazobactam
  • Ceftriaxone
  • Cefoxitin
  • Cephalexin
  • Cidofovir
  • Ciprofloxacin
  • Clarithromycin
  • Clindamycin
  • Colistin (colistimethate)
  • Cycloserine
  • Dalbavancin
  • Daptomycin
  • Delafloxacin
  • Dicloxacillin
  • Doripenem
  • Doxycycline
  • Elbasvir/ grazoprevir
  • Eravacycline
  • Ertapenem
  • Erythromycin
  • Famciclovir
  • Fidaxomicin
  • Fluconazole
  • Flucytosine
  • Foscarnet
  • Fosfomycin
  • Ganciclovir
  • Gentamicin
  • Glecaprevir/ Pibrentasvir
  • Ibrexafungerp
  • Imipenem-cilastatin
  • Imipenem-cilastatin-relebactam
  • Isavuconazole
  • Itraconazole
  • Ivermectin
  • Ledipasvir/sofosbuvir
  • Lefamulin
  • Letermovir
  • Levofloxacin
  • Linezolid
  • Maribavir (Livtencity)
  • Meropenem
  • Meropenem-vaborbactam
  • Metronidazole
  • Methenamine
  • Micafungin
  • Minocycline
  • Molnupiravir (Lagevrio)
  • Moxifloxacin
  • Nafcillin
  • Nitrofurantoin
  • Omadacycline
  • Oritavancin
  • Oseltamivir
  • Oteseconazole (Vivjoa)
  • Oxacillin
  • Paxlovid (nirmatrelvir/ ritonavir)
  • Penicillin
  • Penicillin Skin Test
  • Phenazopyridine
  • Piperacillin-tazobactam
  • Plazomicin
  • Polymyxin B
  • Posaconazole
  • Quinupristin-dalfopristin
  • Remdesivir (Veklury)
  • Ribavirin
  • Rifabutin
  • Rifampin
  • Secnidazole
  • Sofosbuvir/ velpatasvir/ voxilaprevir
  • Sotrovimab (Xevudy)
  • Sulfadiazine
  • Sulfamethoxazole-Trimethoprim (Bactrim)
  • Tedizolid
  • Telavancin
  • Tigecycline
  • Tobramycin
  • Tocilizumab
  • Valacyclovir
  • Valganciclovir
  • Vancomycin
  • Voriconazole
  • Zidovudine
  • Zoster vaccine recombinant, adjuvanted (Shingrix)

Recent

  • Reality Versus Expectation: Being a Specialty Pharmacist
  • Dessert Before Dinner: How To Sweeten Up Pharmacy Topic Discussions For Your Learners 
  • 5 Tips For Advancing Your Antimicrobial Stewardship Practice
  • How To Build A Blog Post
  • Musical Chairs & The ABCs of SARS-CoV-2 Monoclonal Antibodies

Search

Copyright 2016-2020 By Charlie Rose, LLC © · IDStewardship.com · Copyright · Privacy Policy · Terms · Contact