Oral Antivirals for High-risk COVID-19 Patients

Lauren Biehle, PharmD, BCPS, BCIDP; Jeremy W. Vandiver, PharmD, BCPS


US Pharmacist. 2022;47(7):34-41. 

In This Article

Abstract and Introduction


Coronavirus disease 19 (COVID-19) has been a global health crisis since late 2019. While vaccinations, monoclonal antibodies, IV remdesivir, and immunomodulatory therapies are now available to prevent disease and disease progression, there are limitations in their uptake or availability. The Emergency Use Authorization of two oral antiviral therapies, molnupiravir and ritonavir-boosted nirmatrelvir, in December 2021 greatly expanded outpatient access to therapeutics capable of preventing COVID-19 progression in high-risk patients diagnosed early in their disease course.


Infections due to the SARS-CoV-2 virus have led to a global pandemic, with over 500 million cases and more than 6 million deaths worldwide since late 2019.[1] Initial recommended therapies such as dexamethasone, tocilizumab, and remdesivir focused on outcomes of reduction of mortality or reducing hospital length of stay. These therapeutics were primarily recommended for patients in the acute-care setting.[2] Monoclonal antibodies have been developed for use in the outpatient setting as an IV infusion treatment option for patients at high risk for progression to hospitalization or death due to Coronavirus disease 19 (COVID-19). In December 2021, the FDA issued Emergency Use Authorizations (EUA) for two oral options for treatment of COVID-19 in the outpatient setting. The objective of this review is to compare safety, efficacy, and clinical data for molnupiravir and ritonavir-boosted nirmatrelvir (N-R).