Clear Up Confusion About Outpatient Treatments for COVID-19

We're hearing about lots of oral "cocktails" to treat COVID-19 in outpatients...with azithromycin, dexamethasone, ivermectin, etc.

It's tempting to try to repurpose affordable, relatively safe meds...grasping for something to help.

Currently the only authorized options for outpatients are the monoclonal antibodies bamlanivimab or casirivimab/imdevimab...given as IV infusions to those at high risk of serious COVID-19 complications.

There's still NO outpatient ORAL med proven to treat COVID-19 yet.

For example, clarify that ivermectin may prevent SARS-CoV-2 from multiplying in a lab...and seems to have few risks.

But for now, don't recommend it. Evidence in humans so far is limited. Think of hydroxychloroquine as a cautionary tale that preliminary data don't always pan out.

Warn patients not to use ivermectin or other meds intended for animals that can be found online, at pet stores, etc.

Suggest saving dexamethasone for hospitalized patients on supplemental oxygen. Educate that using a steroid too early in COVID-19 may hinder the immune system's ability to fight the virus. Plus short-term use can cause hyperglycemia, delirium, etc.

Advise reserving antibiotics (azithromycin, doxycycline, etc) for bacterial coinfection (pneumonia, etc). These aren't effective against SARS-CoV-2 in humans...and misuse can lead to resistance.

Keep in mind, inappropriate med use can also cause shortages.

OTCs or supplements also lack good evidence and may be risky.

For instance, don't recommend STARTING aspirin just for COVID-19 in outpatients...it's too soon to say if it's effective.

Point out famotidine can accumulate and cause confusion in kidney impairment...and colloidal silver can cause kidney or liver toxicity.

If patients want to take vitamins (vit D, etc) or minerals (zinc, etc) for COVID-19, advise not to exceed usual daily doses...higher doses may do more harm than good.

Steer patients to rest, hydration, analgesics if needed, etc.

Use our chart, Treatments of Interest for COVID-19, to answer questions about colchicine, statins, vitamin D, and other meds. Dispel myths with our chart, COVID Pharmacotherapy FAQs.

Key References

  • https://covid19treatmentguidelines.nih.gov/ (1-26-21)
  • Chest 2021;159(1):85-92
  • N Engl J Med Published online Jul 17, 2020; doi:10.1056/NEJMoa2021436
  • Anesth Analg Published online Oct 21, 2020; doi:10.1213/ANE.0000000000005292
  • www.naturalmedicines.com (1-26-21)
Pharmacist's Letter. February 2021, No. 370203



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