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Updated Aug. 24, 2022

If you are at high risk of becoming severely ill from a COVID-19 infection, we now have a number of medications that can lower this risk. Some protect against infection with the virus and so are given before exposure; some are given after you become infected to prevent serious illness from developing.

All are available at UCSF, though at times supplies may be limited. If that occurs, you may not be able to receive your first-choice treatment and we may need to reserve some drugs for the highest-risk patients.

Risk factors for progressing to severe COVID-19 include:

  • Age 65 and older
  • Overweight
  • Pregnancy
  • An immune system disorder or being on immune-suppressing drugs
  • Chronic kidney disease
  • Diabetes
  • Heart disease or high blood pressure
  • Chronic lung disease
  • Sickle cell disease
  • Neurodevelopmental disorders
  • Ongoing use of advanced medical technologies, such as a home ventilator

Prevention

In December 2021, the Food and Drug Administration (FDA) authorized emergency use of a new treatment specifically to protect immunocompromised people.

The treatment combines two drugs, tixagevimab and cilgavimab, packaged together under the brand name Evusheld. Both drugs are monoclonal antibodies, which mimic the immune system's ability to fight harmful viruses. Treatment consists of two shots given at the same appointment (a single injection of each into the buttocks). The protection lasts six months, and the treatment may be repeated every six months.

Possible side effects include soreness, bruising or bleeding at the injection sites. Less common complications include allergic reactions during or after the injections.

Learn more about tixagevimab and cilgavimab (Evusheld).

You are eligible for Evusheld if you meet the following criteria:

  • You are at least 18 years old (any weight) or 12 years old and weigh at least 88 pounds.
  • You are not currently symptomatic or infected with COVID-19 or had any recent close-contact exposure.
  • Plus, one of the following:
    • You are so severely immunocompromised that your body may not respond adequately to the vaccine. This includes people receiving chemotherapy for blood cancers, transplant recipients and others on immunosuppressant drugs, people with advanced or untreated HIV infection, and people with a primary immune deficiency disease.
    • You have a medical condition or allergy that prevents you from getting vaccinated for COVID-19.

We strongly recommend that you remain up to date with your COVID-19 vaccination series. Evusheld is not a substitute for COVID-19 vaccination.

To learn whether this medication may be right for you, please contact your care provider.

Treatments

The drugs discussed below can prevent a mild case of COVID-19 from turning into a severe one requiring hospitalization. However, they work only if given early in the course of the disease. That means you should contact your doctor as soon as you notice any symptoms of COVID-19, such as fever, cough, sore throat, headache, muscle pain or a general sense of unwellness.

You may be eligible for these treatments if the following criteria apply:

  • You have a confirmed case of COVID.
  • Your symptoms developed within the last five days (for oral treatments) or seven days (for intravenous treatments).
  • Your symptoms are mild to moderate.
  • You are considered at high risk for severe disease.

Because supplies fluctuate, we may not be able to offer every treatment at a given time.

Intravenous (IV) medications

  • Monoclonal antibodies – These medications mimic the immune system's ability to fight off the coronavirus. The method they use may vary, depending on the specific drug. The type of monoclonal antibody we offer may change over time, depending on supplies and current strains of the virus. Monoclonal antibodies must be given within seven days of when your symptoms appeared.

    Possible side effects include allergic reactions during or after the injection.
  • Remdesivir (Veklury) – Developed more than a decade ago for use against other viruses, this is the first drug approved by the FDA for treating COVID-19. It works by blocking the virus from replicating.

    Remdesivir is typically given to COVID-19 patients who become sick enough to be hospitalized, but it's also approved for use in high-risk nonhospitalized patients with mild symptoms. In those cases, it's given as an IV infusion at an outpatient infusion center.

    Side effects of remdesivir include upset stomach and allergic reactions during or after the infusion.

Oral medications

  • Nirmatrelvir and ritonavir (Paxlovid) – This antiviral drug combination slows infection by disrupting the virus's ability to replicate in your body. For most patients, the treatment consists of taking three pills twice a day for five days. You must start treatment within five days of developing COVID symptoms.

    This drug is not an option if you have advanced kidney disease or liver failure. If you have impaired kidney function, the dose must be adjusted. Because little is known about the drug's effects on fertility or pregnancy, you should check with your doctor if you are pregnant, considering pregnancy or breastfeeding.

    In addition, nirmatrelvir and ritonavir may interact with many medications, including immunosuppressants, causing serious side effects. Be sure to check with your doctor or pharmacist about whether this treatment is safe to take with your other medicines. It also can reduce the effectiveness of birth control pills, so if you're on oral birth control, you'll want to temporarily use an alternative method.

    Possible side effects of nirmatrelvir and ritonavir include upset stomach, altered sense of taste and elevated blood pressure.

    Learn more about nirmatrelvir and ritonavir (Paxlovid).
  • Molnupiravir (Lagevrio) – This antiviral medication works by hobbling the genetic code of the virus so it can no longer replicate. The treatment consists of four pills taken twice a day for five days. You must start treatment within five days of developing COVID symptoms.

    Molnupravir is safe to take with other medications. The main safety concern is its potential to harm a fetus, so the drug is not recommended for pregnant women. If you are thinking about getting pregnant, you should use effective contraception while taking the drug and for four days after the last dose. If you have a partner who could become pregnant, you should use effective contraception while taking the drug and for three months after the last dose. Nursing mothers should discuss use of this medication with their doctors and, if using, should pump and discard their breast milk while taking the drug and for four days after the last dose.

    Possible side effects of molnupiravir include upset stomach and dizziness.

    Learn more about molnupiravir (Lagevrio).

While remdesivir has received FDA approval, the rest of these medicines have been made available through a process called emergency use authorization (EUA). The FDA uses EUAs during public health emergencies, such as the current pandemic, when it may not be possible to have all the evidence normally required to approve a new drug, test or device. In these circumstances, the FDA may decide to release a product based on its potential benefits.

During the COVID-19 pandemic, the FDA has required products to meet all of the following conditions before issuing an EUA:

  • The existing scientific evidence, including data from adequate and well-controlled clinical trials, strongly indicates that the product may be effective for diagnosing, treating or preventing COVID-19 or a serious or life-threatening disease or condition caused by COVID-19.
  • The product's known and potential benefits outweigh its known and potential risks.
  • There are no approved, available and adequate alternatives.

If you are eligible, you can access these medications in several ways:

  • Call your provider
  • Contact your provider through MyChart
  • Call the COVID hotline (415) 514-7328

If you are a patient at high-risk for severe COVID-19 and are experiencing life-threatening symptoms, call 911 immediately or go to the emergency room.