How Do COVID-19 Antiviral Drugs Work?

Alexis Bryan13 Dec 2021

COVID-19 antiviral drugs work by preventing the coronavirus from replicating inside our cells. Currently, Remdesivir is the only Food and Drug Administration-approved antiviral drug for the treatment of COVID-19 in hospitalized patients. Antiviral drugs work by slowing or halting the virus' replication process and reducing the disease severity in the body.

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How COVID-19 Antiviral Drugs Work

COVID-19 antiviral drugs work by slowing or halting the virus’s replication process. This stops the spread of the virus throughout your body, reduces disease severity, and allows your body to focus on recovering. Although antiviral drugs may not completely cure the infection, less virus in your body means you will have a less severe case and reduced risk of serious complications from COVID-19.

Antiviral drugs are an effective treatment for COVID-19 but do not replace the role of vaccines. There are two types of antiviral drugs: antiviral pills and antiviral therapy. Antiviral pills are taken by mouth and antiviral therapy is administered via an intravenous (IV) infusion by a healthcare provider. 

Each antiviral drug works a little bit differently in the body and poses different risks to patients. The three general ways antiviral drugs work are:

  • Block receptors so viruses can’t bind to and enter healthy cells
  • Boost the immune system, helping it fight off a viral infection
  • Lower the viral load (amount of active virus) in the body

For this reason, it is necessary to understand the role of antiviral medications in treating mild, moderate, severe, and critical illness in order to optimize treatment for people with COVID-19.

How to Access COVID-19 Antiviral Drugs

To use Remdesivir for COVID-19 treatment, you must have a prescription. It is only administered to patients in a hospital setting.

Currently, Pfizer is seeking an Emergency Use Authorization for a new COVID-19 antiviral pill called Paxlovid (ritonavir). Much more research is necessary, but experts hope it could be prescribed more broadly as an at-home treatment to help reduce illness severity.

Approved Antiviral COVID-19 Drugs

New drugs must go through extensive research before getting FDA approval. The process starts with pre-clinical trials, then safety testing in animals, safety testing in humans, and finally testing for effectiveness in humans.

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There have been multiple antiviral drugs studied for the treatment of COVID-19, but most have proven ineffective. Currently, there is only one expensive, hospital-administered drug to treat hospitalized COVID-19 patients: Remdesivir.

Drug NameWho Can Take
  • Hospitalized adult and pediatric patients (aged ≥12 years and weighing ≥40 kg)

An EUA* is available for:

  • Hospitalized pediatric patients weighing 3.5 kg to <40 kg
  • Or aged <12 years and weighing ≥3.5 kg

*EUA = emergency use authorization; FDA may authorize unapproved medical products or unapproved uses of approved medical products to be used in an emergency to diagnose, treat, or prevent serious or life-threatening diseases.

COVID-19 Treatment Guidelines Panel Recommendations

The COVID-19 Treatment Guidelines Panel (the Panel) also provides recommendations against the use of drugs that are found to be not effective in clinical trials or have insufficient evidence in support of their use. 

The following drugs are not recommended for use in the treatment of COVID-19:

  • Ivermectin (insufficient evidence)
  • Nitazoxanide
  • Hydroxychloroquine or Chloroquine and/or Azithromycin
  • Lopinavir/Ritonavir and Other HIV Protease Inhibitors

COVID-19 Antiviral Pills

New research on COVID-19 antiviral pills has made the headlines in recent days and may soon become available. As seen in recent news, two pills by Merck and Pfizer have proven to be successful in clinical trials in preventing hospitalization and death due to Covid-19. 

These pills are most effective when started early. Since IV drugs are not accessible in many parts of the world, the approval for wide use of antiviral pills for COVID-19 is a promising step towards ending the Covid-19 pandemic.

COVID-19 Antiviral Drugs Frequently Asked Questions (FAQs)

COVID-19 antiviral drugs are currently being studied by scientists to see if they can effectively cure COVID-19 infection. There will likely be more information available in the near future, but we answer a few preliminary questions below.

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Can antivirals cure viral infections?

Antiviral drugs can ease symptoms, shorten the length of infection, and cure viral infections unless the infection is chronic. Viral infections like HIV, hepatitis, and herpes are chronic, and therefore antivirals can not cure them. However, antiviral medicines can make the virus latent (inactive) which reduces, or completely eliminates, symptoms. 

Who will be able to access the new COVID-19 antiviral drugs?

Due to the novelty of COVID-19 antiviral drugs for the treatment of COVID-19, there will be limitations in place on who can access them when they become available for people who are not hospitalized. There are safety concerns associated with all drugs, but especially so with new drugs on the market.

People who are immunocompromised will need to be monitored closely as COVID-19 antivirals become more accessible. Since COVID-19 infection typically lasts longer in these populations, there is more opportunity for resistance to develop and adverse reactions.

Pregnant patients and children are often excluded from clinical trials at first, so they will also likely not be recommended to take COVID-19 antiviral drugs until more research is conducted. 

What is an Emergency Use Authorization?

The Emergency Use Authorization (EUA) authority allows FDA to respond to public health threats, including infectious diseases, by facilitating the availability and use of medical products to diagnose, treat, or prevent disease. When there are no adequate, approved, and available alternatives, the EUA expedites the time for people to access essential medical products.

In terms of COVID-19, there have been EUAs administered for vaccines, drugs, and the following:

  • Blood Purification Devices
  • Continuous Renal Replacement Therapy and Hemodialysis Devices
  • In Vitro Diagnostics
  • Decontamination Systems for Personal Protective Equipment
  • Infusion Pumps
  • Personal Protective Equipment
  • Remote or Wearable Patient Monitoring Devices
  • Respiratory Assist Devices
  • Ventilators and Ventilator Accessories
  • And more

Bottom Line

The COVID-19 pandemic has prompted great medical advancement and lightspeed innovation in the healthcare sector. Antiviral drugs are one of the many treatments being developed for the treatment of COVID-19 and may soon become accessible via pill form.