April 1, 2023

Coronavirus treatment: Do you need Molnupiravir, Monoclonal antibody cocktail or just symptom-based treatment if you test COVID positive? Here’s an explainer – Times of India

We have been living with COVID for a little over two years now but it feels like forever. We have seen how a prescription given to one family member became the prescription for the whole family and even friends. People hoarded medicines that were not even clinically proven to help in COVID treatment. Experimental drugs were taken as ‘COVID antidote’. Many doctors breached COVID treatment protocols because the prescribed route of treatment did not work for their patients and they did what they felt would be appropriate for improving their patient’s condition. All this led to steroid overdose, unnecessary administration of certain drugs and in the process exposed people to many more health risks.

While Ivermectin was the buzzword during the first wave, it was taken over by Remdesivir, Fabiflu, Azithromycin and plasma therapy in the second wave. And now as the third wave hits the country, the baton has been handed over to Molnupiravir and Monoclonal antibody cocktail drugs. The former has not even been included in the national COVID-19 clinical protocol. Considering how many of the previously acclaimed medicines were taken off the drug list for COVID protocol, what should one really do when they test positive? Most importantly, do not self medicate and allow your doctor to prescribe medicines based on your symptoms and criticality.


Dr Lancelot Pinto fears that as these names come to the fore, they will be used indiscriminately both by patients and doctors. “General Practitioners do not update their knowledge often, and there is also a pressure to prescribe something from patients and their families. They often succumb to such pressures and end up overdosing or wrongly prescribing certain drugs which are clearly not needed by the patient.”

“Most cases need symptomatic treatment”

There have been an explosion of cases in the last 72 hours. Dr Sushila Kataria, Senior Director, Internal Medicine, Medanta Gurugram warns, “Most of the cases are Omicron and it is too early to say that there will only be milder cases. We have one Omicron patient on oxygen support right now at Medanta. While it may be milder than Delta, we will know its severity in two weeks’ time.” Half of the patients Dr Kataria is treating right now are those who tested COVID positive previously.

Both Dr Pinto and Dr Sushila advise symptomatic treatment of COVID right now. “Paracetamol, anti allergic, steam and gargles are enough to start the treatment for people who do not have any risk factors. Medicines like Molnupiravir and Monoclonal antibodies cocktail drugs are only for patients who have risk factors like age, obesity, diabetes, hypertension, kidney or liver diseases.”

“Monoclonal antibody cocktail is not effective against Omicron”

“Monoclonal antibody cocktail is being advised for COVID patients with mild symptoms but high risk factors. For others, it’s important to stay connected to your doctors through teleconsultation so if your case escalates, the doctor can immediately decide the next steps,” says Dr Kataria. Moreover, the antibody cocktail drugs available in India right now do not work against the Omicron variant. That’s the reason they have been discontinued in many countries facing Omicron surge.

“Our past experience has shown that anti-viral medicines like Fabiflu did not work very well so they must be used with caution. People should not be given a course extending 5 days. Even Remdesivir which was a 5-day course earlier has now been cut down to 3 days,” she adds.

We also need to understand that all these drugs have been tested on unvaccinated people. So we don’t yet know if these drugs will work in the vaccinated group.

“Molnupiravir has shown limited efficacy and has risks involved”

Molnupiravir is a drug under study right now. “It has limited efficacy when used in unvaccinated high risk individuals, when used early in the disease. In the largest trial done so far, the drug was found to have no significant effect on patients with previous evidence of COVID-19, with low viral load and those with diabetes. There are also serious birth defects risks related to its use. Women are prescribed to be on contraception during and till 4 days after the last dose of the drug, and men are advised to use contraception during and for 3 months after the last dose of the drug. Hence, this drug should NOT be used indiscriminately,” warns Dr Pinto.

Fluvoxamine, an antidepressant, is another drug that is showing some promise in COVID treatment but recommending it for routine use can be risky.

The bottomline

For most individuals with COVID, symptom-based treatment is all that is needed. Paracetamol for fever, decongestants and antihistamines for nasal congestion and inhaled corticosteroids for cough. There are drugs used for COVID treatment but there are limitations to each and we all should act responsibly and not in panic.

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