Skip to main content
U.S. flag

An official website of the United States government

Dot gov

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Https

Secure .gov websites use HTTPS
A lock () or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

Table 7d. Characteristics of Miscellaneous Drugs

Last Updated: March 6, 2023

  • The information in this table is derived from data on the use of these drugs for FDA-approved indications or in investigational trials. It is supplemented with data on the use of these drugs in patients with COVID-19, when available.
  • For dose modifications for patients with organ failure or those who require extracorporeal devices, please refer to product labels or EUAs, when available.
  • There are currently not enough data to determine whether certain medications can be safely coadministered with therapies for the treatment of COVID-19. When using concomitant medications with similar toxicity profiles, consider performing additional safety monitoring.
  • The potential additive, antagonistic, or synergistic effects and the safety of using certain combination therapies for the treatment of COVID-19 are unknown. Clinicians are encouraged to report AEs to the FDA Medwatch program.
  • For drug-drug interaction information, please refer to product labels and visit the Liverpool COVID-19 Drug Interactions website.
  • For the Panel’s recommendations on using the drugs listed in this table, please refer to the drug-specific sections of the Guidelines, Therapeutic Management of Nonhospitalized Adults With COVID-19, and Therapeutic Management of Hospitalized Adults With COVID-19.
Table 7d. Characteristics of Miscellaneous Drugs
Dosing Regimens
Adverse Events Monitoring Parameters Drug-Drug Interaction Potential Comments
Colchicine
Not recommended by the Panel for the treatment of COVID-19. Currently under investigation in clinical trials.

Dose for COVID-19 in COLCORONA Trial

  • Colchicine 0.5 mg twice daily for 3 days, then once daily for 27 days1

Dose for COVID-19 in COLCOVID Trial

  • Colchicine 1.5 mg PO followed by 0.5 mg PO within 2 hours of initial dose, then 0.5 mg PO twice daily for 14 days or until hospital discharge, whichever comes first2
  • Diarrhea
  • Nausea
  • Vomiting
  • Cramping
  • Abdominal pain
  • Bloating
  • Loss of appetite
  • Neuromyotoxicity (rare)3
  • Blood dyscrasias (rare)
  • CBC
  • Renal function
  • Hepatic function
  • P-gp and CYP3A4 substrate
  • The risk of myopathy may be increased with the concomitant use of certain HMG-CoA reductase inhibitors (e.g., atorvastatin, lovastatin, simvastatin) due to potential competitive interactions mediated by P-gp and CYP3A4 pathways.
  • Fatal colchicine toxicity has been reported in individuals with renal or hepatic impairment who used colchicine in conjunction with P-gp inhibitors or strong CYP3A4 inhibitors.
  • Use of colchicine should be avoided in patients with severe renal insufficiency. Patients with moderate renal insufficiency who receive the drug should be monitored for AEs.

Availability

  • In the COLCORONA and COLCOVID trials, 0.5-mg colchicine tablets were used for dosing; in the United States, colchicine is available as 0.6-mg tablets.
Fluvoxamine
Not recommended by the Panel for the treatment of COVID-19. Currently under investigation in clinical trials.

Doses for COVID-19 in Clinical Trials

  • Fluvoxamine 50 mg twice daily
  • Fluvoxamine 100 mg twice daily
  • Fluvoxamine 100 mg 3 times daily
  • Nausea
  • Diarrhea
  • Dyspepsia
  • Asthenia
  • Insomnia
  • Somnolence
  • Sweating
  • Suicidal ideation (rare)
  • Hepatic function
  • Drug-drug interactions
  • Withdrawal symptoms during dose tapering
  • CYP2D6 substrate
  • Fluvoxamine inhibits several CYP isoenzymes (CYP1A2, CYP2C9, CYP3A4, CYP2C19, CYP2D6).
  • Coadministration of tizanidine, thioridazine, alosetron, or pimozide with fluvoxamine is contraindicated.
  • Fluvoxamine may enhance anticoagulant effects of antiplatelets and anticoagulants; consider additional monitoring when these drugs are used concomitantly with fluvoxamine.
  • The use of MAOIs concomitantly with fluvoxamine or within 14 days of treatment with fluvoxamine is contraindicated.
Intravenous Immunoglobulin
Primarily used for the treatment of MIS-C. Currently under investigation in clinical trials.

Dose for MIS-C

  • 1 dose of IVIG 2 g/kg IBW (up to a maximum total dose of 100 g) IV
  • In the event of cardiac dysfunction or fluid overload, consider dividing the dose (IVIG 1 g/kg IBW/dose IV every 24 hours for 2 doses).
  • Allergic reactions, including anaphylaxis
  • Renal failure
  • Thrombotic events
  • Aseptic meningitis syndrome
  • Hemolysis
  • TRALI
  • Transmission of infectious pathogens
  • AEs may vary by formulation.
  • Risk and severity of AEs may increase with high dose or rapid infusion.
  • Transfusion-related reactions
  • Vital signs at baseline and during and after infusion
  • Renal function; discontinue treatment if renal function deteriorates.
  • Not a CYP substrate; no drug-drug interactions expected
  • Rapid infusion should be avoided in patients with renal dysfunction or those who are at risk of thromboembolic events.
Metformin
Not recommended by the Panel for the treatment of COVID-19. Currently under investigation in clinical trials.
Doses for COVID-19 in Clinical Trials
  • Immediate-release metformin 500 mg on Day 1, 500 mg twice daily on Days 2–5, and 500 mg in morning and 1,000 mg in evening on Days 6–14
  • Extended-release metformin 750 mg twice daily for 10 days
  • Diarrhea
  • Nausea and vomiting
  • Headache
  • Lactic acidosis
  • Renal function
  • Hepatic function
  • Drug-drug interactions
  • Alcohol use disorder
  • OCT1 and OCT2 substrate
  • Drugs that interfere with OCT systems (e.g., cimetidine, dolutegravir, ranolazine, vandetanib) could increase systemic exposure to metformin.
  • Concomitant use with carbonic anhydrase inhibitors (e.g. acetazolamide, topiramate, zonisamide) may increase the risk of lactic acidosis.
  • Alcohol intake may increase the risk of lactic acidosis.

References

  1. Tardif JC, Bouabdallaoui N, L’Allier PL, et al. Colchicine for community-treated patients with COVID-19 (COLCORONA): a Phase 3, randomised, double-blinded, adaptive, placebo-controlled, multicentre trial. Lancet Respir Med. 2021;9(8):924-932. Available at: https://www.ncbi.nlm.nih.gov/pubmed/34051877.
  2. Diaz R, Orlandini A, Castellana N, et al. Effect of colchicine vs usual care alone on intubation and 28-day mortality in patients hospitalized with COVID-19: a randomized clinical trial. JAMA Netw Open. 2021;4(12):e2141328. Available at: https://www.ncbi.nlm.nih.gov/pubmed/34964849.
  3. Colchicine (Colcrys) [package insert]. Food and Drug Administration. 2012. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/022352s017lbl.pdf.