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.
Key: AE = adverse event; CBC = complete blood count; CYP = cytochrome P450; EUA = Emergency Use Authorization; FDA = Food and Drug Administration; IBW = ideal body weight; IV = intravenous; IVIG = intravenous immunoglobulin; MAOI = monoamine oxidase inhibitor; MIS-C = multisystem inflammatory syndrome in children; OCT = organic cation transporter; the Panel = the COVID-19 Treatment Guidelines Panel; P-gp = P-glycoprotein; PO = oral; TRALI = transfusion-related acute lung injury

References

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.
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.
Colchicine (Colcrys) [package insert]. Food and Drug Administration. 2012. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/022352s017lbl.pdf.