COVID-19 Therapeutics: Use, Mechanism of Action, and Toxicity (Xenobiotics).

Sudeh Izadmehr, Michael A Chary, Alexander F Barbuto, Marc Tarsillo, Eduardo Fleischer, Michele M Burns

Journal: Journal of medical toxicology : official journal of the American College of Medical Toxicology 2023;19(1):26-36

PMID: 36525217

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Abstract

SARS-CoV-2 emerged in 2019 and led to the COVID-19 pandemic. Efforts to develop therapeutics against SARS-Cov-2 led to both new treatments and attempts to repurpose existing medications. Here, we provide a narrative review of the xenobiotics and alternative remedies used or proposed to treat COVID-19. Most repositioned xenobiotics have had neither the feared toxicity nor the anticipated efficacy. Repurposed viral replication inhibitors are not efficacious and frequently associated with nausea, vomiting, and diarrhea. Antiviral medications designed specifically against SARS-CoV-2 may prevent progression to severe disease in at-risk individuals and appear to have a wide therapeutic index. Colloidal silver, zinc, and ivermectin have no demonstrated efficacy. Ivermectin has a wide therapeutic index but is not efficacious and acquiring it from veterinary sources poses additional danger. Chloroquine has a narrow therapeutic index and no efficacy. A companion review covers vaccines, monoclonal antibodies, and immunotherapies. Together, these two reviews form an update to our 2020 review.

Address: Division of Medical Toxicology, Department of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA. [email protected].; Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island, Boston, MA, USA. [email protected].; Division of Medical Toxicology, Department of Emergency Medicine, Weill Cornell Medical College, New York, NY, USA. [email protected].; Division of Medical Toxicology, Department of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.; Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island, Boston, MA, USA.; Department of Emergency Medicine, Carl R. Darnall Army Medical Center, Fort Hood, TX, USA.; Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.; Division of Medical Toxicology, Department of Emergency Medicine, Weill Cornell Medical College, New York, NY, USA.; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.

DOI: 10.1007/s13181-022-00918-y