Medications Not Recommended

Medications Not Recommended


The Scientific Research Committee ensures timely review of emerging experimental therapies, therefore, off-label use of therapies with only published in vitro data should NOT be implemented until reviewed and sanctioned by this committee; the recommendations below are subject to change based on emerging data or drug shortage information

Therapies NOT Recommend

The medications listed below have been reviewed, but due to lack of evidence, these medications are not currently recommended for the treatment of COVID-19

  • The HFSA, ACC and AHA emphasize the lack of experimental or clinical data on these class of drugs in COVID-19 and recommend that patients currently taking these medications for known beneficial indications (HF, HTN, or ischemic heart disease, for example) be advised to continue
  • They advise against adding/removing beyond what would be done in standard practice and urge individualized treatment decisions based on patient’s clinical presentation and hemodynamics
  • Synthetic vasoactive intestinal peptide (VIP)
  • Mechanism:
    • Binds to receptors on alveolar type II (ATII) cells in the lung
    • ATII cells bind SARS-CoV-2 via their angiotensin-converting enzyme 2 receptors
  • VIP protects alveolar cells and the surrounding pulmonary epithelium by:
    • 1. Blocking cytokines
    • 2. Preventing apoptosis
    • 3. Upregulating surfactant production
  • Animal models of respiratory distress: potent anti-inflammatory and anti-cytokine activity
  • Clinical data are lacking to establish the potential benefits and risks associated with the use of aviptadil in patients with COVID-19
  • There is insufficient evidence to recommend the use of aviptadil for treatment of critical COVID-19 outside of a clinical trial at this time
  • Phase 2b/3 data
    • Aviptadil vs. placebo in patients treated with RDV or other approved/authorized therapies
    • Primary endpoint = Alive & free of respiratory failure at day 28
      • 2.8-fold increased odds of being alive and free of respiratory failure at day 28 (P=0.03)
      • 4-fold increased odds of surviving to 60 days (P=.006)
    • Patients on ventilators at time of randomization demonstrated 10-fold increased odds of survival (P=.03)
    • AEs = mild to moderate diarrhea, systemic hypotension
  • For more information on the Right to Try program, refer to Aviptadil Right to Try - NRx Pharmaceuticals

Based on current evidence demonstrating lack of benefit in preventing invasive mechanical ventilation or death in hospitalized patients, use of azithromycin for treatment of COVID-19 is not recommended

Due to the predominance of the Omicron variant in the US (>99% of COVID-19 cases as of 1/18/22), casirivimab/imdevimab and bamlanivimab/etesevimab are no longer recommended for the treatment of COVID-19

Based on the results of a randomized trial in hospitalized patients with COVID-19 (RECOVERY), colchicine demonstrated no benefit with regards to 28-day mortality or any secondary outcomes; use of colchicine in hospitalized patients is not recommended

Based on studies demonstrating harm and little clinical benefit, the use of hydroxychloroquine for the treatment of COVID-19 is NOT recommended outside of a clinical trial

Current evidence for the benefit of ivermectin is weak and the results of two high-quality randomized controlled trials showed no evidence of benefit, thus ivermectin should not be used for the treatment of COVID-19

  • This recommendation will be periodically re-evaluated if new randomized controlled trials become available

International COVID-19 Guidelines & Statements on the Use of Ivermectin for the Treatment of COVID-19:

Use of lopinavir/ritonavir is not recommended because of unfavorable pharmacodynamics and negative clinical trial data

  • Adjunctive use of micronutrients in COVID-19 patients beyond the recommended daily allowances for supplementation is not supported by scientific evidence
  • If utilization is necessary for the treatment of nutritional deficiencies, a once daily dosing strategy should be employed
  • There is no evidence for or against the management of fever with NSAIDs
  • Acetaminophen is preferred for management of fever, but each clinical scenario should be carefully evaluated
  • Nebulized respiratory medications should be avoided in non-intubated patients unless otherwise indicated in patients with bronchospasms to prevent the spread of the COVID-19
  • For COVID-19 negative non-intubated patients, nebulized respiratory medications are preferred over MDIs
  • If indicated, inhalers (MDIs) with spacers are preferred for non-intubated patients
  • If indicated, nebulized medications with a closed circuit may be used in intubated patients

Widespread use of tPA in critically ill COVID-19 patients is not supported by the currently published studies and is not recommended