Molnupiravir
LAGEVRIO
What it isNucleoside analog causing lethal viral mutagenesis; COVID-19 in those at risk.
Why this oneNo significant drug interactions, which is its advantage over nirmatrelvir-ritonavir in polypharmacy.
What limits itLower efficacy than nirmatrelvir. Contraindicated in pregnancy, and it is not recommended under 18 because of effects on growing cartilage.
FDA-approved for
- COVID-19 (2023)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Mild-to-moderate COVID-19 in high-risk adults (EUA) | Adult | 800 mg BID ×5 days |
Renal No adjustment needed
Hepatic No adjustment needed
Missed dose within 10 h: take ASAP and resume schedule; >10 h late: skip. Do not double the dose.
Instructions
- Start as soon as possible after diagnosis and within 5 days of symptom onset; complete the full 5-day course.
- Take with or without food.
- Do not use for longer than 5 consecutive days.
- May be given via NG/OG/G/GJ tube by opening capsules and mixing contents in water.
Cautions
- Embryo-fetal toxicity (not recommended in pregnancy)
- Hypersensitivity including anaphylaxis
- Bone and cartilage toxicity (not authorized under 18 years)
Adverse reactions
- Diarrhea
- Nausea
- Dizziness
Pregnancy Not recommended — may cause fetal harm based on animal data.
Lactation No human data; breastfeeding not recommended during treatment and for 4 days after the final dose.
NO BOXED WARNINGS
Principal riskNot for pregnancy; mutagenesis concerns
Cost, est. cash$300–$2,000/month
Classes and tags
Clinical profile
Legacy pregnancy categoryNot assigned — PLLR-era drug
Defining liabilityAgent-specific renal, hepatic, hematologic, metabolic and drug-interaction toxicity.
Mechanism of action: Molnupiravir ballicule
