Molnupiravir

LAGEVRIO

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Pronunciation: mol-nyoo-PIR-a-veer

Molnupiravir ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Molnupiravir ballicule

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.

Molnupiravir molecular structure (skeletal formula) — Molecular structure: Molnupiravir

Molnupiravir prescription history

Animated chart of estimated U.S. prescriptions per year, Antivirals (non-HIV) (1966–2026). Molnupiravir enters in 2021 (estimated).

FDA-approved for

COVID-19 (2023)

Principal riskNot for pregnancy; mutagenesis concerns

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryNot assigned — PLLR-era drug

Defining liabilityAgent-specific renal, hepatic, hematologic, metabolic and drug-interaction toxicity.

FDA label

Read the full label on DailyMed ↗

NO BOXED WARNINGS

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.

Available strengths

cap 200 mg

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.

Cost

Molnupiravir (LAGEVRIO)

Strength		#/mo	generic $/mo	CostPlus
200 mg	cap	60 BID		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Molnupiravir is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

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Self-check

What interaction advantage does molnupiravir have over nirmatrelvir-ritonavir?
No significant drug interactions.
Why is molnupiravir not recommended under age 18?
Effects on growing cartilage.