COVID-19 Treatment with Molnupiravir

Clinical Indications

The American College of Physicians, as reported in the Annals of Internal Medicine, recommends molnupiravir for treatment of adults with confirmed mild-to-moderate COVID-19 who are at high risk for progression to severe disease 1
The British Medical Journal suggests that molnupiravir must be initiated within 5 days of symptom onset for optimal effectiveness, with a recommended dosage of 800 mg taken orally every 12 hours for 5 days 2

The World Health Organization, as reported in the BMJ, advises that molnupiravir should not be used in pregnant women due to embryo-fetal toxicity observed in animal studies, and also not recommended for children due to evidence of impact on growth plates and decreased bone formation in animal studies 3 is replaced with:
Men who might father a child should use reliable contraception during treatment and for at least three months after the last dose, as concerns exist about potential genotoxicity, particularly in younger patients 2

The Annals of Internal Medicine suggests that Nirmatrelvir/ritonavir (Paxlovid) is generally considered more efficacious than molnupiravir for reducing hospitalization in high-risk patients 1
The World Health Organization, as reported in the BMJ, recommends against using molnupiravir for moderate-risk patients, as concerns about toxicity outweigh benefits, and strongly recommends against molnupiravir use for low-risk patients 4

For high-risk COVID-19 patients needing oral antiviral therapy, the first choice is Nirmatrelvir/ritonavir (Paxlovid) if no contraindications or drug interactions, and molnupiravir is an alternative if Paxlovid is contraindicated, as suggested by the Annals of Internal Medicine and the BMJ 1, 2