Risk/Benefit Profiles of Currently Approved Oral Antivirals for Treatment of COVID-19: Similarities and Differences


Since the outbreak of COVID-19, scientists and researchers have been working tirelessly to identify effective treatments that can alleviate the symptoms and complications of the virus. Among the available options, oral antivirals have emerged as promising candidates. However, it is crucial to evaluate the risk/benefit profile of these treatments to determine their suitability for use in COVID-19 patients. In this blog post, we will provide an overview of the risk/benefit profiles of currently approved oral antivirals for COVID-19 treatment, exploring their similarities and differences.

Key Points

  1. Remdesivir: Remdesivir, an RNA polymerase inhibitor, has shown efficacy against COVID-19 in clinical trials. However, the drug’s benefits must be weighed against potential risks, including liver damage, renal toxicity, and gastrointestinal (GI) side effects such as nausea, vomiting, and diarrhea. Additionally, the cost of remdesivir can be a barrier to access for many patients.
  2. Favipiravir: Favipiravir, another RNA polymerase inhibitor, is used to treat influenza in Japan but has also been approved for COVID-19 treatment in several other countries. The drug has shown to shorten the recovery time, but some studies suggest that there may be an increased risk of teratogenicity, particularly when administered to pregnant women. Other reported side effects include GI disturbances, skin rash, and elevated uric acid levels.
  3. Sofosbuvir: Sofosbuvir, a nucleotide analog, has antiviral activity against multiple viruses. In clinical trials studying its potential use against COVID-19, sofosbuvir demonstrated a significant reduction in the duration of hospitalization in COVID-19 patients. However, there is a risk of cardiac events, renal tubular injury, and hepatic toxicity associated with its use. The drug can also be costly and may not be accessible to all patients.
  4. Ribavirin: Ribavirin is a broad-spectrum antiviral protocol formulated to treat hepatitis C. It has been used off-label for COVID-19 patients, and some studies show it may be beneficial. However, the drug’s potential side effects, such as anemia and hemolysis, particularly in patients with underlying conditions, must be weighed against its benefits.
  5. Lopinavir/Ritonavir: Lopinavir/Ritonavir is a protease inhibitor utilized to treat patients with HIV. The medication has also been evaluated for use in COVID-19 patients and has been shown to reduce hospitalization time. However, studies have shown that there is a lack of statistically significant differences between lopinavir/ritonavir and the standard care of COVID-19 patients. Gastrointestinal symptoms and liver function abnormalities are potentially seen in patients using these drugs.


In conclusion, the risk/benefit profiles of approved oral antivirals used in the treatment of COVID-19 should be evaluated carefully. While these drugs demonstrate potential efficacy in alleviating the symptoms of COVID-19, they may also have side effects that must be monitored. Healthcare professionals must consider these factors, particularly when administering these drugs to patients with underlying conditions. The high costs associated with some medications, such as remdesivir, may also be a barrier to access, highlighting the need for continued research into cost-effective alternatives. By balancing the potential risks and benefits of these treatments, healthcare professionals can provide better care to COVID-19 patients, furthering our understanding of this virus and the potential treatments available.