Molnupiravir: A Ray of hope in the dark times of Covid-19 crisis?

Molnupiravir is an antiviral medication by Merck. It is a nucleoside analogue that inhibits SARS-CoV-2 replication by viral mutagenesis to treat mild-to-moderate coronavirus disease 2019 (COVID19) in adults with positive results of direct SARS-CoV-2 viral testing who are at high risk for progressing to severe COVID-19, including hospitalization or death. For whom alternative COVID-19 treatment options allowed by FDA are not accessible or clinically appropriate.

The FDA issued a EUA for Molnupiravir for emergency use only because this medication has limitations such as:

• The medicine is not authorized for use in patients less than 18 years.
• This medicine is not approved as an initial treatment of Covid-19 patients hospitalized.
• It is not approved for longer use than 5 consecutive days.
• It is not authorized for pre-exposure or post-exposure treatment of Covid-19.

The medicine Molnupiravir is available in 200 mg capsules, administered orally via the mouth. The active ingredient in the Molnupiravir 200 mg medicine is Molnupiravir, and the inactive ingredients are croscarmellose sodium, hydroxypropyl cellulose, magnesium stearate and microcrystalline cellulose and purified water. It is metabolized to the cytidine nucleoside analogue, NHC, which distributes into cells where NHC is phosphorylated to form the pharmacologically active ribonucleoside triphosphate (NHC-TP). NHC-TP incorporation into SARS-CoV-2 RNA by the viral RNA polymerase (nsp12) results in an accumulation of errors in the viral genome leading to inhibition of replication. The mechanism of action is supported by biochemical and cell culture data, studies of SARS-CoV-2 infection in animal models, and analyses of SARS-CoV-2 genome sequences in human subjects treated with Molnupiravir capsule.

FDA advises that before the administration of Molnupiravir medicine to the patients, healthcare providers should acknowledge the patients about potential risks such as:

1. Molnupiravir is not advised for use in pregnant women or patients planning to become pregnant, as it can cause harm to the fetus.
2. It is not recommended in patients under 18 years as it may affect bone growth and cartilage formation.
3. Breastfeeding is not recommended to the females while taking medicine and after the 4 days from the last dose of Molnupiravir.
4. Healthcare providers should ask the patient about their medical history.

Healthcare professionals recommend the general dosage of Molnupiravir capsules 200 mg is according to the prescription prescribed by the doctor. This medicine can be administered with or without food. One should complete 5 days of treatment. Molnupiravir is a prescribed medicine made available only to healthcare providers, patients, and caregivers. Molnupiravir capsules came as a ray of hope in the form of emergency use medication in the critical times of spreading infections through variants of Coronavirus such as Omicron surge, and it was considered the first oral pill for Covid-19 infection.

Molnupiravir price in India is economical compared to the international price, and it is readily available with many suppliers of generic medicines. India is known as one of the largest generic medicine manufacturers and suppliers globally; therefore, the price of the medication is reasonable.