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

FDA-approved for

COVID-19 (2023)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING EUA mandatory requirements: unapproved product; provide Fact Sheet; document pregnancy counseling and contraception requirements; mandatory reporting of serious adverse events.

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.

NO BOXED WARNINGS

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.

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