COVID-19
Infectious disease caused by SARS-CoV-2, ranging from asymptomatic to severe pneumonia and multi-organ failure.
ICD-10 U07.112 drugs
Also known as: SARS-CoV-2 infection
Drugs used for this condition
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- DAnas Barbariae Hepatis et Cordis Extractum (homeopathic)Not recommended · Homeopathic products (local classification)A homeopathic extract from duck liver and heart, marketed for cold and flu symptoms and sometimes for COVID-19. It has not shown convincing benefit against COVID-19, and there is no evidence base for this use. What actually helps with COVID-19 is vaccination, medicines with proven efficacy prescribed by a doctor in severe cases, and rest, fluids and symptom monitoring in mild ones. The remedy itself is inert and harmless, but do not take it instead of treatment with proven benefit, or you risk missing the care you need.
- DBudesonideNot recommended · Inhaled corticosteroids (ICS)Budesonide is an inhaled corticosteroid used for asthma and COPD. During the pandemic it was promoted as early home treatment for COVID-19 to lower the risk of severe disease. A convincing benefit for this use has not been shown: there is no solid evidence base for inhaled budesonide in COVID-19, and it did not enter international guidelines as a standard treatment. Mild infection responds to supportive care, while in severe disease with oxygen needs systemic corticosteroids have proven benefit under medical supervision.
- FApixabanNot recommended · Direct oral anticoagulants (factor Xa inhibitors)For mild and moderate outpatient COVID-19, apixaban is not prescribed for thrombosis prophylaxis. Apixaban itself was tested in the ACTIV-4B RCT (Connors et al., JAMA 2021): 657 symptomatic outpatients were randomised to aspirin 81 mg, prophylactic apixaban 2.5 mg twice daily, therapeutic apixaban 5 mg twice daily, or placebo. The trial was stopped early for futility at very low event rates: anticoagulants did not reduce hospitalisations, thromboses, or mortality, while therapeutic-dose apixaban produced a 6.9 % absolute increase in bleeding events compared with placebo. The updated ASH 2024 living guideline (Blood Advances) issued a conditional recommendation against routine post-discharge thromboprophylaxis in COVID-19; the WHO Therapeutics Living Guideline and NICE NG191 do not support routine DOAC use in outpatients. Non-severe hospitalised patients benefit from low-molecular-weight heparin under supervision, not oral DOACs. Self-administered Eliquis «just in case» for COVID-19 has no evidence base.
- FBacterial lysates OM-85Not recommended · Other immunostimulantsIn 2020–2022 OM-85 was promoted for COVID-19 prevention in children with recurrent URIs. WHO, NIH, CDC, and ERS did not recommend this practice. Evidence-based prevention is vaccination, masks during high-transmission periods, and hand hygiene.
- FInterferon alpha-2b (nasal formulations)Not recommended · Other topical nasal preparations (local classification)Grippferon was widely recommended in Russian outpatient practice for COVID-19 prevention and treatment in 2020-2022. WHO, NIH, CDC, and IDSA did not support nasal interferon formulations for these indications. No independent multicentre RCTs with clinical outcomes have been published.
- FMeglumine acridone acetateNot recommended · Other immunostimulants (local classification)Cycloferon is absent from international COVID-19 guidelines. It appears in Russian regional outpatient protocols but lacks a systemic evidence base. Benefit is not confirmed by independent multicentre RCTs.
- FOseltamivirNot recommended · Neuraminidase inhibitorsNot effective against COVID-19. Oseltamivir inhibits neuraminidase, which SARS-CoV-2 lacks. The virus uses spike protein and ACE2 receptor for cell entry – an entirely different mechanism. Early oseltamivir prescriptions during COVID were driven by diagnostic uncertainty when influenza had not been ruled out.
- FRivaroxabanNot recommended · Direct oral anticoagulants (factor Xa inhibitors)For mild and moderate outpatient COVID-19, rivaroxaban and other DOACs are not prescribed for thrombosis prophylaxis. The ACTIV-4B RCT (Connors et al., JAMA 2021) compared aspirin, prophylactic-dose apixaban, therapeutic-dose apixaban, and placebo in symptomatic outpatients – the trial was stopped early for futility at very low event rates. Anticoagulants did not reduce hospitalisations, thromboses, or mortality, while bleeding events rose. Rivaroxaban itself was tested separately in outpatients (PREVENT-HD, Circulation 2023; CARE/COALITION VIII, EClinicalMedicine 2023) and also showed no benefit. The updated ASH 2024 living guideline (Blood Advances) issued a conditional recommendation against routine post-discharge thromboprophylaxis in COVID-19; the WHO Therapeutics Living Guideline and NICE NG191 do not support routine DOAC use in outpatients. Non-severe hospitalised patients benefit from low-molecular-weight heparin under supervision, not oral DOACs. One exception is MICHELLE (Ramacciotti et al., Lancet 2022): post-discharge rivaroxaban 10 mg for 35 days reduced VTE in high-thrombotic-risk patients (IMPROVE-DD ≥ 4 or ≥ 2 with D-dimer ≥ 500 ng/mL). ISTH 2023 discusses this tactic only for that selected post-discharge cohort. This narrow scenario does not justify self-administered Xarelto «just in case» for outpatient COVID-19.
- FTiloroneNot recommended · Other antivirals (local classification)The WHO Therapeutics Living Guideline and NIH COVID-19 Treatment Guidelines do not mention tilorone. In 2020–2022 Russia massively prescribed the drug in outpatient COVID-19 care without international evidence support. Agents with established benefit are nirmatrelvir/ritonavir in high-risk outpatients, remdesivir, corticosteroids, and tocilizumab in hospitalised patients.
- FUmifenovirNot recommended · Other antiviralsThe WHO Therapeutics and COVID-19 Living Guideline does not include umifenovir among agents with proven clinical efficacy for COVID-19. Agents with established benefit include nirmatrelvir/ritonavir in high-risk outpatients, remdesivir, corticosteroids, and tocilizumab in hospitalized patients.
- FVitaglutamNot recommended · Other antivirals (local classification)In 2020–2021 Ingavirin was actively marketed in Russian pharmacies for suspected COVID-19. The drug is not mentioned in WHO, NIH, or IDSA guidelines. No independent multicentre RCTs with outcomes (hospitalisation, mortality, symptom duration) have been published.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit