This causes more mutations in all downstream copies than the virus can survive, an effect called viral error catastrophe or lethal mutagenesis. Chemistry
The first synthesis of molnupiravir was disclosed in a patent filed by Emory University in 2018.In the first step, acetone is used as a protecting group to render two of the three hydroxy groups of uridine unreactive to treatment with the acid anhydride of isobutyric acid, which converts the third hydroxy group to its ester. Treatment with 1,2,4-triazole and phosphoryl chloride produces a reactive intermediate in which the triazole portion can be replaced with hydroxylamine. Finally, removal of the protecting group using formic acid converts the material to molnupiravir. : 93–95 
Alternative patented routes to molnupiravir have been reviewed. History
Molnupiravir was developed at Emory University by its drug innovation company, Drug Innovation Ventures at Emory (DRIVE). In 2014, DRIVE began a screening project funded by the Defense Threat Reduction Agency to find an antiviral drug targeting Venezuelan equine encephalitis virus (VEEV), which led to the discovery of EIDD-1931. When turned into the prodrug EIDD-2801 (molnupiravir), the compound also showed activity against other RNA viruses including influenza, Ebola, chikungunya, and various coronaviruses.The international nonproprietary name of the drug was inspired by that of Thors hammer, Mjölnir.
In the United States, it was rejected for the treatment of transthyretin amyloidosis with polyneuropathy because the Food and Drug Administration saw insufficient evidence for its efficacy.Tafamidis can also be used to treat transthyretin amyloidosis with cardiomyopathy. It was approved for the treatment of this form of the disease in the United States in 2019 and in the European Union in 2020. In the United States, there are two approved preparations: tafamidis meglumine (Vyndaqel) and tafamidis (Vyndamax). The two preparations have the same active moiety, tafamidis, but they are not substitutable on a milligram to milligram basis.Tafamidis (Vyndamax) and tafamidis meglumine (Vyndaqel) were approved for medical use in Australia in March 2020. References
Further reading
Adams D (March 2013). "Recent advances in the treatment of familial amyloid polyneuropathy". Ther Adv Neurol Disord. 6 (2): 129–39. doi:10.1177/1756285612470192. PMC 3582309. PMID 23483184. Coelho T, Maia LF, Martins da Silva A,  et al. (August 2012). "Tafamidis for transthyretin familial amyloid polyneuropathy: a randomized, controlled trial". Neurology. 79 (8): 785–92. doi:10.1212/WNL.0b013e3182661eb1. PMC 4098875. PMID 22843282. External links
"Tafamidis". Drug Information Portal. U.S. National Library of Medicine. "Tafamidis meglumine". Drug Information Portal. U.S. National Library of Medicine.