It is the second oral medication against COVID 19 after nirmatrelvir/ritonavir, but with a lower efficacy: about 30% (95% CI, 1–51%) against hospitalization or death in unvaccinated adults with mild or moderate COVID-19 and at least one risk factor for disease progression. Contraindications
Use during pregnancy is not recommended. There are no human data on use during pregnancy to assess the risk of adverse maternal or fetal outcomes. Based on animal data, the drug may cause fetal harm.In rats, bone and cartilage toxicity was observed after repeated dosing. Adverse effects
Adverse reactions observed in the phase III MOVe-OUT study included diarrhea (2%), nausea (1%) and dizziness (1%), all of which were mild or moderate. Overdose
The effects of overdose are unknown, treatment consists of general supportive measures such as monitoring of clinical status. Drug interactions
Based on limited available data, there are no drug interactions. Mechanism of action
Molnupiravir inhibits viral reproduction by promoting widespread mutations in the replication of viral RNA by RNA-directed RNA polymerase. It is metabolized into a ribonucleoside analog that resembles cytidine, β-D-N4-Hydroxycytidine 5′-triphosphate (also called EIDD-1931 5′-triphosphate or NHC-TP). During replication, the viruss enzyme incorporates NHC-TP into newly made RNA instead of using real cytidine. Molnupiravir can swap between two forms (tautomers), one of which mimics cytidine (C) and the other uridine (U). NHC-TP is not recognized as an error by the viruss proofreading exonuclease enzymes, which can replace mutated nucleotides with corrected versions. When the viral RNA polymerase attempts to copy RNA containing molnupiravir, it sometimes interprets it as C and sometimes as U.
Martin Brady holds the Guinness world record for the slowest heart rate with a certified rate over a minute duration of 27 BPM. Professional cyclist Miguel Indurain had, during his career, a resting heart rate of 28 BPM. See also
Bezold–Jarisch reflex

References


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