Drugs used for Treating Covid-19
The second wave of COVID-19 has spread across India. There is an increase in the number of deaths all across the world. The health front is facing extreme worse situations. Most people who fall for the COVID-19, get sick and recover by themselves from home.
The devastating impacts of the coronavirus designated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have led to urgent attempts to discover effective therapeutic agents for inpatient and outpatient treatment of Covid-19. Scientists have been examining a plethora of drugs and several drugs like Azithromycin, Doxycycline, Ivermectin, Vitamin C, Vitamin D, Zinc supplements, and Favipiravir have been found effective in treating Covid-19.
- Azithromycin is used alone during the initial days of the flu-like symptoms caused by this coronavirus.
- Doxycycline is used to treat Covid patients with pulmonary disease which shows subsequent rapid clinical improvement.
- Ivermectin, an FDA-approved anti-parasitic agent, may be beneficial for the treatment of early-onset mild Covid-19 in adult patients.
- Vitamin C, the immune system booster and antioxidant make it a logical choice to explore in Covid infection.
- Vitamin D is another safe and inexpensive medication.
Numerous studies reveal that supplementing with zinc may be helpful for those who are already sick and may protect against respiratory tract infections.
One of the drugs which has recently garnered much attention, especially in India, is an antiviral drug, Favipiravir, administered as a prodrug. It has exhibited rapid viral clearance and faster clinical improvement.
Drug dosing in general population and Kidney patients
Drug dosing is something very important to consider while taking medications, without which desired effectiveness can never be achieved and it can even cause unsought effects. In the case of kidney diseases, drug dosing should be adjusted according to Glomerular Filtration Rate.
Azithromycin and Doxycycline are antibiotics used to treat different types of bacterial infections. Being antibiotic drugs, both Azithromycin and Doxycycline are never effective in the case of viral diseases. It is usually prescribed to evade bacterial infections. Both these antibiotics can be used by kidney patients. In the case of renal failure, azithromycin does not require any modification or adjustment in its dosing and it should be used with enough caution. Being in the tetracycline group, Doxycycline is considered safer with several metabolic properties.
Ivermectin is an antiparasitic drug and it does not work for COVID. First, it was thought to be useful to restrain the replication process of CoV-2, but later it is found that the drug is unsuccessful in inhibiting the replication of viruses. For kidney patients, it is considered safer, as it can be excreted with minimal clearance by the kidneys. With that reason, just like azithromycin, Ivermectin also can be used without any dosing adjustment.
Unlike Azithromycin, Doxycycline and Ivermectin, Favipiravir can be used against COVID. Being an antiviral drug, Favipiravir shows its efficacy in inhibiting the replication of virus and with this medication recovery rate of COVID patients have increased. Although the drug is effective enough to act against viral diseases, with the unavailability of ample data, it is not recommended to kidney patients.
Micronutrients like vitamin C, vitamin D and zinc are generally used to enhance the immune system and also to improve the overall functioning of the human body. They are never harmful and can be consumed in the case of their deficiency. No benefits can be reaped from these micronutrients in treating COVID. A low dose of vitamin C is recommendable to kidney patients, as in that respect oxalosis will not be caused. Just like vitamin C, vitamin D also can be harmful if it is taken in higher dosages, so it is better to take the medication properly. Zinc also does not have much role in treating COVID and its intake does not make any significant effect in COVID patients. When consumed properly, zinc can enhance the nutritional status of kidney patients.
Side effects of Covid drugs on Kidney
The global COVID-19 pandemic has led a race to discover medications that can boost the prognosis of the disease. Major drug interactions like Azithromycin, Doxycycline, Ivermectin, Vitamin C, Vitamin D, Zinc supplements, and Fabipiravir are cited here. There can be side effects of covid drug dosing on kidneys as well.
Azithromycin is a well-established drug of choice in association with the treatment of respiratory tract infection which is now used to treat Covid 19. However, in elderly patients, azithromycin may create a reversible acute kidney injury. The exact mechanism behind this adverse event is yet unclear but some studies justified it as azithromycin-induced interstitial nephritis. So, patient monitoring must be performed carefully when consuming azithromycin.
Doxycycline also exhibited promising results in the treatment of COVID 19 infection. Doxycycline has been examined as a safe broad-spectrum antibiotic for patients with renal failure. Although doxycycline maintains many of the metabolic properties of the tetracycline group, toxic blood levels normally do not ensue because of the drug’s unique extrarenal route of excretion.
Safety and efficacy are crucial when trying any drug for a new indication. WHO recommends against the use of Ivermectin for Covid – 19 except within clinical examinations. There are no dosage adjustments provided by the manufacturer for Ivermectin. This drug is highly linked to plasma proteins (93%), primarily albumin, and can be displaced, improving free fractions in patients with loss of capacity. A study in rats implied that the use of Ivermectin can compromise kidney and liver integrity.
Vitamin C supplements are taken with the idea that they help prevent the common cold which is now used in the therapy of coronavirus infection. Consuming too much vitamin C may increase the amount of oxalate in the kidneys, which can lead to kidney stones. Kidney failure has also been reported in people who have taken more than 2,000 mg a day. However, this is very rare in healthy people.
Some research demonstrates that having healthy levels of vitamin D can benefit keep the immune system active and may protect against respiratory illnesses in general. It suggested that patients hospitalized with COVID-19 who had sufficient levels of vitamin D had a decreased threat for adverse effects and death. Taking too much vitamin D can cause troubles such as constipation in more serious cases, kidney stones, and kidney damage. It may lead to kidney injury in people with healthy kidneys, as well as those with common kidney disease.
A high dose of zinc supplementation has been shown to enhance the immunity of patients with the Torque Teno virus and is recommended either for or against the treatment of Covid 19. In some cases, zinc intake might result in kidney and stomach damage and can cause other side effects.
Fabipiravir is an anti-viral drug that has just garnered attention, specifically in India, designed for influenza. Anyway, the adverse effect of favipiravir might be clinically important in patients with a record of kidney function impairment, and where there is concomitant use of other drugs affecting blood uric acid elevation.
Still there is no final guidelines on the management, all above-mentioned are still investigational.