Antivirals and the potential benefits of orally Inhaled Drug Administration in COVID-19 Treatment

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Date
2022Author
Şahin, GökbenAkbal-Dağıstan, Özlem
Çulha, Meltem
Ertürk, Aybige
Başarır, Nur Sena
Yıldız-Peköz, Ayça
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Sahin G, Akbal-Dagistan O, Culha M, Erturk A, Basarir NS, Sancar S, Yildiz-Pekoz A. Antivirals and the Potential Benefits of Orally Inhaled Drug Administration in COVID-19 Treatment. J Pharm Sci. 2022 Jun 9:S0022-3549(22)00248-9. doi: 10.1016/j.xphs.2022.06.004. Epub ahead of print. PMID: 35691607; PMCID: PMC9181835.Abstract
Coronavirus Disease 2019 (COVID-19) pandemic has been on the agenda of humanity for more than 2
years. In the meantime, the pandemic has caused economic shutdowns, halt of daily lives and global
mobility, overcrowding of the healthcare systems, panic, and worse, more than 6 million deaths.
Today, there is still no specific therapy for COVID-19. Research focuses on repurposing of antiviral
drugs that are licensed or currently in the research phase, with a known systemic safety profile.
However, local safety profile should also be evaluated depending on the new indication,
administration route and dosage form. Additionally, various vaccines have been developed. But the
causative virus, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), has undergone
multiple variations, too. The premise that vaccines may suffice to eradicate new and all variants is
unreliable, as they are based on earlier versions of the virus. Therefore, a specific medication therapy
for COVID-19 is crucial and needed in order to prevent severe complications of the disease. Even
though there is no specific drug that inhibits the replication of the disease-causing virus, among the
current treatment options, systemic antivirals are the most medically appropriate. As SARS-CoV-2
directly targets the lungs and initiates lung damage, treating COVID-19 with inhalants can offer many
advantages over the enteral/parenteral administration. Inhaled drug delivery provides higher drug
concentration, specifically in the pulmonary system. This enables the reduction of systemic side
effects and produces a rapid clinical response. In this article, the most frequently (systemically) used
antiviral compounds are reviewed including Remdesivir, Favipiravir, Molnupiravir, Lopinavir-
Ritonavir, Umifenovir, Chloroquine, Hydroxychloroquine and Heparin. A comprehensive literature
search was conducted to provide insight into the potential inhaled use of these antiviral drugs and
the current studies on inhalation therapy for COVID-19 was presented. A brief evaluation was also
made on the use of inhaler devices in the treatment of COVID-19. Inhaled antivirals paired with
suitable inhaler devices should be considered for COVID-19 treatment options