Context: Recently, Glenmark Pharmaceuticals has received manufacturing and marketing approval from India’s drug regulator, making FabiFlu the first oral Favipiravir-approved medication in India for the treatment of COVID-19.
Background 

• FabiFlu will be used for treating COVID-19 patients with mild to moderate symptoms and will be made available by next week across the country. 

Key Points

• On the first day, a patient will be administered 1800 mg twice each. From the second day, the patient will be given 800 mg twice a day for upto 14 days as per the doctor’s advice. The medicine can be administered to patients between the age group of 18 and 75. 
• Since the approval is under emergency category due to the pandemic, the patient has to give an undertaking before consuming the medicine. 
• 70 to 80% of Covid-19 patients are from the mild and medium category for which the drug has been approved. A patient of this type need not be admitted to the hospital and can stay at home. 
• Once administered the drug will help in bringing down the viral load on the patient. Glenmark is the first company to come out with an oral antiviral drug for mild and moderate Covid-19 treatment. 
• Favipiravir can be used in Covid-19 patients with co-morbid conditions such as diabetes and heart disease with mild to moderate Covid-19 symptoms. 
• It offers rapid reduction in viral load within four days and provides faster symptomatic and radiological improvement. 
• Favipiravir has been used in Russia, Japan and China to treat such patients and has been proved successful. 
• At the moment the drug will be under restricted use, which means it can be consumed only under doctor’s guidance and supervision. People without prescription cannot buy it.

List of Treatments for COVID-19 used in India

Remdesivir

• Remdesivir, an antiviral drug first developed for treating Ebola in 2014, is one of the possible Covid-19 treatments being investigated in the WHO’s Solidarity Trial. It inhibits viral replication in the body.
• US National Institutes of Allergies and Infectious Diseases released preliminary trial results showing recovery time of Covid patients given remdesivir improved from 15 to 11 days.
• The Drug Controller General of India on June 1 approved a five-day regime of remdesivir.
• Doctors are currently prescribing it for moderately to severely ill patients.
• Remdesivir costs Rs 10,000-20,000 per vial.

Favipiravir

• Favipiravir is an antiviral given to inhibit viral replication, It is used as an anti-influenza drug.
• First manufactured by Japan’s Fujifilm Toyama Chemical Ltd, it is manufactured in India by Glenmark Pharmaceutical and Strides Pharma.
• It is being used for moderately symptomatic to severely ill Covid patients, but access is not easy.

Tocilizumab

• This is an immunosuppressant commonly used to treat for rheumatoid arthritis.
• This is an expensive drug, that costs Rs 40,000-60,000 per dose, it is used as a preventive against ventilator requirement, government hospitals are giving it free.
• Tocilizumab is manufactured by Roche Pharma, and marketed by Cipla.
• In India it is sold under the brand name Actemra.

Itolizumab

• This drug is commonly used for the skin disorder psoriasis, rheumatoid arthritis, multiple sclerosis, and autoimmune disorders. In India, Biocon launched it in 2013.
• It is being trailled in Mumbai and Delhi on moderately to severely ill Covid patients. Initial results will come by July. “The trial will take some time. 

Hydroxychloroquine

• This antimalarial drug is a subject of debate over its efficacy against Covid.
• India is the largest producer of this drug.
• Doctors use HCQ use in Covid patients with symptoms as mild as headache, fever, body pain, and even in critically ill patients.
• ICMR guidelines recommend low doses for nine days.
• This drug is helping in faster recovery, but that is just preliminary assessment.
• Side effects of the drug includes chaotic heartbeat.

Doxycycline + ivermectin

• Doxycycline is an antibiotic used to fight infection in the urinary tract, eye, or respiratory tract.
• Ivermectin is an anti-parasite drug for treatment of scabies, head lice, and filariasis.
• The combination is used to treat Covid patients with acute symptoms.
• There is very little information about these two drugs on Covid-19 patients and It is still in experimental stage.

Ritonavir + lopinavir

• These antivirals are commonly used to treat HIV patients.
• They are being investigated in the Solidarity Trial.
• Some studies suggest they reduce mortality risk in Covid-19 patients, while others have found no major improvement.
• Over a dozen manufacturers supply ritonavir and lopinavir in India.
• Doctors sometimes use the combination for severely ill patients.

Plasma therapy

• This is meant for critical patients with low oxygen saturation levels, or those suffering a cytokine storm.
• Patients who have recovered from severe Covid-19 donate their plasma, which is then injected into other critical patients to boost their immunity.
• A protocol approved by ICMR is used to select which patient is best suited for plasma therapy.
• Preference is given to those at risk of cytokine storm, extreme breathlessness with severe pneumonia.