Molnupiravir for in-patients
General Information
Drug class: Antiviral
Molnupiravir is a 5´-isobutyrate prodrug that is hydrolysed to N4-hydroxycytidine (NHC) prior to reaching systemic circulation.
A BlueTeq form must be completed. This should be completed by clinical team or Micro/ID. This can be completed retrospectively.
Restricted: Formulary. On advice of Micro/ID, Molnupiravir is an option for treating mild to moderate COVID‑19 in adults who have a positive SARS‑CoV‑2 test, only if:
- they have 1 or more risk factors for progression to severe COVID‑19 (as defined in section 5 of NICE's technology appraisal guidance on nirmatrelvir plus ritonavir and tocilizumab for treating COVID-19)* AND
- nirmatrelvir plus ritonavir is contraindicated or unsuitable.
*The groups of clinical conditions are as below and details of the risk factors for progression to severe COVID-19 in adults can be found HERE.
- Down's syndrome and other genetic disorders
- Solid cancer
- Haematological diseases and recipients of haematological stem cell transplant (HSCT)
- Renal disease
- Liver diseases
- Solid organ transplant recipients
- Immune-mediated inflammatory disorders (diseases in which autoimmune or autoinflammation-based pathways are implicated in disease, for example, inflammatory arthritis, connective tissue diseases, inflammatory skin diseases, inflammatory gastrointestinal disease)
- Respiratory
- Immune deficiencies
- HIV/AIDS
- Neurological disorders
Dosage for ADULTS
To be commenced within 5 days of symptom onset.
The recommended course length is 5 days.
800 mg (four 200 mg capsules) po BD for 5 days.
Renal and hepatic impairment
Renal impairment
No dose adjustment required.
Hepatic impairment
No dose adjustment required.
Interactions
All interactions should be checked using The Liverpool COVID-19 Drug Interaction Checker and Summary of Product Characteristics.
Pregnancy and breastfeeding
See BNF and Summary of Product Characteristics
References
- Merck Sharp & Dohme (UK) Limited. Lagevrio 200 mg hard capsules summary of product characteristics. Electronic medicines compendium. Last revision of the text 24/9/25. Accessed via www.medicines.org.uk Accessed 17/4/26.
- British National Formulary. Molnupiravir. BNF online accessed via www.medicinescomplete.com Accessed 17/4/26.
- The Renal Drug Database. Molnupiravir. Last updated 10/4/26. Accessed via https://renaldrugdatabase.com Accessed 17/4/26.
- National Institute for Health and Care Excellence. Technology appraisal guidance 1056. Molnupiravir for treating COVID-19. Last updated 26/2/26. Accessed via www.nice.org.uk Accessed 17/4/26