Using molnupiravir in practice

Helen Davis, Director, North West Medicines Information CentrePublished

Advice on swallowing difficulties, use in pregnancy and breastfeeding, and signposting to advice to give to patients.

Swallowing difficulties

Guidance for healthcare professionals on how to administer molnupiravir in people who have difficulty swallowing capsules is available from .

Pregnancy

All pharmacy professionals involved with supply of molnupiravir (Lagevrio®) must be aware of the statement in the SmPC that Lagevrio is not recommended during pregnancy.

Pregnancy prevention

The NHSE SOP for CMDUs states that all individuals of childbearing potential who are prescribed molnupiravir should be advised to use effective contraception for the duration of treatment and for 4 days after the last dose of molnupiravir.

Pregnancy registry

Individuals are not required to take a pregnancy test before starting treatment. However, all healthcare professionals are asked to ensure that any patients who receive a COVID antiviral while pregnant are reported to the UKCOVID-19 antivirals in pregnancy registry on 0344 892 0909 so that they can be followed up.

For more information, go to bumps – best use of medicine in pregnancy.

Breastfeeding

It’s not known how much molnupiravir passes into breast milk.

The SmPC states that breastfeeding is not recommended during treatment with molnupiravir and for 4 days after the last dose.

An individual risk assessment should be conducted for each patient, taking into account the benefits of any treatment and the benefits of continued breastfeeding.

Breastfeeding can continue if you have COVID-19 infection, or have had a COVID-19 vaccine.

Further SPS information and advice on molnupiravir is available.

Patient Information

Typically, few patients are likely to read the Patient Information Leaflet so it is essential that they are provided with key information at every interaction with a healthcare professional.

Patients can also be referred to further NHS sources of information:

Oral antiviral resources

Using nirmatrelvir and ritonavir (Paxlovid) in practice

Use in patients taking interacting medicines, those with swallowing difficulties, or who are pregnant or breastfeeding, and signposting to patient advice.

Using COVID-19 oral antivirals in practice

Deployment should address a range of factors and be implemented through different mechanisms. Collecting data and learning will support continued safe use.