Off-label Use of Medicines in COVID-19: A Lesson For Future

The COVID-19 infection is rapidly spreading worldwide. Treating this new viral infection is a great challenge worldwide. There is no specific and approved medication for its treatment, so some medications are considered off-label. Antivirals, corticosteroids, antimalarial agents, and antibiotics are proposed in different countries to treat COVID-19. This narrative review discussed the off-label use of medications for COVID-19 and the beneficial and adverse effects of them. Evidence was collected and sorted from the literature ranging from 2019 to 2022 on scientific databases such as Web of Science, PubMed, and Scopus with suitable keywords. All papers, namely systematic reviews, case studies, and clinical guidelines, were evaluated. Antimalarial agents, antivirals, antibiotics, corticosteroids, NSAIDs, biological medicines, Ivermectin, and melatonin were reviewed in this study. Some medications have direct antiviral effects, and many can reduce infection symptoms and hospitalization. In some clinical trial trials, even some of them, such as corticosteroids, can lower death rates, particularly during the cytokine storm period. However, the effectiveness of some medications has not been understood. Besides, the side effects of off-label use of these medications must be considered a serious concern. There are no proven medications for COVID-19 yet. Off-label use of medications is a double-edged sword that can have advantages outweighing its disadvantages. The COVID-19 crisis taught us many lessons about dealing with health-related crises and their treatment management. One of the most important lessons is paying more attention to the discovery and development of novel drugs and vaccines based on modern technology.