Medicines and COVID-19

This page was last updated: 3 April 2020 at 7:39 PM

This site contains general information to assist health professionals in NZ respond to questions/concerns from the public about medicines and COVID-19. The information is compiled by a multidisciplinary team including pharmacists, pharmacologists and infectious diseases experts.

If you feel there are additional areas we need to cover, or for questions relating to specific patients, please contact us. If you cannot make contact by phone then please use email.


  • Patients should be advised to keep at least 1-2 weeks’ supply of their medicines.
  • Prescribers should only prescribe the usual maximum supplies of medicines (one month for controlled drugs, three months for non-controlled drugs). Pharmacy dispensing is limited to one month except for oral contraceptives.
  • Access criteria to some medicines have changed (see Current supply section).
  • The Ministry of Health has released criteria (see Remote prescribing section) to allow remote prescribing of non-controlled medicines.
  • Patients should be advised not to stop any regular medicines unless there is a conventional indication to do so.
  • The treatment of COVID-19 is supportive. There are no medicines which should be prescribed for the direct treatment of COVID-19 outside of a clinical trial.
  • For symptomatic treatment of COVID-19 (pain and fever), paracetamol is preferred.
  • NSAIDs may still be used for refractory symptoms with the usual cautions and contraindications (e.g. elderly patients, renal impairment). 

Medicine supply

The global effects of COVID-19 on manufacturing plants and transportation are likely to result in disruptions to the medicine supply chain. PHARMAC are working closely with the Ministry of Health (MoH) and suppliers to help maintain medicine supply chains. See PHARMAC: Information for coronavirus/COVID-19

Current supply

Patients should be advised to keep at least 1-2 weeks’ supply of their medicines.

However, to reduce hoarding dispensing of non-controlled medicines, other than oral contraceptives, is limited to one month. Prescribers should adhere to the usual prescribing restrictions (three month supply for non-controlled medicines and one month for controlled medicines).

Access criteria to some medicines have changed.

For a list of medicines associated with supply issues, such as paracetamol, see PHARMAC: Medicine and device supply issues

For a list of medicines where PHARMAC have changed access criteria (either to facilitate access e.g. sacubitril with valsartan, or restrict access e.g. hydroxychloroquine) as part of the COVID-19 response, see: PHARMAC: Medicines with amended access criteria

Patients may be anxious about medicine shortages and ask to stock-up on their regular medicines. This practice will lead to earlier and more problematic medicine shortages. Reassure patients that PHARMAC, the MoH, pharmacies and suppliers are working together to ensure equitable access to medicines. Prescribers should not issue multiple prescriptions for the same medicine. Pharmacies should not dispense more than one month’s supply of non-controlled medicines, with the exception of oral contraceptives for which a three month supply can be dispensed.

National advice, produced at CDHB, can be found here: COVID-19 Advice for prescribers and pharmacists about medicine supply. If this document is inaccessible due to password protection, use this link to access an older version. 

Remote prescribing

Remote prescribing by email or NZePS is possible for non-controlled drugs if Ministry of Health criteria are met (see below).

Remote prescribing has been facilitated by the Ministry of Health (MoH). Full details can be found here.

The New Zealand ePrescription Service (NZePS) is a secure prescribing system used in the community. The following GP Practice Management Systems (PMS) can produce electronic prescriptions via NZePS:

  • MedTech32, MedTech Evolution
  • MyPractice
  • Indici
  • Medimap.

These can be sent directly to pharmacies electronically, in which case a physical signature is not required. The prescription can also be printed and faxed to pharmacies. Contact the vendor for your PMS for guidance on accessing the PMS remotely to prescribe from home.

A physical signature is not required for under the following conditions:

  • The prescription is for non-controlled drugs only; and
  • The prescription is a NZePS barcoded prescription; and
  • The system that generates the prescription has been authorised by the Ministry of Health for Signature Exempt Prescriptions; and
  • The prescription is downloaded at the pharmacy from NZePS.

If you are not connected to NZePS you can email written prescriptions to pharmacies. These must be physically signed, and the original sent to the pharmacy by post or courier (within seven working days for non-controlled medicines and two working days for controlled medicines). The email must meet secure messaging criteria. For pharmacy email addresses see Healthpoint.

Medicines reported to worsen COVID-19

There are no clinical studies showing increased harm from any medicine use in relation to COVID-19. Patients should be advised not to stop any regular medicines unless there is a conventional indication to do so.

COVID-19 uses angiotension-coverting enzyme 2 (ACE2) to enter cells. There is pre-clinical data from in vitro and animal studies that some medicines may upregulate ACE2, raising concerns that these medicines could increase the severity of COVID-19 infection. However, there are no clinical data (including the publications from the large number of cases in China) to support this theory.

Immunosuppression theoretically increases the risk of coronavirus infection but there is no clinical evidence to support this.

Ibuprofen and other Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Patients on long-term NSAIDs should continue to take them unless there is a conventional reason to stop (e.g. bleeding or acute kidney injury).

Paracetamol is preferred for symptomatic treatment of COVID-19, particularly in older patients or patients with comorbidities who are more vulnerable to adverse effects of NSAIDs. However, NSAIDs may still be used for refractory symptoms.

There has been longstanding concern over NSAIDs in viral infections. Randomised controlled trials and observational data comparing NSAIDs and paracetamol have produced mixed results that some showing no difference and others a small effect of NSAIDs. Overall, the data are too few to draw a convincing conclusion.

This existing concern has been compounded over the potential for NSAIDs to upregulate ACE2 in animal models. However, there are no clinical studies looking specifically at NSAIDs and COVID-19. Additionally, there are no data to support NSAIDs increasing the probability of becoming infected with COVID-19, or transmitting COVID-19. The European Medicines Agency (EMA) and World Health Organisation (WHO) have both acknowledged the theoretical concerns but still permit use of NSAIDs with COVID-19.

The usual contraindications and cautions still apply to NSAID use as they did prior to COVID-19, for example patients with renal impairment, heart failure or increased risk of gastrointestinal bleeding.

Angiotensin Converting Enzyme Inhibitors (ACEIs) and Angiotensin Receptor Blockers (ARBs)

Patients already taking ACEIs or ARBs should continue them unless there is a conventional reason not to (e.g. hyperkalaemia, acute kidney injury).

ACEIs and ARBs upregulate ACE2 in animal studies (see above). ACE2 receptors have been shown to be the entry point into human cells for SARS-CoV-2. Observational studies of patients with COVID-19 have shown increased mortality for patients with underlying health conditions including diabetes and cardiovascular disease. Reports have suggested this could be due to ACEI and ARB use, however there are no data to substantiate this.

The usual contraindications and cautions still apply to ACEI and ARB use as they did prior to COVID-19, for example patients with hyperkalaemia or hypotension. Current consensus is that ACEIs and ARBs should be continued unless a conventional reason for cessation applies. See, for example, NEJM: Renin–Angiotensin–Aldosterone System Inhibitors in Patients with Covid-19. Some diabetes and renal specialists are opting to not start ACEIs or ARBs imminently in their diabetic patients with microalbuminuria, due to the unclear impact these medicines may have with COVID-19, and the low clinical risk if delayed temporarily.

Antidiabetic Medicines

Patients already taking thiazolidinediones (e.g. pioglitazone) should continue them unless there is a conventional reason not to (e.g. heart failure, history of bladder cancer).

Thiazolidinediones, such as pioglitazone, upregulate ACE2 in animal studies (see above). Observational studies of patients with COVID-19 have shown increased hospitalisation and mortality for patients with diabetes (7.3% vs 0.9%). Reports have suggested this could be due to ACEI and ARB use, however there are no data to substantiate this. Diabetes has separately been shown to upregulate ACE2 and increases the risk of other infections, both of which add to the confounding in the observational data.

The usual contraindications and cautions still apply to ACEI and ARB use as they did prior to COVID-19, for example patients with heart failure or a history of bladder cancer. We recommend clinicians continue usual practice around the use of pioglitazone during the COVID-19 pandemic.


Patients should continue immunosuppressants while they remain well, even after potential COVID-19 exposure.

We refer to immunosuppressants as any medicine dampening immune response, including those described as “immunomodulatory” rather than immunosuppressive. Examples of these medicines include corticosteroids, Disease Modifying Anti-Rheumatic Drugs (DMARDs), and monoclonal antibodies that affect the immune system.

Immunosuppressants theoretically increase the chances of contracting coronavirus, or developing more severe infection. However, the extent of this effect is uncertain. Ceasing immunosuppressants could destabilise control of the underlying disease resulting in direct patient harm from disease, risk of hospitalisation (and COVID-19 exposure), and use of more immunosuppressing regimens (such as high-dose corticosteroids) to regain disease control. The long duration of effect of most immunosuppressants means omitting doses after COVID-19 exposure, for example, confers little or no short-term reduction of immunosuppression.

The management of immunosuppression for patients with an active infection is dependent on individual factors, such as the indication for immunosuppression and severity of the infection. It is therefore not possible to provide explicit guidance here, but clinicians are advised to use the same approach as applies to other significant viral infections, such as influenza. Discussion with the relevant specialist is recommended.

Medicines reported as treatment for COVID-19

The treatment of COVID-19 is supportive. There are no medicines which should be prescribed for the direct treatment of COVID-19 outside of a clinical trial.

Although there is pre-clinical data to support the efficacy of some medicines in vitro, there are no trials sufficient to justify using these medicines routinely for the treatment of COVID-19. Treatment remains supportive, although some medicines may be useful as part of supportive care, including paracetamol and oxygen.

CDHB memo: Specific medicines to treat COVID-19 infection

CDC: Interim clinical guidance for management of patients with confirmed coronavirus disease (COVID-19)

WHO: Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected

Chloroquine and Hydroxychloroquine

Chloroquine and hydroxychloroquine currently have no role in the management of COVID-19.

There are pre-clinical data that these medicines may possess activity against COVID-19. However, there is only a single published clinical study: a non-randomised trial of 36 patients in France which has significant methodological flaws. Two further studies from China (a brief report of chloroquine use in more than 100 patients without clinical details and a randomised trial of 62 patients reporting a benefit for hydroxychloroquine) have received significant attention. However, these are currently unpublished, not peer-reviewed and so cannot form the basis of clinical decision making.

Overall, there is currently insufficient evidence of benefit to recommend using chloroquine or hydroxychloroquine for the treatment of COVID-19. Inappropriate use outside of clinical trials risks unnecessary adverse effects and creating a shortage of these medicines for established indications e.g. rheumatoid arthritis. Accordingly, PHARMAC has restricted funding of hydroxychloroquine to approved indications (rheumatoid arthritis, systemic or discoid lupus erythematosus, malaria).


Antivirals currently have no role in the management of COVID-19.

A number of antivirals are being investigated for activity against coronaviruses:

  • Darunavir
    • Being evaluated in vitro for potential activity against coronavirus.
  • Favilavir (also known as favipiravir)
    • Published evidence is limited to two open-label trials with significant limitations.
  • Galidesivir
    • Clinical studies are awaited.
  • Lopinavir-ritonavir
    • While one randomised controlled trial (against standard care) of 199 patients did not show a significant difference in time to clinical improvement, larger trials are under way.
  • Remdesivir
    • Multiple randomised controlled trials are under way.
  • New molecules under development (e.g. EIDD-2801)

Overall, there are no randomised controlled trials to support the use of these medicines to treat humans with suspected or confirmed COVID-19 infection.

Further, some studies show increased adverse reactions with the use of antivirals compared to standard care (e.g. nausea/vomiting/diarrhoea with lopinavir-ritonavir). Inappropriate use of antivirals places patients at risk of harm without demonstrated evidence of benefit.


Biologics currently have no role in the management of COVID-19.

Biologics are being investigated for activity against coronaviruses:

  • Anakinra
    • The basis for using anakinra is purely theoretical. Severe COVID-19 is associated with a marked inflammatory response, which may be the basis of the inflammatory lung damage. Anakinra is a recombinant protein similar to the endogenous interleukin 1 receptor antagonist protein, and therefore reduces interleukin-1 mediated inflammation. There are no clinical data supporting the use of anakinra, however.


Corticosteroids currently do not have a routine role in the treatment of COVID-19.

Patients should continue prescribed corticosteroids while they remain well, even after potential COVID-19 exposure.

Patients with asthma and/or COPD who use corticosteroid inhalers or oral corticosteroids as part of their asthma/COPD plan should continue to do so.

Corticosteroids are not recommended for the treatment of pneumonia from COVID-19 except if there are other conventional indications e.g. exacerbation of chronic obstructive pulmonary disease (COPD). This recommendation is based on studies which found corticosteroid use was associated with delayed viral clearance and increased mortality in patients with influenza and Middle Eastern Respiratory Syndrome (MERS) coronavirus. During the Severe Acute Respiratory Syndrome (SARS) coronavirus pandemic, corticosteroids were widely used to manage SARS. However, there was no strong evidence of their effectiveness and some evidence of harm.

See CDC: Interim clinical guidance for management of patients with confirmed coronavirus disease (COVID-19)

Patients who are using long-term oral or inhaled corticosteroids may have an increased risk of contracting coronavirus or developing more severe COVID-19 symptoms. However, patients should not stop long-term corticosteroids abruptly solely because of the current pandemic, or if they are exposed to someone with COVID-19 or develop COVID-19. Abrupt cessation is unlikely to be of benefit and more likely to cause harm e.g. adrenal crisis, uncontrolled asthma.

There is minimal systemic exposure from topical corticosteroids. There is no evidence that topical corticosteroids for dermatological conditions e.g. eczema, psoriasis increase the chance of COVID-19 when used appropriately.

Patients with moderate to severe asthma and COPD are at higher risk of developing more severe symptoms of COVID-19. These patients may have ‘back-pocket’ prescriptions for self-administration of systemic corticosteroids. Patients using ‘back-pocket’ prescriptions should continue to do so during the pandemic. However, the symptoms of COVID-19 may be mistaken for an exacerbation of asthma and/or COPD so patients should be advised to seek medical attention urgently if self-administering corticosteroids. Note, prescriptions can be issued remotely (see remote prescribing section) and most pharmacies will have contactless delivery services prioritised for high risk patients.


Paracetamol can treat symptoms of COVID-19 but does not improve clinical outcomes.

There are reports on social media that paracetamol can “cure” COVID-19. There is no scientific evidence to support this claim, or a plausible theory. Patients should be supported to use paracetamol in a supportive role, but warned that it does not protect them from serious harm from COVID-19 and is therefore not a substitute for established methods of infection control.

For information on dispensing paracetamol see PHARMAC: Paracetamol supply issue.

Discontinuation of the combination product cilazapril with hydrochlorothiazide tablets

Apo-Cilazapril/Hydrochlorothiazide® has been discontinued and supply in NZ is expected to run out by July 2020. We recommend all patients taking this product be reviewed and changed to an alternative treatment. From 1st March, prescriptions for existing patients will need to be annotated for funding. See PHARMAC guidance for more details.

Cilazapril tablets are still available and hydrochlorthiazide is available in combination with quinapril.

Note: cilazapril is not used widely overseas and there is potential for supply issues in the future. It is suggested to consider the fully funded long-acting ACE inhibitors, enalapril, perindopril and lisinopril, which are used widely internationally. 

Hydrochlorthiazide has a shorter half-life and weaker evidence base than other widely available thiazide diuretics. It is recommended to consider the fully funded long-acting thiazide diuretics, chlortalidone, bendroflumethiazide and indapamide.

See Health Pathways and BPAC guidance for advice on management, or contact the Christchurch Medicines Information Service for advice on specific patients.

Calculating renal function: eGFR or CrCl?

estimated Glomerular Filtration Rate (eGFR; units mL/min/1.73m2) is often used in practice for determining renal function since it is readily available via lab results. It should be adjusted for body surface area  in individuals with extremes of size. Alternatively, the Cockcroft-Gault formula (CrCl) can be used.

For more background information, see:

– recent MHRA article. Note they refer to eGFR as the reported lab value (mL/min/1.73m2) rather than adjusting for the individual patient’s body surface area.

– our section on Prescribing in Renal Impairment or the CDHB Pink Book guidelines (Canterbury only).

Ranitidine recall update (09/12/19)

The availability of ranitidine is extremely limited. Famotidine IV/oral is currently funded for hospital use, and 20 mg tablets will be fully funded in community from 1st January 2020 under Section 29 (unlicensed medicine). 

See Medsafe’s statement for more details on the product recall – 


Alternative management options include:

Gastroesophageal reflux disease (GORD):

  • consider trialling cessation of H2-antagonist therapy
  • lifestyle modification (e.g. avoiding foods that trigger symptoms, such as alcohol and caffeine)
  • antacids e.g. aluminium (e.g. Alu-tab 600 mg tablets – fully funded)
  • alginates (Gaviscon Double Strength®tablets and Acidex® liquid – partially funded)
  • proton-pump inhibitors – omeprazole, pantoprazole and lansoprazole are all fully funded. Also suitable to use in pregnancy
  • See HealthPathways for more guidance  (Canterbury only)


Chronic urticaria: 

Withdrawal of dosulepin (dothiepin) and doxepin from New Zealand

Two tricyclic antidepressants (TCAs), dosulepin (dothiepin) and doxepin will no longer be available in New Zealand.

When transitioning patients to alternatives, consider:

  • Is a TCA still appropriate? TCAs are associated with a higher risk of adverse outcomes in people with cardiovascular disease and older adults.
  • Individual psychiatric history. Switching therapy increases the risk of relapse of mental illness and psychosocial support and/or referral may be needed.
  • Antidepressant discontinuation syndrome. TCAs are associated with discontinuation symptoms, particularly if stopped abruptly after more than 4 weeks of regular use.
  • Individual TCAs are not dose equivalent. Dose titration may be needed when switching to another TCA.
  • Dosulepin (dothiepin) and doxepin are sedating antidepressants, switching to a less-sedating antidepressant (e.g. SSRI, nortriptyline) may cause sleep problems.

For general information on switching antidepressants, discontinuation symptoms and their relative adverse effects see Health professionals are also welcome to contact our service for more specific or detailed advice on switching therapy.

Notifications from PHARMAC regarding the withdrawal of these medicines:

Pregabalin is now fully funded

Pregabalin is a gabapentinoid that is now fully funded and indicated as an option for patients with neuropathic pain, as well as focal seizures and generalised anxiety (unlicensed). Pregabalin may offer advantages over gabapentin in patients where adherence to a three-times-daily regimen is problematic or where gastrointestinal absorption may be impaired. The efficacy of gabapentinoids should be reviewed after initiation and dose escalations, as many patients obtain minimal benefit but experience adverse effects. Gabapentinoids also have the potential to be abused. For more information, see the bulletin published by the CDHB Analgesic Stewardship Committee on our website.