Favipiravir in Kids With COVID Causes Eye Color Change as a Side Effect

Highlights:

A rare side effect of Covid medication Favipiravir has recently been documented in a male infant
Discoloration of the child's eyes within 18 hours of therapy was noted returning back to normal color within 5 days of medication cessation
Monitoring of Favipiravir therapy in children due to the potential side effect of corneal discoloration needs further investigation

A 6-month-old male patient in Thailand, was reportedly confirmed to be suffering from COVID 19 infection. As per the first line treatment protocol, he was prescribed Favipiravir. Following 18 hours after initiation of treatment, the child's mother detected a bluish discoloration of the cornea.

When reported, the pediatrician advised to discontinue therapy diagnosing it to be a case of Favipiravir -induced corneal discoloration. The corneal discoloration returned to normal color on Day 5 after stopping the medicine. A further ophthalmic evaluation detected no long term eye defects.

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‘In a rare complication from a treatment of Covid-19 antiviral, the eyes of a six-month-old baby boy turned an unusual shade of blue. #COVID19 #Covidinchildren #Covidtreatmentinchildren’

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Covid 19 in Children: What do Treatment Guidelines Say?

Currently, recommendations for managing COVID-19 in children are very few. Effective measures including personal hygiene and anti-virals are the main stay of treatment against the SARS-CoV-2 infection. In accordance with the Thai National Treatment Guidelines for COVID-19 issued by the Ministry of Public Health 2022, among the antiviral medicines, Favipiravir is the mainstay of antiviral treatment for COVID-19 in children. This use is limited to cases with mild-to-moderate illness. The most common side effects of Favipiravir include increase in uric acid production, diarrhea, and neutropenia. The most commonly reported side-effects together contribute to roughly 20% of adverse events. Bluish discoloration of the cornea as a side effect was first reported in 2021 by Raiturcar et al ().

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Favipiravir : What do We Know About the Anti-Viral Medicine?

Favipiravir, belongs to the class of anti-viral drugs that targets the viral RNA-dependent RNA polymerase enzyme. Known for its efficacy during the Pandemic Influenza in 2014 and other viral diseases like Ebola; Favipiravir was used against SARS Cov-2 during the outbreak of COVID. Since its treatment profile and recent data documented higher rate of viral clearance and shorter clinical improvement time in hospitalized patients, it received a place in several treatment protocols against SARS-CoV-2 infection.

Favipiravir remains the mainstay of oral antiviral treatment in Thailand for children with COVID-19. The current recommended dose is 35 mg/kg twice daily on Day 1 followed by 15 mg/kg twice daily on Days 2–5 ().

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Liquid Formulations Of Favipiravir: Desired Preparation for Children

Chula Pharmaceutical Sciences in collaboration with the Chulabhorn Royal Academy and the private sector, developed Thailand’s first favipiravir liquid formula for children and COVID-19 patients. It won the Prime Minister’s Award at the Startup and Innovation Thailand Expo 2021 (SITE 2021) organized by the National Innovation Agency (NIA). The Chulabhorn Royal Academy’s formula of liquid favipiravir is convenient to administer the medicine to young patients or those having trouble swallowing tablets. At present, favipiravir is used in pediatric patients aged 2 months old and above ().

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Take Home Message: Favipiravir Therapy

This case report highlights an unusual adverse effect of Favipiravir therapy. While Favipiravir is currently the mainstay of oral antiviral treatment for children with COVID-19, its safety profile in children is uncertain and needs further extensive research.

Monitoring the long-term safety, adverse effects, dosing and administration of Favipiravir in pediatric patients is of utmost importance. The reported adverse event, although rare, should be closely evaluated and monitored. Because it is these measures that can help prevent long term consequences in pediatric and adult patients alike.

References:

An unusual case of bluish discoloration of the cornea after favipiravir therapy for COVID-19 - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8837286/)
Bioactive natural products in COVID-19 therapy - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9438897/)
Thailand’s First Pediatric Liquid Favipiravir – An innovation from Chula Faculty of Pharmaceutical Sciences for COVID-19 Patients - (https://www.chula.ac.th/en/highlight/78458/)

Source-Medindia