Ask Your Pharmacist

October 19, 2022

Q:

Is there a medication that pharmacists can now prescribe to treat COVID-19?

A:

Pharmacists in New Brunswick have recently been granted authority to assess, and where appropriate, to prescribe, treatment for mild to moderate COVID-19 infection.

Paxlovid includes a combination of two anti-viral medications, nirmatrelvir and ritonavir.

To be eligible for Paxlovid a person must be within five days of symptom onset of COVID-19 and have a positive test result. This includes a laboratory-confirmed PCR test, or a point of care test such as Abbott’s ID test or other Point of Care Tests (POCT), also known as rapid antigen tests. 

You are considered at higher risk if you do not have your primary series of immunization(s?) against COVID-19. This means those who do not have two doses of COVID-19 vaccine. Older adults are also considered higher risk, as are those with one or more chronic health conditions. If you are moderately to severely immunocompromised due to a medical condition, medication, or treatment, you may also be at higher risk. 

Your pharmacist can advise you about the risks and benefits of treatment with Paxlovid. Often, the decision will not be black and white. and it will be important to weigh the pros and cons with your pharmacist, who will not hesitate to seek the expert opinion of other health professionals such as your doctors, nurse practitioners, or specialists involved in your medical history.

Treatment with Paxlovid is not a "magic bullet" that will completely eliminate your illness. The best we can hope for is that the medication will lessen the severity of your illness and prevent your symptoms from worsening so that you can hopefully avoid more serious outcomes such as a hospital stay, critical illness, or even death.

It is important to remember that Paxlovid therapy is only for mild to moderate infection in people whose symptoms are not improving. Such symptoms may include cough, sore throat, fever, chills, tiredness and malaise, muscle aches, diarrhea, nausea, vomiting, or headache. Those who have any signs of difficulty breathing, shortness of breath, chest tightness, or the need for oxygen therapy should be assessed by a physician or nurse practitioner. Paxlovid may not be the best treatment for these patients and other medications and therapies may be a better choice.

Dosing of Paxlovid for patients with normal kidney function is three tablets twice daily for five days. Paxlovid is dispensed in a box containing 5 tinfoil cards. Each card is colour-divided with three yellow foil containing three tablets and three blue foil containing three tablets. The three yellow foil tablets are to be taken each morning with a full glass of water, and the three blue foil containing tablets are taken each evening with a full glass of water. Paxlovid may be taken with or without food. The tablets may be crushed.

If you have impaired kidney health, you may not be a candidate for Paxlovid. Your pharmacist will advise you on dosing directions.

Paxlovid is generally well tolerated with the most common side effects being nausea, diarrhea, loss of taste, and rarely vomiting.  

However, there are several significant drug interactions with Paxlovid. Your pharmacist must have a complete list of every medication you are taking, both by prescription and over-the-counter, as well as herbal remedies, in order to thoroughly check for potential interactions and advise you. Make sure you understand how to take Paxlovid, and what to do with your other medications while on Paxlovid therapy. If you are at all unclear, be sure to ask and clarify.

It is important to note, if you have COVID-19 please don’t come to your community pharmacy for assessment. The best way to assess your eligibility for Plaxlovid is to call your local pharmacy and schedule a phone appointment.

If you are eligible, the pharmacist will counsel you during this appointment on safe use of the medication. Please allow your pharmacist adequate time to prepare your prescription, make needed dosage adjustments, and prepare counselling advice for your individual plan. This may take up to an hour or more depending on other priorities at any given time.

Arrangements will be made with you to either have the medication delivered to your home, to have a trusted non-infected friend or family member pick the prescription up for you, or we will make arrangements for a curbside pick-up.  

 

Dr. Kevin Duplisea (PharmD BSc. Pharm, BSc. ACPR) is a pharmacist at Shoppers Drug Mart in Quispamsis, New Brunswick. His opinions are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. Send your questions to AskYourNBPharmacist@gmail.com.