COVID-19 pills starting to become available

Oral medications to treat COVID-19 are starting to become available locally, but so far only in limited supply. Mark Johannigman, corporate director of pharmacy services and supply chain for Blanchard Valley Health System, said the health system has "a limited supply" on hand and has "dispensed several prescriptions to patients that qualify." He added that oral antiviral agents are a possible treatment option in high-risk patients and are being reserved locally for those who fit this criteria until more supply becomes available. Johannigman said the medications should be started "as soon as possible after testing positive for COVID-19," and within five days of symptom onset. "Unlike vaccines, they do not prevent the disease but provide additional treatment options when monoclonal antibody therapy is not available or contraindicated," he said. The oral agents were granted emergency use authorization, Johannigman said, so there are limited studies so far on their safety and efficacy. Paxlovid, made by Pfizer, is a combination of two antiviral medications, said Dr. Nathaniel Ratnasamy, medical director of Hancock Public Health and an infectious disease physician for the health system. One is a protease inhibitor, a medication that blocks the virus from replicating in people's cells, he said. "Paxlovid consists of nirmatrelvir, which inhibits a SARS-CoV-2 protein to stop the virus from replicating, and ritonavir, which slows down nirmatrelvir's breakdown to help it remain in the body for a longer period at higher concentrations," states a U.S. Food and Drug Administration press release from December, announcing the drug's emergency use authorization. Ratnasamy said the treatment is typically three pills, given twice a day for five days. Studies show the greatest benefit if the medication is started within the first five days of symptom onset, but ideally it should begin as early as possible. Ratnasamy said Paxlovid is not recommended for hospitalized patients, and is only for symptomatic people. Studies have mainly been conducted on patients with the delta variant of the virus, but scientists believe it would work against omicron as well, Ratnasamy said. He said a study found 0.08% of patients who took the medication ended up being hospitalized, compared with 6.3% given a placebo. And there were zero deaths in that study among the patients taking the medication, compared with 12 among those taking the placebo. Ratnasamy said side effects can include taste alteration, diarrhea, elevated blood pressure and muscle pains. However, most of these were experienced by few people, with the most common — taste alteration — being reported by 6% of patients. So, Ratnasamy said, most people should tolerate it well. But Paxlovid can interact with other medications, including some psychiatric and heart medications, Ratnasamy said. Patients and their doctors should be aware of this, and may in some cases need to change their dose of other medications. He said it's important that health care providers get a complete list of medications the patient is taking, including over-the-counter and herbal medications. An FDA fact sheet on Paxlovid urges patients to tell their health care provider if they: have any allergies; have liver or kidney disease; are pregnant or plan to become pregnant; are breastfeeding a child; or have any serious illnesses. It also states that people with kidney disease may need a different dose, and that Paxlovid can affect how birth control pills work. There is not a lot of clinical data yet in pregnant or breastfeeding patients, and the medication has not yet been tried in children, Ratnasamy said. Another medication is Molnupiravir, which is made by Merck. Ratnasamy said this is also an oral medication, to be started within five days of symptom onset. It is not authorized for patients 18 and younger, and is not recommended for hospitalized patients. He said this treatment is four capsules to be given twice a day for five days. Ratnasamy said Molnupiravir "definitely helps," but, so far, hasn't been found to be quite as effective as Paxlovid. Experts are awaiting more data. He said Molnupiravir will likely be used less often than other treatments such as monoclonal antibodies, Paxlovid and remdesivir. He said one study found that 6.8% of people receiving the medication, compared with 9.7% of those receiving a placebo, ended up in the hospital. And 0.1% of those receiving the medication and 1.3% of those receiving a placebo died of the virus. Side effects can include diarrhea, nausea and dizziness, but, again, these symptoms are experienced by relatively few people. An FDA Molnupiravir fact sheet states that the treatment is not recommended for use in pregnancy, although in some cases it may be given if no other treatment option seems appropriate. It also advises patients to tell their health care provider if they: have any allergies; are breastfeeding or plan to breastfeed; have any serious illnesses; or are taking any medicines (prescription, over-the-counter, vitamins or herbal products). Ratnasamy said the drug works differently than Paxlovid. "Molnupiravir is a medication that works by introducing errors into the SARS-CoV-2 virus' genetic code, which prevents the virus from further replicating," states an FDA press release, also from December, announcing the medication's emergency use authorization for the treatment of mild-to-moderate COVID-19 both in adults at high risk of progressing to more severe illness and for whom other treatment options are "not accessible or clinically appropriate." Noting that monoclonal antibody infusions should also be given as soon as possible, Ratnasamy urged anyone who tests positive to call their doctor immediately. With a limited supply of these medications, Ratnasamy said, they are being especially directed to those considered at highest risk. Arthurs: 419-427-8494