Tag: covid-19 treatments

Oral Antiviral COVID Treatments

Paxlovid and Molnupiravir are two new oral antiviral COVID treatments that were recently authorized.

As you are likely aware, a couple of new oral antiviral COVID treatments were recently authorized.

While that’s good news, especially if you have COVID and are at high risk for complications, it is important to understand that these still aren’t a quick cure for COVID.

Oral Antiviral COVID Treatments

So what do these treatments do then?

“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.”

Coronavirus (COVID-19) Update: FDA Authorizes First Oral Antiviral for Treatment of COVID-19

If you have COVID, taking these medications will hopefully keep you out of the hospital or keep you from dying!

“In this analysis, 1,039 patients had received Paxlovid, and 1,046 patients had received placebo and among these patients, 0.8% who received Paxlovid were hospitalized or died during 28 days of follow-up compared to 6% of the patients who received placebo.”

Coronavirus (COVID-19) Update: FDA Authorizes First Oral Antiviral for Treatment of COVID-19

Paxlovid can be given to adults and children who are at least 12 years old with mild to moderate COVID-19 and who are at high risk of disease progression.

Each dose of Paxlovid consists of 2 pink tablets of nirmatrelvir with 1 white tablet of ritonavir. For each dose, you take all 3 pills at the same time. Paxlovid is given twice a day for 5 days.

Now, although ritonavir is included in Paxlovid to slow down the breakdown of nirmatrelvir, it can also affect other medications you might be taking.

That means Paxlovid is contraindicated if you are already taking any medication that is dependent on CYP3A for clearance or which induces CPY3A, including, but not limited to amiodarone, colchicine, clozapine, lovastatin, sildenafil, trazolam, carbamazepine, phenobarbital, phenytoin, rifamin, and St. John’s Wort. Ask your health care professional and pharmacist if you have any drug interactions before taking Paxlovid.

What about side effects?

In addition to liver problems and drug interactions, possible side effects of Paxlovid include dysgeusia (altered or impaired sense of taste), diarrhea, increased blood pressure, and myalgia (muscle aches).

There are also concerns about extra risks in those with uncontrolled or undiagnosed HIV-1 infection who take Paxlovid.

Where can you get Paxlovid?

As it was just authorized, Paxlovid is in limited supply in most pharmacies and will likely be hard to find.

Your health care professional can prescribe Paxlovid to those who meet the requirements of the EUA. And they have been distributed to many pharmacies, although you may have to call around to get your prescription filled.

Another oral medication, Molnupiravir, was also recently authorized and can be given twice a day for 5 days. Molnupiravir is a nucleoside analogue that inhibits SARS-CoV-2 replication by viral mutagenesis, targeting SARS-CoV-2 RNA-dependent RNA polymerase (RdRp).

“FDA has issued an EUA for the emergency use of the unapproved product molnupiravir for the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adults who are at high risk for progressing to severe COVID-19, including hospitalization or death, and for whom alternative COVID-19 treatment options authorized by FDA are not accessible or clinically appropriate.”

Frequently Asked Questions on the Emergency Use Authorization for Molnupiravir for Treatment of COVID-19

Unlike Paxlovid, Molnupiravir should only be prescribed when all other alternative COVID-19 treatment options authorized by FDA are not accessible
or clinically appropriate.

“Possible side effects of molnupiravir include diarrhea, nausea, and dizziness. Molnupiravir is not recommended for use during pregnancy because findings from animal reproduction studies showed that molnupiravir may cause fetal harm when administered to pregnant individuals.”

Frequently Asked Questions on the Emergency Use Authorization for Molnupiravir for Treatment of COVID-19

You should not take molnupiravir if you are pregnant or breastfeeding.

“Females of childbearing potential are advised to use a reliable method of contraception correctly and consistently, as applicable, for the duration of treatment and for four days after the last dose of molnupiravir.”

Frequently Asked Questions on the Emergency Use Authorization for Molnupiravir for Treatment of COVID-19

In addition to the warnings about pregnancy, you should not get pregnant while taking Molnupiravir. In fact, although the risk is thought to be low and studies are ongoing, to avoid pregnancy, sexually active males “with partners of childbearing potential are advised to use a reliable method of contraception correctly and consistently during treatment and for at least three months after the last dose of Molnupiravir.”

Your health care provider can prescribe Molnupiravir, but it will likely also be in short supply for a while.

What To Know About Oral Antiviral COVID Treatments

While it is great that we now have even more treatments available when folks get COVID, it is important to understand that these are still unapproved drugs that are authorized for use under Emergency Use Authorization.

More on COVID Treatments

The Latest COVID-19 Treatment Regimens

The latest COVID-19 treatment regimens do not include zinc, vitamin C, vitamin D, CBD oil, azithromycin, or hydroxychloroquine.

As cases surge once again, let’s do an update on COVID-19 treatment regimens, after all, you have likely been hearing about cures and treatments for months now, right?

This doc also has a daily "immune booster" regimen that has you taking zinc, aspirin, vitamin B12, vitamin D3, NAC, vitamin C, probiotics, CBD oil, and Elderberry, in addition to taking hydroxychloroquine, azithromycin, budesonide, methylprednisolone, losartan, and ivermectim when you get sick with COVID-19.
This doc also has a daily “immune booster” regimen that has you taking zinc, aspirin, vitamin B12, vitamin D3, NAC, vitamin C, probiotics, CBD oil, and Elderberry, in addition to taking hydroxychloroquine, azithromycin, budesonide, methylprednisolone, losartan, and ivermectim when you get sick with COVID-19.

Unfortunately, despite the “treatments” that some folks are pushing, there still isn’t a cure and there aren’t many treatments that are very effective for COVID-19.

Sure, the FDA has granted emergency use authorization (EUA) for some treatments, including monoclonal antibodies, convalescent plasma, remdesivir, bamlanivimab, baricitinib, and casirivimab and imdevimab, but many are either for patients with severe COVID-19, who are progressing to severe COVID-19, or they are in limited supply.

The Latest COVID-19 Treatment Regimens

But why wouldn’t you take over a dozen medicines if someone on the Internet tells you they read a bunch of well designed studies, he has the support of “America’s Frontline Doctors,” and he has his own statistics proving they work?

Take home point - don't trust a health care provider who says that masks and lockdowns do nothing.
Take home point – don’t trust a health care provider who says that masks and lockdowns do nothing.

Because it all quickly falls apart if you really take a close look at what he is doing.

Consider Dr. Procter’s comparison of “death rates”…

He is trying to talk about the case fatality rate, but fails to mention any of the things that would cause his practice to have lower rates than the rest of the world, especially younger patients without many co-morbid conditions who aren’t yet hospitalized.

How many of Dr. Procter's patients are over age 65?
How many of Dr. Procter’s patients are over age 65?

And the bias in his data aside, there is evidence that shows his recommended treatments don’t work.

Some are even dangerous.

“The results of an observational study suggest that delayed viral clearance may be a concern in patients with non-severe COVID-19 who are receiving corticosteroids without antiviral drugs. Corticosteroids have also been associated with delayed viral clearance and/or worse clinical outcomes in patients with other viral respiratory infections.”

Therapeutic Management of Patients with COVID-19

So you should likely avoid these medications and unless you have a vitamin deficiency (zinc and vitamin C deficiency are very uncommon in developed countries), there is likely no good reason to take extra or high doses of vitamins to try and prevent or treat COVID-19.

The latest NIH recommendations for treating COVID-19 in non-hospitalized patients.

You should certainly make sure you are getting plenty of all of these important nutrients, especially vitamin D, but understand that the kind of multi-drug COVID-19 treatment regimens you might see some doctors pushing are not proven, are not recommended, and likely won’t help you get better any faster.

And again, some are harmful!

So why do some people think they work?

“Garlic is a healthy food that may have some antimicrobial properties. However, there is no evidence from the current outbreak that eating garlic has protected people from the new coronavirus.”

Coronavirus disease (COVID-19) advice for the public: Mythbusters

Probably the same reason that some folks think that eating garlic works against COVID-19 – it is a highly variable disease and some people have very mild symptoms and get better quickly. If you are lucky enough to be one of these people and you tried some alternative treatment, you will likely associate your quick recovery with that treatment, even if it was just a coincidence.

“New symptoms are usually due to the virus rather than side effects of medications.”

Brian Procter, MD

And if you are really lucky when following one of these treatment regimens, you won’t suffer any side effects as you try to recover from your COVID-19 symptoms. Especially if you are being treated by a doctor who might ignore those side effects…

So what treatments can work?

  • monoclonal antibodies, but except for sotrovimab, they don’t work well against the Omicon variant
  • high-titer COVID-19 convalescent plasma, but only only for the treatment of hospitalized patients with COVID-19 early in their disease course or hospitalized patients who have impaired humoral immunity
  • paxlovid (nirmatrelvir and ritonavir) – an oral antiviral that was recently authorized and can be given twice a day for 5 days to those nonhospitalized patients who test positive for SARS-CoV-2,who are at least 12 years old with mild to moderate COVID-19 and who are at high risk of disease progression
  • remdesivir – an IV medication that can be given once a day for 3 days to those nonhospitalized patients who test positive for SARS-CoV-2,who are at least 12 years old with mild to moderate COVID-19 and who are at high risk of disease progression
  • molnupiravir – was recently authorized and can be given twice a day for 5 days to those nonhospitalized patients who test positive for SARS-CoV-2, who are at least 18 years old with mild to moderate COVID-19 and who are at high risk of disease progression
  • dexamethasone – typically only used in hospitalized patients who require oxygen

And of course, better than getting sick and relying on these treatments, you should encourage everyone to get vaccinated and boosted!

More on COVID-19 Treatment Regimens

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