154 - What’s New With Paxlovid: Drug Interactions, Pharmacist Prescribing, “Paxlovid Mouth”, and a Brief Drug Review

HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast

Sean P. Kane, PharmD, BCPS

Health & Fitness, Medications, Rosalindfranklin, Rfums, Pharmacy, Pharmd, Pharmacist, Medicine, Drugs

5 • 644 Ratings

🗓️ 27 September 2022

⏱️ 44 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this episode, we review Paxlovid (nirmatrelvir/ritonavir) from the perspective of its pharmacology, efficacy, safety, pharmacists’ authority to prescribe, drug interactions, and rebound symptoms after Paxlovid therapy.

Key Concepts

Paxlovid is the preferred outpatient therapy for COVID-19 in patients at high risk for progressing to severe COVID-19. It likely has similar efficacy to IV monoclonal antibodies and IV outpatient remdesivir but differences in vaccination rates and patient populations makes a direct comparison difficult.
The 5-day course of Paxlovid is generally well tolerated. “Paxlovid mouth” (dysgeusia) is relatively common and is characterized by a terrible metallic or garbage-like taste in the mouth during therapy.
As of July 2022, licensed pharmacists have the authority to assess patients for Paxlovid and prescribe the therapy; however, Medicare/Medicaid reimbursement has not clearly established how reimbursement of clinical services can occur.
“Rebound” COVID-19 symptoms may or may not be due to Paxlovid (versus the natural course of the disease). If rebound symptoms occur, they are almost always mild or asymptomatic in nature and do not require additional treatment.

References

DailyMed - PAXLOVID- nirmatrelvir and ritonavir kit (nih.gov). https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7bdddfba-bd31-44cb-ba9e-23a4e17a4691
Underlying Medical Conditions Associated with Higher Risk for Severe COVID-19: Information for Healthcare Professionals. CDC. June 15, 2022. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/underlyingconditions.html
EPIC-HR Study: Hammond J, Leister-Tebbe H, Gardner A, et al. Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19. N Engl J Med. 2022;386(15):1397-1408. doi:10.1056/NEJMoa2118542. https://www.nejm.org/doi/full/10.1056/NEJMoa2118542
COVID-19 Rebound After Paxlovid Treatment. CDC Health Alert Network. May 24, 2022. https://emergency.cdc.gov/han/2022/han00467.asp
FDA Authorizes Pharmacists to Prescribe Paxlovid with Certain Limitations. Administration for Strategic Preparedness & Response (ASPR). July 6, 2022. https://aspr.hhs.gov/COVID-19/Therapeutics/updates/Pages/important-update-06July2022.aspx
PAXLOVID Patient Eligibility Screening Checklist Tool for Prescribers. https://www.fda.gov/media/158165/download

Transcript

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0:00.0	Welcome to Helix Talk, an educational podcast for healthcare students and providers covering real-life clinical pearls, professional pharmacy topics, and drug therapy discussions.
0:11.0	This podcast is provided by pharmacists and faculty members at Rosal Franklin University College of Pharmacy.
0:17.0	This podcast contains general information for educational purposes only. This is not professional
0:22.4	advice and should not be used in lieu of obtaining advice from a qualified health care provider.
0:27.2	And now on to the show. Welcome to Helix Talk, episode 154. I'm your co-host, Dr. Kaine.
0:35.9	And I'm Dr. Patel. And the title of today's episode is
0:39.2	What's New with Pax-Livid, Drug Interactions, Pharmacist Prescribing, Pax-Lid Mal, and a brief
0:46.0	drug review. It looks like we have a great potpoury to review Pax-Lovid from just overall
0:52.8	perspective of pharmacology, efficacy, its safety, you know,
0:57.6	where we stand for a pharmacist's authority to prescribe this drug, drug interactions, things to monitor,
1:04.0	and then some of the issues, quote-unquote, we have noticed with that, such as the ADRs or even
1:09.6	the rebound symptoms after PaxSover
1:12.2	therapy. Absolutely. So Dr. Pacta, we know that Pax-Livit has been out for a while now and it's
1:17.6	been prescribed a lot. So the focus of today's episode is more on what's new or different or something
1:23.0	that providers need to know about Pax-Livett as opposed to the very nuts and bolts of
1:28.4	Paxovit and going through the initial clinical data for it.
1:32.0	So as we understand, Paxovit is a combination of two different medications.
1:37.5	So not necessarily co-formulated as in two molecules and one tablets, but they're co-packaged or combo blister packs available.
1:48.3	So we have the near matrelovir and rotonevere as part of this combination blister package.
1:55.9	Yeah, and the new drug here is near matrelovir, and this is a protease inhibitor. This is the drug that is active for the COVID-19 virus.
2:04.7	It's actually a protease inhibitor.
2:06.3	And what that means is that when viruses make their proteins that they need, they have
	...

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