Pfizer’s antiviral drug Paxlovid is designed to reduce the risk of hospitalization in patients with COVID-19, and is approved for use across Canada.
Although it has the potential to provide relief to hospitals during coronavirus outbreaks, some doctors and pharmacists believe it is not being used as widely as it should be.
Dr. Brian Conway is Medical Director of the Vancouver Infectious Diseases Center and Assistant Professor in the Department of Pharmacology and Therapeutics at the University of British Columbia. He said the lack of use could be due to a number of factors, including restrictions on who can prescribe it and a lack of awareness of the treatment, both among the public and among healthcare professionals.
“We may not be prescribing it broadly enough,” Conway told CTVNews.ca. “My feeling is that when I talk to family doctors who might be the front line, they don’t know. Many pharmacists. I’ve had to work with them and explain to them what this stuff is. There’s no not taken a lot of effort to make sure everyone knows what it is.
HOW IT WORKS
According to Health Canada, Paxlovid is an antiviral medication in pill form that works best to limit the severity of COVID-19 when taken early in an infection with mild to moderate symptoms.
Patients take two doses a day for five days, and each dose consists of two pink tablets of nirmatrelvir and one white tablet of ritonavir. Nirmatrelvir is an antiviral drug that inhibits a SARS-CoV-2 protein to prevent the virus from replicating, while ritonavir delays the breakdown of nirmatrelvir to help it work longer in the body.
Eligible patients are taking the drug at home after testing positive for COVID-19. According to the Ontario COVID-19 Science Advisory Table, side effects are generally mild and may include taste disturbance, diarrhea, muscle aches, vomiting, high blood pressure, and headache.
WHO IS ELIGIBLE
In Canada, Paxlovid is approved for people who test positive for COVID-19 and who are at increased risk of developing severe symptoms of COVID-19 that may require hospitalization.
It’s up to the provinces and territories to prioritize who qualifies, but Health Canada says age is the most important risk factor for serious illness and hospitalization, seniors who are unvaccinated or whose vaccinations are not up-to-date being the most at risk.
Other eligible adults include immunocompromised people and those with serious underlying conditions such as obesity or diabetes, as well as people over the age of 60 living in underserved, rural or remote communities or in institutions. collective care.
Paxlovid is not approved for people who have not tested positive for COVID-19, patients who are already being treated in hospital for COVID-19, or anyone under the age of 18.
The drug interacts with dozens of common medications, including certain heart medications, certain antibiotics, hormonal contraceptives, and those used to treat erectile dysfunction, blood cholesterol, and seasonal allergies.
It is also not recommended at full strength for people with kidney problems. Anyone with kidney problems or taking any medication that may interact with Paxlovid should consult their healthcare provider.
Provinces and territories are responsible for prioritizing access to Paxlovid, so anyone with questions about their own eligibility should contact their local or provincial public health department or healthcare provider.
WHO CAN PRESCRIBE AND DELIVER IT
Provinces and territories have the power to decide who can prescribe and dispense Paxlovid, which Conway says has created a patchwork of policies ranging from simple and streamlined to complicated and bureaucratic.
“So different provinces have different approaches, the simplest being if someone is positive on a rapid test they can report that result to a pharmacist or the pharmacist can do the test on the spot and then the pharmacist can bond with a doctor, a brief interaction occurs and the drug is prescribed,” Conway said. “So that’s the easiest.”
Provinces where pharmacists can prescribe Paxlovid to patients who test positive for COVID-19 include Quebec, Alberta, Saskatchewan, and Newfoundland and Labrador.
In other provinces, pharmacies can dispense Paxlovid, but only doctors and nurse practitioners can prescribe it. This is the case in Ontario and British Columbia.
“The most complicated [system] is potentially the one we have here in BC, where there’s a form that has to be filled out and they’ve established eligibility criteria for Paxlovid, and the individual has to meet those requirements,” Conway said.
Conway says the process is so complicated that some doctors have chosen not to prescribe Paxlovid to avoid filling out the paperwork.
In a July 11 press release, Dr. Danielle Paes, chief pharmacist of the Canadian Pharmacists Association, called on provincial governments to empower pharmacists to provide point-of-care testing and prescribe treatment for COVID-19 such as Paxlovid
“Quebec was the first jurisdiction in the world to allow pharmacists to prescribe Paxlovid and has seen a marked increase in the use of the COVID-19 antiviral, helping to keep patients out of hospitals. Other provinces have followed suit, but many have yet to activate this essential service,” said Dr. Paes.
“Pharmacist-prescribed Paxlovid is just one example of the kind of innovative community care that will reduce pressure on our hospitals while expanding access to the services and care Canadians rely on.
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