Your Local Pharmacist Can Now Prescribe Paxlovid To Treat COVID-19

Terry Ann Donner, BSN, RN

On July 6, 2022, the Food and Drug Administration (FDA) announced that state-licensed pharmacists are authorized to prescribe the Covid-19 anti-viral medication, Paxlovid, in limited circumstances. Manufactured by Pfizer, Paxlovid decreases the severity of COVID-19 symptoms and hospitalizations. To be effective, Paxlovid must be administered within five (5) days of the onset of mild to moderate COVID symptoms. Overcrowding in emergency rooms, long waits to get a primary care physician appointment, or not having a primary care physician often results in delaying treatment beyond the five (5) day period when Paxlovid is most effective. For individuals with chronic conditions, such as hypertension, diabetes or those 65 years of age and older, losing the ability to be treated timely with Paxlovid can result in serious illness and hospitalization.

The Role of the Pharmacist During the Pandemic

Since the beginning of the pandemic in 2020, pharmacists have been boots on the ground, keeping pharmacies open and serving individuals in the community. Social distancing and eventually masking guidelines based upon Centers for Disease Control and Prevention recommendations were adopted, and the pharmacist became the informal community educator on signs and symptoms of COVID, testing and treatment options, and eventually advocating for and administering vaccinations.

Pharmacists have unique access to those who are medically and socially vulnerable because 90% of Americans live within 5 miles of a community pharmacy. This at-risk population often does not have easy access to other medical services, such as primary care physicians or clinics, due to transportation issues. Paxlovid is only effective if the symptoms of COVID-19 are mild to moderate and the medication is given within five (5) days of the onset of symptoms.

What is Paxlovid?

Manufactured by Pfizer, Paxlovid consists of 2 generic medications nirmatrelvir and ritonavir. Nirmatrelvir is an anti-viral medication that stops the SARS-CoV-2 protein from replicating and entering uninfected cells. Ritonavir, which is used in the treatment of HIV/AIDS, stops the nirmatrelvir from being broken down too quickly, giving it time to do its job. 3 pills (two nirmatrelvir and one ritonavir) are given twice a day for 5 days.

Pfizer has represented that Paxlovid is effective against Omicron. However, there have not yet been any studies published in peer-reviewed medical journals.

The FDA gave emergency use authorization to physicians and other individuals with prescriptive authority, like physician assistants and advance practice nurses, in December 2021 to treat mild to moderate COVID-19 in adults and children who are 12 years of age or older and weigh at least 40 kilograms (88 pounds), if: (1) they have a positive COVID-19 test, and (2) are at high risk for hospitalization or death. Individuals with cancer, obesity, diabetes, or other chronic disease and those 65 years of age and older are considered high risk for hospitalization or death from COVID-19 and are potential candidates for treatment with Paxlovid.

Paxlovid cannot be prescribed if:

An individual needs to be hospitalized due to severe COVID-19 symptoms, or
It is being prescribed as a method of pre-exposure or post-exposure prevention of COVID-19.

In addition to the above guidelines, pharmacists cannot prescribe Paxlovid unless:

The pharmacist has sufficient information to assess an individual’s renal and hepatic function through access to electronic or printed health records, which are less than 12 months old, or after consultation with a health care provider who has a relationship with the patient; and
The pharmacist is able to obtain a comprehensive list of medications (prescription medications, supplements and over-the-counter medications) to assess the potential for drug interactions with Paxlovid.

If the pharmacist cannot evaluate the renal or hepatic function from the individual’s medical records, there is not sufficient information on the medications being taken or certain medications must be modified to avoid drug interactions with Paxlovid, the pharmacist cannot prescribe Paxlovid and will have to refer the individual for additional clinical evaluation.

Getting access to health records or speaking with other health care providers can cause delays that may go beyond the 5-day window of opportunity for treatment. If an individual can print copies of his electronic medical records from his health care provider’s patient portal, it will help him get access to timely treatment.

Other Considerations in Prescribing Paxlovid

There is a long list of medications that Paxlovid may interact with, including organ anti-rejection medications, medications used to treat heart arrhythmias, anticoagulants, or blood thinners, and cholesterol medications like Lipitor.

The list of side effects is also considerable, including altered sense of taste, muscle aches, increased blood pressure, diarrhea, abdominal pain, nausea, malaise, and liver complications. The individual will have to be counseled by the pharmacist about these potential complications and to contact a physician if he develops any of the potential side effects.

Allergic reactions with Paxlovid are also possible, including hives, difficulty swallowing or breathing, throat tightness, swelling of mouth, lips, or face, hoorificeness and/or skin rash.

Rebound COVID-19

Rebound of COVID-19 symptoms has been reported in some individuals within 2 to 8 days after completing the 5-day course of Paxlovid. Some individuals have tested positive again without symptoms, and others have a recurrence of symptoms. This phenomenon is still under study and may be part of the natural history of COVID-19 in some individuals, regardless of treatment with Paxlovid. The recommendation has been to restart isolation for 5 days.

When Will Pharmacists Start Prescribing Paxlovid?

As of the date of this article, pharmacists at several big pharmacy chains, had not received instruction on how to proceed with their prescriptive authority, but were told that it was coming soon.

References

Breaking: FDA permits pharmacists to prescribe Paxlovid to treat COVID-19

Coronavirus (COVID-19) Update: FDA Authorizes Pharmacists to Prescribe Paxlovid with Certain Limitations

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

Pharmacists Can Now Prescribe Paxlovid With Certain Limitations

Excluding Pharmacists from COVID Antiviral Prescribing Hurts Most Vulnerable

The availability of pharmacies in the United States: 2007-2015