Antivirals

NIH Resource: Drug-Drug Interactions Between Ritonavir-Boosted Nirmatrelvir (Paxlovid) and Concomitant Medications

Ritonavir, a strong cytochrome P450 (CYP) 3A4 inhibitor and a P-glycoprotein inhibitor, is coadministered with nirmatrelvir to increase the blood concentration of nirmatrelvir, thereby making it effective against SARS-CoV-2. Ritonavir may also increase blood concentrations of certain concomitant medications. Because ritonavir-boosted nirmatrelvir (Paxlovid) is the only highly effective oral antiviral for the treatment of COVID-19, drug interactions that can be safely managed should not preclude the use of this medication.

WHO resource: WHO updates its treatment guidelines to include molnupiravir

WHO has updated its living guidelines on COVID-19 therapeutics to include a conditional recommendation on molnupiravir, a new antiviral medicine.

This is the first oral antiviral drug to be included in the treatment guidelines for COVID-19. As this is a new medicine, there is little safety data. WHO recommends active monitoring for drug safety, along with other strategies to mitigate potential harms.

Fact Sheet: COVID-19 Test to Treat

Through this program, people are able to get tested and – if they are positive and treatments are appropriate for them – receive a prescription from a health care provider, and have their prescription filled all at one location. These “One-Stop Test to Treat” sites are available at hundreds of locations nationwide, including pharmacy-based clinics, Health Resources Services Administration (HRSA)-supported federally-qualified health centers (FQHCs), and long-term care facilities. People can continue to be tested and treated by their own health care providers who
can appropriately prescribe these oral antivirals at locations where the medicines are distributed. 

NIH Resource: The COVID-19 Treatment Guidelines Panel’s Interim Statement on Patient Prioritization for Outpatient Anti-SARS-CoV-2 Therapies or Preventive Strategies When There Are Logistical or Supply Constraints

The COVID-19 Treatment Guidelines Panel (the Panel) has recommended several therapeutic agents for the treatment and prevention of SARS-CoV-2 infection in individuals who are at high risk for progression to severe COVID-19. These anti-SARS-CoV-2 therapeutics are of greatest benefit for nonhospitalized patients who have risk factors for progression to severe COVID-19. With the increase in cases of COVID-19 and the emergence of the Omicron (B.1.1.529) variant of concern, there may be logistical or supply constraints that make it impossible to offer the available therapy to all eligible patients, making patient triage necessary. 

Regarding multimodality therapies, specifically steroids, what would you administer to a patient with COVID-19 today? If the patient were on remdesivir, would you continue the remdesivir for the full duration of therapy?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on July 14, 2021

Treatments of Moderate and Severe COVID-19 Pneumonia

Antiviral and Immunomodulatory Therapies for COVID-19. This is SCCM curated COVID-19 microlearning content.

Curriculum Topic: Infectious Complications & Management of COVID-19 Infection / Nosocomial

What is your local practice for using Remdesivir in the ICU?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on December 9, 2020.

What is your experience with COVID-19 patients and ECMO?

Despite remdesivir, dexamethasone, and twice-daily anticoagulation, a patient’s condition continues to deteriorate. The patient is intubated, and every possible ventilation mode has been tried. The P/F ratio is decreasing, and pressure ventilation is not working. What is your experience with COVID-19 patients and ECMO? This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on November 4, 2020.

Which medications are used for a hemodynamically unstable intubated patient who is progressing toward or has developed acute respiratory distress syndrome? Are remdesivir or steroids used? What about anticoagulation, given the high risk of thrombosis?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on November 4, 2020.

For a stable patient on the ward who needs 2 to 4 liters of oxygen, is hemodynamically stable, and does not seem to be deteriorating, would you start a medication such as remdesivir or steroids or would you wait until the patient’s condition starts to det

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on November 4, 2020.

Would you use remdesivir or steroids as early as admittance to the emergency department? Do you advocate their use?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on November 4, 2020.

Should dexamethasone or remdesivir be started on a patient who requires oxygen via nasal cannula and is highly suspected of having COVID-19 if test results are still pending?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on September 9, 2020.

COVID-19 Pharmacology Debates: Steroid and Antiviral Use in COVID-19 Patients

ASHP and the SCCM teamed up in their second series of therapeutic debates in the management of COVID-19. In the first debate, the content matter experts reviewed the latest literature and debate the use of steroids for treatment of COVID-19.