paxlovid and timing of steroid injection?

[ctts]

Anyone have any thoughts about the timing of steroid injection after taking Paxovid?

Would anyone do injection while taking? Probably would not want them in office though as they are likely still infectious.

Immediately after finishing? Or wait X number of days after taking Paxlovid?

I told my patient to wait 1 week, and assuming that they are asymptomatic or clearly recovering at that point.

---

Members don't see this ad.

 

[MitchLevi]

No idea, but if a pt is sick with any illness they don't get a procedure from me.

One week off antibiotics if given ABx.

One week after sickness.

 

[DOctorJay]

agree with Mitch,

I want things resolved before I stick someone to minimize chances of being blamed for anything

 

[Ducttape]

If they are on paxlovid, they were diagnosed within the past 5 days.

I wouldn't do any injection on someone who is being treated for covid for at least a week after they are off restrictions. Ie at least 2 weeks after testing positive.

 

[au bon pain]

2 weeks s/p course of abx for whatever infection and all those symptoms resolved.

2 weeks s/p paxlovid and must be symptom- free, but if any ongoing/residual symptoms (ie chance of rebound) than more like 3 weeks.

For other viruses (ie hsv) treated with an antiviral, generally 2 weeks after finishing med/complete resolution of symptoms. Except no no consideration for tamiflu as it’s garbage anyway.

 

[clubdeac]

Knew a surgeon who was treating an infected ACDF order a lumbar ESI for a lady’s sciatica. What do ya know 3 days later she develops a lumbar epidural abscess. 🤦🏻‍♂️🤦🏻‍♂️

Always wait several weeks until infection has cleared

 

[p1at0]

This is an excellent question. The issue is RITONAVIR. Ritonavir is a landmine. Ritonavir strongly inhibits cytochromes that metabolize steroid. There are numerous publications on this topic. There are “black box” warnings on ritonavir in other countries, regarding in part this issue. Many reports have been published describing patients who have had recent medications containing ritonavir, with devastating outcomes after steroid administration. For example, Cushing’s or avascular necrosis after a single musculoskeletal steroid injection. It is not entirely clear what time is required for cytochromes to regenerate after stopping ritonavir, to a clinically meaningful degree, to dodge the adverse effects of markedly amplified steroid. I have been insisting on about two months.