Paxlovid dispensing

[owlegrad]

So where I work we have a form we have to fill out before we dispense Paxlovid. It’s basically a checklist of items to make sure the patient qualifies in the first place (positive Covid test, etc) and doesn’t have any disqualifications (renal function, interactions, etc).

I am curious if this is normal or just extra work my job is having us do?

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[Igra]

So where I work we have a form we have to fill out before we dispense Paxlovid. It’s basically a checklist of items to make sure the patient qualifies in the first place (positive Covid test, etc) and doesn’t have any disqualifications (renal function, interactions, etc).

I am curious if this is normal or just extra work my job is having us do?

A friend of mine says she has to do very similar things at her retail location, idk how you're supposed to verify renal function without labs though...also she has been dealing with doctors who insist on prescribing it regardless of absolute contraindications with other drugs

 

[WorthlessOxygen]

Never had to do that myself but I did always make sure to verify kidney function before dispensing

 

[RXDOC1986]

So where I work we have a form we have to fill out before we dispense Paxlovid. It’s basically a checklist of items to make sure the patient qualifies in the first place (positive Covid test, etc) and doesn’t have any disqualifications (renal function, interactions, etc).

I am curious if this is normal or just extra work my job is having us do?

You didn't specify retail or hospital - here at the hospital, we have to fill out(long) electronic forms for every specific medication use - ie REMDESIVIR, REGEN-COV (IV treatment that includes two monoclonal antibody medications: casirivimab and imdevimab)
detailed documentation is part of daily work

 

[Pronounce Doxazosin]

So where I work we have a form we have to fill out before we dispense Paxlovid. It’s basically a checklist of items to make sure the patient qualifies in the first place (positive Covid test, etc) and doesn’t have any disqualifications (renal function, interactions, etc).

I am curious if this is normal or just extra work my job is having us do?

Sounds stupid, unless you are actually prescribing the meds to the patient

 

[RxPreceptor]

yeah, getting out of hand. MDs not giving a damn and wanting to use it prophylactically has been grinding my gears lately. Just blatantly overlooking common interactions too and blatantly not understanding renal function objectively (30-60mL/min CrCl range is a lot more common than one would think with 65+YOs). I‘d regularly get MDs sending for normal renal function doses of Paxlovid for 80+YOs…when I’d call said MD their excuse would be said patient is not on dialysis…again demonstrating true ignorance in renal function

would like to see more MDs be more willing to use molnupiruvir when paxlovid has too many risk factors (interactions, uncertain renal function, etc.)

 

[mentos]

No form for us, but we have to check for positive Covid test and renal function. I'm not sure if anyone would notice if those things weren't checked though.

 

[VA Hopeful Dr]

yeah, getting out of hand. MDs not giving a damn and wanting to use it prophylactically has been grinding my gears lately. Just blatantly overlooking common interactions too and blatantly not understanding renal function objectively (30-60mL/min CrCl range is a lot more common than one would think with 65+YOs). I‘d regularly get MDs sending for normal renal function doses of Paxlovid for 80+YOs…when I’d call said MD their excuse would be said patient is not on dialysis…again demonstrating true ignorance in renal function

would like to see more MDs be more willing to use molnupiruvir when paxlovid has too many risk factors (interactions, uncertain renal function, etc.)

Every time I get a call from a pharmacist for something that I think is obvious and self-explanatory which irritates me I come here and am reminded that many of my colleagues are either lazy, ignorant, or both.

On the subject of molnupiruvir, I thought I remember hearing that the evidence on that one wasn't as good as for Paxlovid. Am I making that up or does it also in theory work fairly well?

 

[Rockinacoustic]

Every time I get a call from a pharmacist for something that I think is obvious and self-explanatory which irritates me I come here and am reminded that many of my colleagues are either lazy, ignorant, or both.

On the subject of molnupiruvir, I thought I remember hearing that the evidence on that one wasn't as good as for Paxlovid. Am I making that up or does it also in theory work fairly well?

None of these treatments have been compared head-to-head, but Paxlovid reduced the rates of hospitalization and death 88%, and molnupiravir by 30% in their respective trials compared to placebo. Nonhospitalized Adults: Therapeutic Management | COVID-19 Treatment Guidelines

 

[VA Hopeful Dr]

None of these treatments have been compared head-to-head, but Paxlovid reduced the rates of hospitalization and death 88%, and molnupiravir by 30% in their respective trials compared to placebo. Nonhospitalized Adults: Therapeutic Management | COVID-19 Treatment Guidelines

Yep, don't expect us to start using molnupiravir anytime soon.

My personally, if there are contraindications to Paxlovid (which as y'all well know is very often) I send them for antibody infusions. If that wasn't an option, I guess the other would be better than nothing.

 

[RxPreceptor]

Yep, don't expect us to start using molnupiravir anytime soon.

My personally, if there are contraindications to Paxlovid (which as y'all well know is very often) I send them for antibody infusions. If that wasn't an option, I guess the other would be better than nothing.

I’m thinking along the lines of those 80+YOs with multiple contraindicated interactions major interactions (tamsulosin, simvastatin, blood thinners) who are getting prescribed standard renal dose paxlovid without any word/forethought from MD on managing interactions/holding any meds. Truly half assed prescribing

we all know paxlovid is more efficacious but sometimes you’ve got to compromise given circumstances

 

[Rockinacoustic]

In my experience there are many interactions, but few that are absolute contraindications without appropriate management.

Dispensing this drug just exemplifies how fragmented our health care system is, and I can't imagine how my retail/outpatient colleagues are doing so in good faith.

"Here- take this drug for 5 days, hold/halve these specific medications, and then resume them at the normal dose a few days after your finish... what do you mean you had a televisit with a new provider and didn't tell them you were on Eliquis?"

 

[Dred Pirate]

Every time I get a call from a pharmacist for something that I think is obvious and self-explanatory which irritates me I come here and am reminded that many of my colleagues are either lazy, ignorant, or both.

On the subject of molnupiruvir, I thought I remember hearing that the evidence on that one wasn't as good as for Paxlovid. Am I making that up or does it also in theory work fairly well?

unfortunately all professions have those that are lazy and/or ignorant -

 

[VA Hopeful Dr]

And then we have people that just are awesome at their jobs like everyone on this thread

 

[Abby Atwood]

Calculation for eGFR is a little less extreme in its adjustment for age compared to CrCL.

For an 80 year old 5’6” 140lb woman with a SCr of 0.9 mg/dL:
- CrCL = 46 mL/min
- eGFR = 64 mL/min adjusted for BSA.

Unlike most drugs, Paxlovid uses eGFR for renal adjustment. People on here are probably a few steps ahead of me on this, but I was surprised by that when the drug was released under its EUA. We see CrCL so much more commonly.

 

[RXDOC1986]

Calculation for eGFR is a little less extreme in its adjustment for age compared to CrCL.

For an 80 year old 5’6” 140lb woman with a SCr of 0.9 mg/dL:
- CrCL = 46 mL/min
- eGFR = 64 mL/min adjusted for BSA.

Unlike most drugs, Paxlovid uses eGFR for renal adjustment. People on here are probably a few steps ahead of me on this, but I was surprised by that when the drug was released under its EUA. We see CrCL so much more commonly.

The main difference between GFR and CrCl is that GFR is the flow rate of filtered fluid through the kidney whereas CrCl is the volume of blood plasma cleared of creatinine per unit time. Furthermore, CrCl is a useful measurement for approximating GFR (not the other way around)

Based on the above two calculations, it is easy to see why GFR is the better indicator - if CrCl was continued to be used, more elderly patients would be excluded from taking Paxlovid!
BTW, w/80+ patients SCr is always rounded up to 1.0, significant if measured SCr is in the 0.7 or lower range.

 

[Dr Wario]

It is the new Tamiflu, everyone will get it when they have a sniffle so the terrible doctors here can proclaim they "did something".

 

[mentos]

It is the new Tamiflu, everyone will get it when they have a sniffle so the terrible doctors here can proclaim they "did something".

It's funny how Tamiflu dispensing has gone way down since Covid, at least where I'm at.

 

[VA Hopeful Dr]

It's funny how Tamiflu dispensing has gone way down since Covid, at least where I'm at.

I mean, so did documented flu cases since 2020. I cannot speak for everyone, but for the first year and a half of the pandemic it was incredibly difficult to test for covid and flu at the same time.

Now I have a rapid PCR machine that does both within 45 minutes. If flu turns up positive and they're within the tamiflu window you better believe I'm giving it to them. And yes, we all know it doesn't really do very much but until the money the insurance companies pay me is not tied in any way to patient satisfaction then I'm going to keep doing it.

 

[Old Timer]

It's funny how Tamiflu dispensing has gone way down since Covid, at least where I'm at.

All viral infections, especially in kids, were way down at the height of covid.,

 

[GrandTheftAutumn]

And then we have people that just are awesome at their jobs like everyone on this thread

Everyone... until I joined this thread

 

[GrandTheftAutumn]

It's funny how in 2020 I dispensed 0 Tamiflu

 

[RXDOC1986]

It is the new Tamiflu, everyone will get it when they have a sniffle so the terrible doctors here can proclaim they "did something".

That was exactly what I thought, don't work retail, had no idea of Paxlovid use.

Until my wife and daughter came back from 2 weeks in Spain and France, and got sick (3 days later) all the mild symptoms, very obviously COVID. They went to an urgent care, both tested positive, and were prescribed all kinds of meds but no Paxlovid! I asked the very young physician, why no Paxlovid? He said there was a bulletin from the CDC to control and limit the use to much more serious cases.
Second surprise, I was in close contact with wife and daughter the first two days back when no symptoms. I didn't get sick or test positive!

 

[VA Hopeful Dr]

That was exactly what I thought, don't work retail, had no idea of Paxlovid use.

Until my wife and daughter came back from 2 weeks in Spain and France, and got sick (3 days later) all the mild symptoms, very obviously COVID. They went to an urgent care, both tested positive, and were prescribed all kinds of meds but no Paxlovid! I asked the very young physician, why no Paxlovid? He said there was a bulletin from the CDC to control and limit the use to much more serious cases.
Second surprise, I was in close contact with wife and daughter the first two days back when no symptoms. I didn't get sick or test positive!

Yeah urgent cares are weird about it here too. Technically its only supposed to be used for people with symptoms at risk for developing severe disease but most of the PCPs I know aren't picky about prescribing it.

 

[RxPreceptor]

Have had MDs attempt to self prescribe Paxlovid for prophylactic use…that phone call didn‘t last very long. Made several of my techs LFAO overhearing when I asked if said physician tested positive recently

 

[BidingMyTime]

I asked the very young physician, why no Paxlovid? He said there was a bulletin from the CDC to control and limit the use to much more serious cases.

Paxlovid can have (rare) very serious effects, even death. As with any drug, the risks vs benefits of its use have to be weight, and it sounds like with your family, the risks of Paxlovid outweighed any benefits they may have got from it.