Pfizer’s antiviral medication Paxlovid is designed to reduce the risk of hospitalization in patients with COVID-19, and it’s approved for use across Canada.
Although it has the potential to take some pressure off hospitals during coronavirus surges, some doctors and pharmacists believe it isn’t being used as widely as it should.
Dr. Brian Conway is the medical director of the Vancouver Infectious Diseases Center and an assistant professor in the University of British Columbia’s Department of Pharmacology and Therapeutics. He said the lack of uptake could be due to a number of factors, including restrictions on who can prescribe it and a lack of awareness about the treatment, both among the public and medical professionals.
“It may be that we’re not prescribing it broadly enough,” Conway told CTVNews.ca. “My sense is when I speak to family physicians who might be the first line, they aren’t aware of it. Many pharmacists I’ve had to work with and explain to them what this stuff is. There hasn’t been a big push 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 the course of an infection with mild to moderate symptoms.
Patients take two doses each day for five days, and each dose consists of two pink nirmatrelvir tablets and one white ritonavir tablet. Nirmatrelvir is an antiviral drug that inhibits a SARS-CoV-2 protein to stop the virus from replicating, while ritonavir delays the breakdown of nirmatrelvir to help it work in the body for longer.
Eligible patients take 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 an altered sense of taste, diarrhea, muscle pain, vomiting, high blood pressure and headache.
WHO IS ELIGIBLE
In Canada, Paxlovid is approved for people who have tested positive for COVID-19 and who are at increased risk of developing serious COVID-19 symptoms that could require hospitalization.
It’s up to provinces and territories to prioritize who is eligible, but Health Canada says age is the strongest risk factor for severe illness and hospitalization, with unvaccinated seniors or seniors whose vaccinations are not up to date facing the most risk.
Other eligible adults include those who are immunocompromised and those who have serious underlying conditions such as obesity or diabetes, and people over 60 living in underserved, rural or remote communities or congregate care settings.
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 18.
The drug interacts with dozens of common medications, including some heart medicines, 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 who is taking a medication that might interact with Paxlovid should consult their health-care provider.
Provinces and territories are in charge of prioritizing access to Paxlovid, so anyone with questions about their own eligibility should contact their local or provincial public health service or their health-care provider.
WHO CAN PRESCRIBE AND DISPENSE IT
Provinces and territories have the authority to decide who can prescribe and dispense Paxlovid, which Conway said has created a patchwork of policies that range from simple and streamlined to complicated and bureaucratic.
“So different provinces have different approaches, the most simple being that if someone tests positive on a rapid test, they can communicate that result to a pharmacist or the pharmacist may do the test onsite, and then the pharmacist can link to a physician, a brief interaction occurs, and the medication is prescribed,” Conway said. “So that’s the simplest.”
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 British Columbia, where there is a form that needs to be completed and they’ve established criteria for eligibility for Paxlovid, and the individual has to meet these requirements,” Conway said.
Conway says the process is so convoluted that some doctors have opted not to prescribe Paxlovid to avoid filling out the paperwork.
In a media release on July 11, Dr. Danielle Paes, chief pharmacist officer of the Canadian Pharmacists Association, called on provincial governments to empower pharmacists to provide point-of-care testing and prescribe COVID-19 treatments such as Paxlovid
“Quebec was the first jurisdiction in the world to enable pharmacists to prescribe for Paxlovid and saw a marked increase in use of the COVID-19 antiviral, helping to keep patients out of hospitals. Other provinces have followed suit, but many have not yet enabled this critical service,” Dr. Paes said.
“Pharmacist-prescribed Paxlovid is just one example of the kind of innovative community care that will reduce the strain on our hospitals while expanding access to the services and care Canadians rely on.”