Pandemic: Life on the ground

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Gunnar
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Re: Pandemic: Life on the ground

Post by Gunnar »

In my case, so far, it is like the mildest and shortest cold I have ever had. I first tested positive last Thursday and after 3 full days of taking Paxlovid, with only 2 days left to go, I feel like I am already over it, though I realize that is probably too optimistic an assessment of my situation. I'm anxiously anticipating the likelihood of rebound symptoms and hoping they will not occur or will be no more severe nor of longer duration than I have so far experienced. Even the unpleasant Paxlovid taste in my mouth has improved to barely perceptible.
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Re: Pandemic: Life on the ground

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From the link that Gunnar posted above. Trying to see if we can get the list up here in readable form.

Box 1. Commonly Prescribed Outpatient Medications Not Expected to Have Clinically Relevant Interactions With Ritonavir-Boosted Nirmatrelvir (Paxlovid)

Medications Without Clinically Relevant Interactions

These commonly prescribed medications may be coadministered without dose adjustment and without increased monitoring.a This list is not inclusive of all noninteracting medications within each drug category.

Acid reducing agents
Famotidine
Omeprazole
Pantoprazole

Allergy medications
Cetirizine
Diphenhydramine
Loratadine

Anti-infective agents
Azithromycin
Hydroxychloroquine

Cardiovascular agents
Aspirin
Atenolol
Carvedilol
Furosemide
Hydrochlorothiazide
Irbesartan
Isosorbide Dinitrate
Lisinopril
Losartan
Metoprolol
Prasugrel

Diabetes medications
Empagliflozin
Insulin
Metformin
Pioglitazone

Immunosuppressants
Methotrexate
Mycophenolate
Prednisone

Lipid-modifying agents
Ezetimibe
Pitavastatin


Pain medications
Acetaminophen
Aspirin
Codeine

Respiratory medications
Corticosteroids (inhaled)
Formoterol
Montelukast

Miscellaneous
Allopurinol

Contraceptives (oral)b
Donepezil
Enoxaparin
Finasteride
Levothyroxine
Ondansetron

a This list is primarily based on the most common medication searches by U.S. users on the Liverpool COVID-19 Drug Interactions website between January 1 and April 13, 2022 (internal communication, April 2022). The Liverpool website classifies these medications as those that have no interaction or weak interaction with ritonavir-boosted nirmatrelvir.
b The Food and Drug Administration Emergency Use Authorization for ritonavir-boosted nirmatrelvir suggests that individuals who use contraceptive products containing ethinyl estradiol consider using a backup, nonhormonal contraceptive method because coadministration may result in low ethinyl estradiol levels. However, the low level is not expected to be clinically significant during 5 days of therapy. The progestin concentration of a combined hormonal contraceptive is expected to remain similar or increase with coadministration, which would maintain the effectiveness of the oral contraceptive.
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Re: Pandemic: Life on the ground

Post by Jersey Girl »

Box 2. Outpatient Medications That Have Clinically Relevant Drug-Drug Interactions With Ritonavir-Boosted Nirmatrelvir (Paxlovid)
Not all medications that may interact with ritonavir-boosted nirmatrelvir are included in Box 2. Deviation from the recommended strategies may be appropriate in certain clinical scenarios.

Prescribe Alternative COVID-19 Therapy

For these medications, management strategies are not possible or feasible, or the risks outweigh the potential benefits.

Anticonvulsants
Carbamazepine
Phenobarbital
Phenytoin
Primidone

Anti-infective agents
Glecaprevir/pibrentasvir
Rifampin
Rifapentine

Immunosuppressants
Voclosporin

Cardiovascular agents
Amiodarone
Clopidogrela,b
Disopyramide
Dofetilide
Dronedarone
Eplerenone
Flecainide
Ivabradine
Propafenone
Quinidine

Neuropsychiatric agents
Clozapine
Lumateperone
Lurasidone
Midazolam (oral)
Pimozide

Pain medications
Meperidine (pethidine)

Pulmonary hypertension medications
Sildenafil
Tadalafil
Vardenafil

Miscellaneous
Bosentan
Certain chemotherapeutic agentsc
Ergot derivatives
Lumacaftor/ivacaftor
St. John’s wort
Tolvaptan
Last edited by Jersey Girl on Tue Jul 05, 2022 3:26 am, edited 1 time in total.
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Re: Pandemic: Life on the ground

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Temporarily Withhold Concomitant Medication, If Clinically Appropriate

Withhold these medications during ritonavir-boosted nirmatrelvir treatment and for at least 2–3 days after treatment completion. They may need to be withheld for longer if the patient is elderly or the medication has a long half-life. If withholding is not clinically appropriate, use an alternative concomitant medication or COVID-19 therapy.

Anticoagulants
Rivaroxaband

Anti-infective agents
Erythromycin

BPH medications
Alfuzosin
Silodosin

Cardiovascular agents
Aliskiren
Ranolazine
Ticagrelorb
Vorapaxar

Immunosuppressantsf
Everolimus
Sirolimus
Tacrolimus

Lipid-modifying agents
Atorvastatine
Lomitapide
Lovastatine
Rosuvastatine
Simvastatine

Migraine medications
Eletriptan
Rimegepant
Ubrogepant

Neuropsychiatric agents
Clonazepamg
Clorazepateg
Diazepamg
Estazolamg
Flurazepamg
Suvorexant
Triazolamg

Erectile dysfunction medications
Avanafil

Respiratory medications
Salmeterol

Miscellaneous
Certain chemotherapeutic agentsc
Colchicineh
Finerenone
Flibanserin
Naloxegol

Adjust Concomitant Medication Dose and Monitor for Adverse Effects
Consult the Liverpool COVID-19 Drug Interactions website or the Ontario COVID-19 Science Advisory Table for specific dosing recommendations.i If the dose of the concomitant medication cannot be adjusted, withhold the medication (if clinically appropriate) or use an alternative concomitant medication or COVID-19 therapy.

Anticoagulants
Apixaban
Dabigatran
Edoxaban

Anti-infective agents
Clarithromycin
Itraconazole
Ketoconazole
Maraviroc
Rifabutin

BPH medications
Tamsulosin

Cardiovascular agents
Cilostazol
Digoxin
Mexiletine

Diabetes medications
Saxagliptin

Erectile dysfunction medications
Sildenafil
Tadalafil
Vardenafil

Immunosuppressantsf

Cyclosporine

Neuropsychiatric agents

Alprazolamg
Aripiprazole
Brexpiprazole
Buspirone
Cariprazine
Chlordiazepoxideg
Clobazamg
Iloperidone
Pimavanserin
Quetiapine
Trazodone

Pain medications

Fentanyl
Hydrocodone
Oxycodone

Pulmonary hypertension medications
Riociguat

Miscellaneous
Certain chemotherapeutic agentsc
Darifenacin
Elexacaftor/tezacaftor/
ivacaftor
Eluxadoline
Ivacaftor
Tezacaftor/ivacaftor

Continue Concomitant Medication and Monitor for Adverse Effects
Pre-emptive dose adjustment is not required but may be considered. Educate patients on potential adverse effects. Consult the Liverpool COVID-19 Drug Interactions website or the Ontario COVID-19 Science Advisory Table for monitoring guidance and dose adjustment information if needed.i

Anticoagulants
Warfarin

Anti-infective agents
Cobicistat or ritonavir-boosted antiretrovirals
Isavuconazole
Posaconazole
Voriconazole

BPH medications
Doxazosin
Terazosin

Diabetes medications
Glyburide

Cardiovascular agents
Amlodipine
Diltiazem
Felodipine
Nifedipine
Sacubitril
Valsartan
Verapamil

Neuropsychiatric agents
Haloperidol
Hydroxyzine
Mirtazapine
Risperidone
Ziprasidone
Zolpidem

Pain medications
Buprenorphine
Hydromorphone
Methadone
Morphine
Tramadol

a Reduced effectiveness of clopidogrel is likely. It may be acceptable to continue clopidogrel if the benefit of ritonavir-boosted nirmatrelvir treatment outweighs the risk of reduced clopidogrel effectiveness.
b For patients at very high risk of thrombosis (e.g., received a coronary stent within the past 6 weeks), consider prescribing an alternative antiplatelet (e.g., prasugrel) or an alternative COVID-19 therapy.
c Ritonavir-boosted nirmatrelvir may increase concentrations of some chemotherapeutic agents, leading to an increased potential for drug toxicities. Some chemotherapeutic agents may decrease the effectiveness of ritonavir-boosted nirmatrelvir. Please refer to the FDA EUA ritonavir-boosted nirmatrelvir fact sheet and the prescribing information for the chemotherapeutic agent and consult the patient’s specialist provider. The University Health Network/Kingston Health Sciences Centre is an additional resource for evaluating drug-drug interactions for chemotherapeutic agents.
d For patients at high risk of arterial or venous thrombosis (e.g., had a stroke within the past 3 months with a CHA2DS2-VASc score of 7–9 or a pulmonary embolism within the past month), consult the primary or specialty provider and consider using an alternative anticoagulant or COVID-19 therapy.
e For lovastatin and simvastatin, withhold at least 12 hours before initiation of ritonavir-boosted nirmatrelvir, during treatment, and for 5 days after treatment completion. For atorvastatin and rosuvastatin, withhold at the beginning of treatment with ritonavir-boosted nirmatrelvir and resume after completion of the 5-day course. If withholding a statin is not clinically appropriate (e.g., the patient had a recent myocardial infarction), the doses of atorvastatin and rosuvastatin can be adjusted and continued, and lovastatin and simvastatin should be switched to an alternative statin.
f Consult a patient’s specialist providers before coadministering these immunosuppressants and ritonavir-boosted nirmatrelvir. These immunosuppressants have significant drug-drug interaction potential with ritonavir, and close monitoring may not be feasible. Alternative COVID-19 therapy may need to be considered. See the American Society of Transplantation statement for more information.
g Abrupt discontinuation or rapid dose reduction of benzodiazepines may precipitate an acute withdrawal reaction.2 The risk is greatest for patients who have been using high doses of benzodiazepines over an extended period.
h For patients with severe hepatic or renal impairment, coadministration of colchicine and ritonavir-boosted nirmatrelvir is contraindicated due to the potential for serious or life-threatening reactions.
i For medications not included on the Liverpool COVID-19 Drug Interactions website or the Ontario COVID-19 Science Advisory Table, refer to the medication’s FDA label for information on coadministration with ritonavir or other strong CYP3A4 and/or P-gp inhibitors.

Key: BPH = benign prostatic hyperplasia; CHA2DS2-VASc = congestive heart failure, hypertension, age, diabetes, stroke, vascular disease; CYP = cytochrome P450; EUA = Emergency Use Authorization; FDA = Food and Drug Administration; P-gp = P-glycoprotein
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Re: Pandemic: Life on the ground

Post by Gunnar »

Hawkeye wrote:
Mon Jul 04, 2022 11:20 am
It seems barely possible that the Paxlovid might be doing me more harm than the covid-19 would have!
You need to do what the science tells you to do. There's no room for individual decisions with your doctor. If you would have practiced proper socialist distancing, you wouldn't have gotten infected. Now it's likely that you've spread it to other people.
I certainly have no problem with doing what science recommends. Do you? If you do have a problem with that, why? Is there really any doubt in your mind that the scientific method is the most reliable means available to us for discovering new truths and further refining and/or correcting old concepts or misconceptions? Because science is dedicated to constantly questioning and reevaluating as necessary even its most cherished and longest held conceptions, it is inherently self-correcting in the long run and progressive towards ever greater accuracy and precision.

In contrast, the religious, faith-based approach to knowledge is prone to occasional error and injustice and the perpetuation of both when they inevitably occur.

Science is of necessity progressive, because it can't reliably improve or advance otherwise. This is why it is unequivocally true that reality itself must, at least in the long run, have an inherent liberal bias. Diehard, hard right doctrinaire conservatism, on the other hand, leads inevitably to stagnation, intolerance, regression and tyranny.
Last edited by Gunnar on Tue Jul 05, 2022 5:51 am, edited 1 time in total.
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Re: Pandemic: Life on the ground

Post by Jersey Girl »

Hawkeye wrote:
Mon Jul 04, 2022 11:20 am
It seems barely possible that the Paxlovid might be doing me more harm than the covid-19 would have!
You need to do what the science tells you to do. There's no room for individual decisions with your doctor. If you would have practiced proper socialist distancing, you wouldn't have gotten infected. Now it's likely that you've spread it to other people.
The people you are addressing on this thread are patients and while they are not your patients, I assume that ridiculing people when they are ill for political purposes isn't in keeping with the ethics of your own profession. Perhaps you could list those here for us to examine or in lieu of that, maybe you could at least act like a human being to them.
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Re: Pandemic: Life on the ground

Post by Hawkeye »

Gunnar wrote:
Tue Jul 05, 2022 5:20 am
Hawkeye wrote:
Mon Jul 04, 2022 11:20 am


You need to do what the science tells you to do. There's no room for individual decisions with your doctor. If you would have practiced proper socialist distancing, you wouldn't have gotten infected. Now it's likely that you've spread it to other people.
I certainly have no problem with doing what science recommends. Do you? If you do have a problem with that, why? Is there really any doubt in your mind that the scientific method is the most reliable means available to us for discovering new truths and further refining and/or correcting old concepts or misconceptions? Because science is dedicated to constantly questioning and reevaluating as necessary even its most cherished and longest held conceptions, it is inherently self-correcting in the long run and progressive towards ever greater accuracy and precision.

In contrast, the religious, faith-based approach to knowledge is prone to occasional error and injustice and the perpetuation of both when they inevitably occur.

Science is of necessity progressive, because it can't reliably improve or advance otherwise. This is why it is unequivocally true that reality itself must, at least in the long run, have an inherent liberal bias. Diehard, hard right doctrinaire conservatism, on the other hand, leads inevitably to stagnation, intolerance, regression and tyranny.
You helped trash our economy over a bad flu and nothing more. You did it because of your hatred for DJT and his America first agenda. And now you don't even have the intellectual honesty to admit how over the top your lockdown response was.
The best part about this is waiting four years to see how all the crazy apocalyptic predictions made by the fear mongering idiots in Right Wing media turned out to be painfully wrong...Gasoline would hit $10/gallon. Hyperinflation would ensue.
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Re: Pandemic: Life on the ground

Post by Chap »

Hawkeye wrote:
Tue Jul 05, 2022 12:18 pm
You helped trash our economy over a bad flu and nothing more.
An elderly person I know was living happily at home, supported by helpers who visited in the morning and evening. He could walk about his house and garden, and go upstairs to bed using a chairlift. He could heat up his meals, eat them, and wash up. It was not a life rich in new experiences, but he had no complaints and was quite cheerful whenever I spoke with him.

Then he got COVID. It did not kill him, but deprived him of most of his muscular strength so he could not longer do the smallest thing for himself, let alone walk around. Now he is sitting miserably in a wheelchair, shut in his room in an institution. There are many others with long-term muscular and nerve damage that has put them in similar situations, and there is a high proportion of relatively young people in such a condition.

And you call that "a bad flu and nothing more"?
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Re: Pandemic: Life on the ground

Post by Gunnar »

Chap wrote:
Tue Jul 05, 2022 12:41 pm
Hawkeye wrote:
Tue Jul 05, 2022 12:18 pm
You helped trash our economy over a bad flu and nothing more.
An elderly person I know was living happily at home, supported by helpers who visited in the morning and evening. He could walk about his house and garden, and go upstairs to bed using a chairlift. He could heat up his meals, eat them, and wash up. It was not a life rich in new experiences, but he had no complaints and was quite cheerful whenever I spoke with him.

Then he got COVID. It did not kill him, but deprived him of most of his muscular strength so he could not longer do the smallest thing for himself, let alone walk around. Now he is sitting miserably in a wheelchair, shut in his room in an institution. There are many others with long-term muscular and nerve damage that has put them in similar situations, and there is a high proportion of relatively young people in such a condition.

And you call that "a bad flu and nothing more"?
Isn't that amazing! And he has the temerity and lack of self-awareness to accuse others of intellectual dishonesty! The most extreme example of "backfire effect" I have ever encountered! Figuratively he is intellectually in as severe and limited straits as your friend's physical limitations, I would say. And he has willfully put himself there! :cry:
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Re: Pandemic: Life on the ground

Post by canpakes »

Hawkeye wrote:
Tue Jul 05, 2022 12:18 pm
You helped trash our economy over a bad flu and nothing more. You did it because of your hatred for DJT and his America first agenda. And now you don't even have the intellectual honesty to admit how over the top your lockdown response was.

Then there’s the point of view that maybe ‘America First’ actually meant acknowledging the problem early, getting out ahead with countermeasures instead of fighting them every step of the way, and cooperating with each other and each State through example, instead of trying to set people against each other for the sake of partisan politics. Maybe all of that could have been accomplished by a leader who wasn’t afraid to be seen with a piece of cloth on his face. But, I guess that we’ll never know how an America First like that would have worked out.
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