Paxlovid for cancer patients with Covid?

[tarhoosier]

Visited cancer center consultant and asked about Paxlovid, perhaps prescribed in advance of Covid diagnosis since I have aggravating issues with disease and age. M. O. said they do not Rx Paxlovid for their patients because even those in Tax and Platinum infusion cycles who contract covid rarely require hospitalisation. Over the counter and occasional other anti congestions and symptom relief medications work as well. To avoid interaction with infusions and with little to no evidence of benefit in comparison it is not their practice. This surprised me but they know their business.

[cesces]

I think I saw some place that paxlovid doesn't work with the new variants.

The real reason they won't prescribe you paxlovid, is that to do so is way way off label.

And I think it is (or was) only prescribed by sort of specialists.

And it might be professionally uncomfortable for them to ask for such an off label use.

[tarhoosier in reply to cesces]

I asked my primary physician and he wrote for molnupiravir, the other new anti-covid symptom drug. His interaction advisor on his prescription computer screen showed a pax-xtandi problem. I have molnu... and may use it if it progresses to near hospitalisation stage. I will ask my M. O. in March when I see him. He is in NYC, I in Charlotte*

*the consultation this week was with the M. O for my wife who has breast cancer.

To fill prescription I had to learn that Pax and Molnu are distributed through Walgreen and CVS only as these drugs were the product of Project Warp Speed and the government decreed the contract so as to make them as widely available as possible. Some CVS/Walgreen pharmacies are not supplied. One must call or visit to know for sure. I had to go to three before I found the molnu...

[Jancapper in reply to cesces]

Given Tarhoosier’s aggravating circumstances, it is not unreasonable to prescribe Paxlovid as a precautionary measure. If he should test positive for COVID, he would have the medication on hand immediately thereby saving him an unnecessary trip to a healthcare provider and potentially exposing others around him as well. Additionally, the earlier a COVID positive patient starts, the more effective the drug.

[cesces in reply to Jancapper]

I wasn't questioning the logic.

Just that paxlovid was/is hard to get. Only a few docs prescribe it to my understanding.

And unless you have some clout, you just are not likely to get it off label.

Things may have changed though.

[leebeth in reply to cesces]

How is it off label? I must be missing something.

Being over 65, virtually all of my friends who have had Covid have received Paxlovid. They all got the scripts from their primary physicians. Even pharmacists can now prescribe it.

I wonder if you are thinking of Evusheld, which has been shown to be ineffective against the new variants. On the other hand, a recent study published in the Annals of Internal Medicine last month showed a 44% reduction in hospitalization or death among those who received Paxlovid, and an 81% among the unvaccinated. This study was conducted during Omicron, with a mix of sub variants. This retrospective, propensity score matched study of 45,000 patients from the Brigham&Women’s database.

Our MO had us both receive Evusheld in 2022, when it was still effective, and encourages Paxlovid use. He recently took it himself, and supports its use for his patients.

It is interesting to see the differences in practice, although my friends who have taken Paxlovid are scattered across the country.

[cesces in reply to leebeth]

I asked my Doc a while back for the prescription.

At that time there was a limited supply. There were only certain practices that were administering it.

You had to be at "high risk" which was narrowly defined and strictly construed.

Not our definition of high risk.

Perhaps things have changed.

Or maybe I have that mixed up with the injectable of similar function.

[leebeth in reply to cesces]

I think you might have it mixed up with Evusheld, which does have risk categories. The scientific community is lamenting the under-utilization of Paxlovid.

My husband was the first person to have Evusheld in our community last March. Our primary also is an infectious disease specialist and he had no clue how to order it! I had to find out the process and walk him through it. By the time I was starting chemo in August, many patients had received it.

[tarhoosier]

Perhaps the "Off script" comment means writing a prescription without diagnosis of the condition, or with no condition. Writing for Pax or molnu... without diagnosis of Covid is certainly not part of the prescribing protocol. Perhaps the doctor considers it a reasonable practice considering patient factors and the insurance will cover cost. Writing a rx for a condition different than that approved is "off script" so I assume writing for condition not (yet) diagnosed would be the same.

[TeleGuy]

Checking Medscape, Paxlovid interacts with several drugs people like us are on, including apalutamide, enzalutamide, prednisone, dexamethasone, and several of the statins. I got COVID in the fall and was able to get bebtelovimab, one of the monoclonal antibodies that help fight it.

[HopefulSis]

As Teleguy replied above- paxlovid is not compatible with several medications. Check the list!