Paxlovid and Xeralto

[beanlake14]

My husband just tested positive for the first time. We were able to get Paxlovid for him. My pharmacist told me that if I test positive, this would not be good for me as I’m on xeralto. Has anyone taken a different treatment? He does have a new one that he hasn’t prescribed yet. I will speak with my oncologist Monday, but I was just wondering if anyone had been in this predicament. Thank you’

[cajunjeff]

Beanlake, I got Covid Tuesday night and took my first dose of paxlovid Wednesday night. I have two more days of paxlovid and will be done with it then.

I was surprised when I picked up my paxlovid how many drugs negatively interact with it. I knew from previous reading to pause my acalabrutinib. I like my doctors a lot, but I took it my own and googled each drug I was on to see how they interact. I found out that I should pause my statin meds as well. No one told me, I had to figure it out. We all need to be proactive and do our own research when we can.

I am not aware of a drug that is nearly as effective with omicron Covid as paxlovid is. I am over the hump I hope, I’m certainly much better after three days of paxlovid. Would I be feeling just as well without it? Who knows? I think it helped.

You might just have to do a balancing test if you can’t take your xarelto and paxlovid together. Which risk is greater? Going through Covid without treatment and risk more serious Covid or pausing Xarelto and the risk that comes with that?

That’s probably a medical decision you should discuss with your doc. In my case, the risk to me of pausing my statin and acalabrutinib is not that big compared to the risk Covid presents to me with my weakened immune system. I would think pausing xarelto five days would be okay, but I have zero medical qualifications to make that call. Your doc should know.

Finally, I might add, this is not the same Covid we saw at the start. Omicron appears to be much less serious with a very small mortality rate. It seems that most of our members on here who have written about it have done well. Good luck to you. I do think the answer to your question might not be a one size fits all such that some people might need to be more concerned than others about pausing meds and everyone should do so in consultation with their doctor.

[beanlake14 in reply to cajunjeff]

Thank you, and be well

[SofiaDeo]

Anyone taking any medicine metabolized by liver enzymes needs to be cautious taking Paxlovid. One of the components of it, severely inhibits common liver enzymes, so blood levels of any drugs metabolized in the liver will be increased. If you are unable to temporarily decrease or even stop the other medication, you shouldn't take the Paxlovid. And it's up to the non-CLL doctor to decide if the other medication can be adjusted or paused, safely.

Those taking the BTK's for their CLL have to decrease or stop the BTKi, so the BTKi blood level doesn't shoot up and cause neutropenia or low platelets, or other potential side effects from "too high " blood levels. With non-CLL meds, the doc prescribing *those* will decide if you can or should decrease or stop it, or just not take the Paxlovid. That pharmacist was guessing your doctor would not want the Xeralto dose changed at all. There is no "absolute contraindication". But it wouldn't be ideal to have your blood levels of it jump up unpredictably.

[flyhigher]

Beanlake14, when I got Covid mid-October, "them's wot know" at the CDMU prescribed Lagevrio (pills). My CLL medication was discussed so I presume that was in preference to Paxlovid. When I checked in with my consultant mid-November he asked whether I had paused my Acalabrutinib, and seemed doubly satisified that I hadn't been told to pause it and that I had continued taking it. And the Lagevrio worked for me without any side effects that I could notice.

So there is at least one alternative to Paxlovid. I know you're US but this shows more alternatives: nhs.uk/conditions/coronavir...

[SeymourB in reply to flyhigher]

flyhigher -

The therapeutics on that list appear to be listed in the order of presumed effectiveness. They are by no means equivalent. Sotrovimab is no longer available in the U.S. as of April 5, 2022 because of presumed ineffectiveness based on in-vitro neutralization testing against the BA.2 variant.

There hasn't been much in-vivo effectiveness studied with later Omicron variants. Often, reports on such testing are released months after new variants have arrived. See the reference below on tests of Sotrivimab (Xevudy) vs. Molnupiravir (Lagevrio).

Remdesivir (Veklury) is normally given by multiple infusions. In some parts of the U.S., such infusions can be done on an outpatient basis. Sadly, many hospitals do not offer it at all. An oral version is being tested in China under the name VV116, and looks to be at least as good as Paxlovid on older Omicron variants. No clue as to when it will be available here.

That said, a few of us have gotten through a COVID Omicron infection without COVID meds at all. But I wonder, do we ever hear about those among us who died or had a really rough time?

The seriousness of a COVID infection depends so much on the dose of the virus, immune function, existing comorbidities, and I'm sorry to say, additional infections often undiagnosed by medicos.

=seymour=

Reference:

bmj.com/content/379/bmj-202...

Comparative effectiveness of sotrovimab and molnupiravir for prevention of severe covid-19 outcomes in patients in the community: observational cohort study with the OpenSAFELY platform

Published 16 November 2022, but covering cases between 16 December 2021 and 10 February 2022.

"Results Between 16 December 2021 and 10 February 2022, 3331 and 2689 patients were treated with sotrovimab and molnupiravir, respectively, with no substantial differences in baseline characteristics. Mean age of all 6020 patients was 52 (standard deviation 16) years; 59% were women, 89% were white, and 88% had received three or more covid-19 vaccinations. Within 28 days of the start of treatment, 87 (1.4%) patients were admitted to hospital or died of infection from SARS-CoV-2 (32 treated with sotrovimab and 55 with molnupiravir)."

"Conclusions In routine care of adult patients in England with covid-19 in the community, at high risk of severe outcomes from covid-19, those who received sotrovimab were at lower risk of severe outcomes of covid-19 than those treated with molnupiravir [Lagevrio]."

"Compared with patients treated with molnupiravir, those in the sotrovimab group were younger (mean age 57.9 v 61.4 years), and had a lower proportion of patients with Down’s syndrome (1.4% v 3.4%), immune mediated inflammatory disorders (44.7% v 47.7%), diabetes (22.7% v 25.3%), chronic cardiac diseases (17.9% v 21.5%), and hypertension (46.9% vs. 50.8%), and a higher proportion of solid organ transplant recipients (15.0% v 11.0%) and patients with haematological disease (18.3% v 14.9%). The two groups were similar for other characteristics (supplementary table 2)."

[NoClew]

Remdesivir is now approved for outpatient use. I opted for 3 days / half hour infusions instead of Paxlovid. Did not have to stop Acalabrutinib or any of my other meds. There are few if any drug complications. I had no reaction or side effects and my covid symptoms were no nore than upper resp congestion, a mildly productive cough, fatigue and some flu like body aches. I felt stupid for letting my guard down and getting exposed by a close friend, but grateful to get the Remdesivir started right away.

[beanlake14 in reply to NoClew]

This seems like a great option. Thank you

[SeymourB in reply to NoClew]

tverickson -

It's been approved for outpatient use for over a year now, I believe. The problem seems to be that many hospitals and clinics do not want to even stock it in their pharmacies. So one must call around to each hospital.

I suggest calling a hospital's main number, and either ask for the pharmacy or the infusion center.

=seymour=

[LynnB1947]

Diagnosed with COVID in mid-December. I paused all my meds just to be safe - ibrutinib, coumadin, lipitor, valtrex, & lisinopril. Within 2 days of starting Paxlovid, my temps which had been 101F+ were low-grade. I restarted meds 2 days after finishing Paxlovid. Doing just fine now.

LynnB

[SeymourB in reply to LynnB1947]

LynnB1947 -

I think Valtrex and Lisinoprial don't have an interaction with Paxlovid based on these drug checkers:

reference.medscape.com/drug...

medscape.co.uk/drug-interac...

drugs.com/interaction/list/

drugs.com/drug_interactions... (linked from drugs.com/uk/):

=seymour=

[LynnB1947 in reply to SeymourB]

I agree. I just decided that I would take a medical holiday on everything. I knew that was an interaction for coumadin, ibrutinib, and lipitor. In my stupor of COVID & fever, I didn't find a prohibition for Valtrex or Lisinopril but I decided to stop them anyway.

Oh, and by the way, there's also a "no-go" for Viagra.

[studebaker]

I was on Paxlovid and they stopped Xarelto and I was given Fragments injections into my abdomen instead until I finished Paxlovid plus two days after and then went back on Xarelto.

There are a lot of interactions with Paxlovid so it is excellent idea to discuss it with your doctor. Hopefully, you will not get COVID 🤞🏻

Dana

[beanlake14 in reply to studebaker]

great idea. Thank you