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Posts Tagged ‘COVID-19’

Covid-19 Outpatient Treatment in 2022. By Our Student Pharmacist, Connor Glasgow.

In the early stage of the Covid-19 pandemic, significant developments in containing, preventing, and mitigating spread of Covid-19 were at the forefront of healthcare development. This can be most obviously seen with the rapid production of effective vaccines and subsequent vaccination campaigns.

As of this month, approximately 63% of the population is vaccinated, and among the vaccinated population there is a sharp decline of hospitalizations and death due to Covid-19. That being said, due to variant strains such as Omicron, mild to moderate breakthrough cases are not uncommon and the need for effective outpatient therapy remains high.

This article will list available treatments and their place in therapy. It is of note that most prescription medications provided to treat Covid itself and not symptomatology are reserved for those who are at risk of developing severe symptoms.


Novel oral antivirals:

  • Nirmatrelvir-ritonavir
    • First-line option for non-hospitalized patients
    • Inhibitor of Sars-Cov2 main protease and pharmacokinetic enhancer
    • Dose is two tablet regimen, 300 mg (nirmatrelvir) and 100 mg (ritonavir) twice a day for five days within five days of symptom onset
    • Contraindicated in patients on CYP3A4 metabolized medications with high risk of severe adverse effects and those with kidney function issues and an eGFR under 30ml/min
      • Caution in patients with hepatic impairment
      • Caution in patients with uncontrolled HIV due to resistance concerns
    • Requires renal adjustment to 150 mg-100 mg (respectively) twice daily if eGFR is between 30 and 60ml/min
    • Allowed for patients 12 and older with a body weight of 40 kg or more
  • Molnupravir
    • Second-line option for non-hospitalized patients
    • Cytidine nucleotide analog
    • Dose is 800 mg every 12 hours for five days
    • Contraindicated in pregnancy and for those under 18
      • Cartilage and bone toxicity reported in animal studies
      • No formal studies on pregnant patients or those under 18
      • Pregnancy test recommended before administration
    • No known drug interactions
      • Studies are limited
    • Seemingly well tolerated
      • Most common adverse events were diarrhea, dizziness, and nausea
      • Occurred in under 2% of patients
    • Specific variant coverage has not been studied
    • Generally considered lower efficacy compared to nirmatrelvir-ritonavir


Monoclonal antibodies:

  • Sotrovimab
    • First-line for non-hospitalized patients in areas where Omicron is primary variant or Omicron is confirmed variant
    • Recombinant human IgG1 antibody binds to preserved epitope on Sars-Cov2 spike protein
    • Dose is single 500 mg IV infusion within 10 days of infection
    • Contraindicated in patients with history of hypersensitivity or those hospitalized
    • Reproductive effects not studied
    • Adverse reactions:
      • Diarrhea, rash, chills, and dizziness
    • Only drug interaction is with Covid-19 vaccine, which may reduce effectiveness
      • If previously vaccinated, must wait 90 days from vaccination to administer for treatment.
  • Casirivimab-indevimab
    • First-line for non-hospitalized patients in areas where Omicron is NOT primary variant or confirmed variant is NOT Omicron
    • Recombinant human IgG1 antibody binds to two seperate epitopes on Sars-Cov2 spike protein
    • Dose is 600-600 mg (respectively) single IV dose within 10 days of exposure
    • Contraindicated if hypersensitivity to drug product
    • Adverse reactions:
      • Nausea, vomiting, and pain at site of injection
    • Only drug interaction is with Covid-19 vaccine, which may reduce effectiveness
      • If previously vaccinated, must wait 90 days from vaccination to administer for treatment.
  • Bamlanivimab-etesevimab
    • First-line for non-hospitalized patients in areas where Omicron is NOT primary variant or confirmed variant is NOT Omicron
    • Recombinant human IgG1 antibody binds to two seperate epitopes on Sars-Cov2 spike protein
    • Dose is 700 mg and 1,400 mg (respectively) single IV dose as soon as possible following exposure
    • No current contraindications. Research is limited.
    • Adverse reactions:
      • Rash, dizziness, fever, and nausea
    • Only drug interaction is with Covid-19 vaccine, which may reduce effectiveness
      • If previously vaccinated, must wait 90 days from vaccination to administer for treatment.


Parenteral antiviral:

  • Remdesivir
    • First-line option for both hospitalized and non-hospitalized patients
    • Adenosine triphosphate analog
    • Dose is 200 mg IV loading dose, then 100 mg IV for five days
    • Only contraindication is hypersensitivity to drug product
    • Adverse reactions
      • Nausea, rash, increased ALT/AST, and possible bradycardia
    • Efficacy can be reduced by concurrent administration of hydroxychloroquine
      • Combination is not recommended
    • Caution in patients with kidney function issues and eGFR under 30ml/min
    • Not recommended in patients with AST levels over 10 times ULN
    • While studies are small and preliminary, use in pregnant women is possible under physician guidance.


  • Fact sheet for healthcare providers: Emergency use … (2021, December 22). Retrieved January 26, 2022, from https://www.fda.gov/media/155050/download
  • Fact sheet for healthcare providers: Emergency use … (2021, December 23). Retrieved January 26, 2022, from https://www.fda.gov/media/155054/download
  • Fact sheet for healthcare providers: Emergency use … (2021, November 30). Retrieved January 26, 2022, from https://www.fda.gov/media/149533/download
  • Fact sheet for healthcare providers: Emergency use … (2021, November 1). Retrieved January 26, 2022, from https://www.fda.gov/media/145611/download
  • Fact sheet for healthcare providers: Emergency use … (2022, January 1). Retrieved January 26, 2022, from https://www.fda.gov/media/145802/download
  • Fact sheet for healthcare providers: Emergency use … (2020, October 1). Retrieved January 26, 2022, from https://www.fda.gov/media/214787/download
  • COVID-19: Outpatient evaluation and management of acute illness in adults. UpToDate. (2022, January 24). Retrieved January 26, 2022, from https://www.uptodate.com/contents/covid-19-outpatient-evaluation-and-management-of-acute-illness-in-adults#!

Ivermectin and Covid-19: Does it Work? By Our Student Pharmacist, Connor Glasgow.


The Covid-19 pandemic has presented a unique challenge to the healthcare community. The novel disease spread like wildfire and, with it, the need for information followed just as swiftly.

In response, we developed vaccines to help prevent the spread, and continued to develop treatments for the disease, which were lacking early on. As a result, novel medications were tried and created.

Alongside synthesis of novel Covid-19 treatments, other research has focused on finding effective antiviral treatment in existing and unconventional medications. Unfortunately, few pilot studies have yet to produce robust data supporting use of such medications. However, interest in these medications has remained at the forefront of discussion, often due to political motivations and cost-considerations compared to novel medications.

These factors have propelled small pilot studies to the forefront of discussion and granted enough of a platform to persuade a portion of the population to believe in the efficacy of these medications. While there have been previous examples of these medications, namely hydroxychloroquine, the most recent example is the medication ivermectin.

Ivermectin is approved as an antiparasitic used in a variety of organisms including hookworm, scabies, lice, and more exotic parasites, and has noted antiviral, antibacterial, and antineoplastic properties. In addition, the safety profile of ivermectin makes the large-scale use of the medication feasible.

Proposal of ivermectin as a treatment for Covid-19 began as a study performed by Monash Biomedicine Institute in Australia, led by Kylie Wagstaff. The study involved in vitro exposure of Sars-Cov2 infected cells over a period of 48 hours, which demonstrated a decrease in viral load compared to the control group.

The cell-line used in the experiment was Vero/hSLAM, which had previously been used as a receptacle for measles and related viruses. The scope of the trial was limited and was presented as a proof-of-concept about the use of ivermectin as a novel Sars-Cov2 treatment and was unable to demonstrate clinical efficacy in vivo. The study instead suggested clinical trials be performed.

Since that point, multiple trials have been performed to test the efficacy of ivermectin in vivo. The results of those trials have themselves been subject to a meta-analysis review to determine significance of the data.

One such meta-analysis performed concluded that the evidence for use of Ivermectin remains a low certainty of evidence. Of note, this meta-analysis included mostly pre-prints, or studies that have not yet been subject to peer review, represented the most optimistic data for the use of ivermectin.

On paper, the proposal of ivermectin for Sars-Cov2 treatment is reasonable and is reinforced by in vitro data. However, multiple clinical trials, both approved and pre-approved, have failed to yet demonstrate the efficacy required for clinical use.

Use of ivermectin itself may have limited safety concerns, however, evidence-based medical practice should dictate other options be preferred, such as novel therapies. Use of poorly evidenced medication can lead to patients receiving suboptimal therapy and should be avoided if at all possible.

With our current data, use of ivermectin is not optimal at this time, and more robust data is required for clinical use.



  1. Caly L, Druce JD, Catton MG, Jans DA, Wagstaff KM. The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Res. 2020 Jun;178:104787. doi: 10.1016/j.antiviral.2020.104787. Epub 2020 Apr 3. PMID: 32251768; PMCID: PMC7129059.
  2. Deng J, Zhou F, Ali S, Heybati K, Hou W, Huang E, Wong CY. Efficacy and safety of ivermectin for the treatment of COVID-19: a systematic review and meta-analysis. QJM. 2021 Dec 20;114(10):721-732. doi: 10.1093/qjmed/hcab247. PMID: 34570241; PMCID: PMC8500108.
  3. Deng J, Zhou F, Ali S, Heybati K, Hou W, Huang E, Wong CY. Efficacy and safety of ivermectin for the treatment of COVID-19: a systematic review and meta-analysis. QJM. 2021 Dec 20;114(10):721-732. doi: 10.1093/qjmed/hcab247. PMID: 34570241; PMCID: PMC8500108.
  4. Zein AFMZ, Sulistiyana CS, Raffaelo WM, Pranata R. Ivermectin and mortality in patients with COVID-19: A systematic review, meta-analysis, and meta-regression of randomized controlled trials. Diabetes Metab Syndr. 2021 Jul-Aug;15(4):102186. doi: 10.1016/j.dsx.2021.102186. Epub 2021 Jun 27. PMID: 34237554; PMCID: PMC8236126.

Over-the-Counter Medications to Help Combat Covid-19. By Our Student Pharmacist, Sandy Saleh.

immune system

COVID-19 has taken over the year of 2020. At the beginning of this year, the virus quickly spread and made it to the USA in a matter of weeks. The more we know about COVID-19, the more we realize that prescription drugs will not be able to help with the accompanying sickness.

COVID-19 is a virus. It is much harder to make medications to kill viruses than it is to make medications, such as antibiotics, to fight bacterial infections. The difficulty in fighting a virus is due to the fact that viruses invade our actual body cells while bacteria are freestanding and multiple on their own. Creating a drug that targets the virus without targeting body cells and causing damage is very difficult. We do have some antivirals for viral infections such as cold sores, but those antivirals only keep the cold sore virus from spreading. This is why many people have recurring cold sores and have to take the medications long term or every time a cold sore pops up. The virus stays in the body.

Most viral illnesses rely on your body to recognize the virus and fight the virus on its own. The flu is an example of a virus that usually goes away on its own due to a person’s immune system. People with weaker immune systems sometimes have more trouble fighting illnesses and have more complications from viruses.

The Food and Drug Administration (FDA) currently has only one drug that is approved to help with COVID-19. Remdesivir is an antiviral reserved for people who get super sick and it seems to help lower the risk of dying from the virus and possibly shortens hospital stays. Remdesivir is an expensive injectable drug and is not available to the general public.

Vaccines are used to prevent people from getting a virus and are probably not helpful for people actively infected.

vitaminsThe best way to combat COVID-19 is with over-the-counter (OTC) products that you can find at your local pharmacy. Since the human body does have the ability to fight off viruses, it is important that we take care of our bodies and keep up with its needs.

Our bodies need vitamins, which we can’t make on our own and vitamins play a huge role in our immune systems. Vitamins A, D, C and E support the immune system and help fight off infections. Vitamin C and D have been shown to shorten the length and severity of viral infections and other illnesses especially if a person is deficient in those vitamins.

Zinc is a mineral that is recommended to take at the first signs of illness because it helps the body make proteins that help the immune system.

Daily multi-vitamins are often recommended to take whether we are sick or healthy. Even though our bodies need vitamins, talk to a doctor or pharmacist about any supplements before you begin them.

Other options to help with COVID are OTC products to manage symptoms while your body fights off the virus. Many people with COVID develop a cough. Some people like using dextromethorphan for coughs, although cough drops may be best to minimize other side effects like drowsiness.

Acetaminophen or ibuprofen can help with headaches and body aches. Talk to a pharmacist for the best personal option for any existing conditions or medications you have. There was early talk about ibuprofen worsening COVID, but there is no evidence to support this claim. Make sure to follow package directions and read all warnings for all medications.

For stomach and diarrhea issues, it is best to allow these symptoms to run their course and to stay hydrated. If you can’t keep liquids down or become dizzy, contact a provider.


Just remember, pharmacists are the best for information on OTC medications and are easily reachable by phone while isolating for COVID. Pharmacists can review current symptoms and make sure that any OTC products you want to use do not interact with current medications and are safe for use.

Is It the Flu or COVID-19? Here Is Everything You Need to Know This Season. By Our Student Pharmacist, Cassadie Baker.

As the flu season ramps up this year, you might still have questions about how to protect yourself and your loved ones during the COVID-19 pandemic. Here are answers to some common questions about both illnesses.

What is the difference between the flu and COVID-19?

Both infections are caused by respiratory viruses, however, these viruses are different from each other. Influenza is caused by different strains of the Type A or Type B influenza virus, which mutate rapidly and vary from year to year. COVID-19 is caused by a new coronavirus called SARS-CoV-2, which began spreading in 2019. The diagram below summarizes a comparison between the viruses.


Is there a way to tell if I have either the flu or COVID-19 at home?

Unfortunately, there is no way to differentiate between the flu and COVID-19 based on symptoms alone. Both viruses cause mild to severe respiratory infections, and they cause many of the same symptoms including, but not limited to:

  • Cough
  • Fever (100°F or greater)
  • Difficulty breathing
  • Sore throat
  • Fatigue
  • Headaches or muscle aches
  • Nasal congestion
  • Diarrhea
  • Vomiting

Sometimes a person experiences a loss of taste or smell after contracting COVID-19, however, not everyone who gets COVID-19 experiences this and in many cases will not show symptoms at all. To complicate matters, it is also possible to contract both COVID-19 and the flu at the same time!

So, what should I do if I feel sick?

While some feel pressured to continue going to work or other activities, the best thing that you can do is stay at home! Getting adequate rest helps your immune system combat the infection more effectively. Additionally, some people are at increased risk of severe complications from catching either of these viruses. Even if you’re not sure, isolate yourself to prevent the spread in case you are infected.

What are signs or symptoms that I should report to my doctor right away?

If you show any symptoms listed above, contact your primary care provider. They may refer you to a clinic for either flu or COVID-19 testing. It is especially important to notify your doctor if you are at least 65 years old, pregnant, or have chronic conditions such as asthma, COPD, or heart failure.

If you experience severe symptoms such as wheezing or a fever of at least 103°F, go to the nearest urgent care or ER. These may be signs of complications such as pneumonia, and they require treatment as soon as possible.

What should I do to protect myself and others?

There are quite a few things you can do! First, if you need to cough, do so into a tissue or your elbow. Both influenza and coronaviruses are airborne, which means that they primarily spread via droplets that are coughed, sneezed, or even talked into the air. Avoid close contact with anyone that you know is sick, if possible. Wear a mask that covers your nose and mouth, and keep a distance of about six feet between individuals to minimize the spread of COVID-19.

Viruses can survive on your hands or surfaces for extended periods of time. Wipe down dirty surfaces, and wash your hands regularly. If soap is not available, use hand sanitizer containing at least 60% of ethyl alcohol (ethanol), as demonstrated below.


Finally, get the flu shot if you haven’t already! The vaccine covers four of the most dangerous strains of influenza so that if you come into contact your symptoms are minimized, if not completely prevented. It takes two weeks for your immune system to build up, so get vaccinated sooner rather than later.

Where can I find more information about the flu and COVID-19?

CDC.gov regularly updates their website as soon as new information is available about either virus. You can also visit your county’s public health website for information regarding local outbreaks and COVID-19 testing locations.


Staying Safe While Enjoying Summer. By Our Student Pharmacist, Stephanie Brokaw.

Precautions to Take During the Ongoing Covid-19 Pandemic:

As various businesses and recreational facilities begin and continue to open as we approach summer, it is important to remember that there are still new cases of COVID-19 and hospitalizations occurring related to the disease. Regardless of what activities you engage in this summer, it is important to keep in mind various safety tips needed to keep yourself and your families safe.

Some of these safety recommendations by the Centers for Disease Control and Prevention (CDC) include:

  • Continue to practice social distancing by staying at least 6 feet apart from people you do not live with.
  • Use facial coverings when possible, especially when maintaining 6 feet distances from other individuals may be difficult.
  • When visiting public spaces like restaurants, call ahead to make a reservation (when applicable) to avoid long wait times and increasing your exposure to other people who may be asymptomatic carriers of COVID-19.
  • If you experience symptoms of COVID-19, which include fever, cough, shortness of breath, or sore throat, avoid public places and public transportation.
  • Utilize services such as online ordering, delivery, and curbside pick-up for essential items or ask someone outside of your household who is not experiencing symptoms to obtain essential items for you and drop them off on your doorstep.
  • Wash your hands often especially after coughing and sneezing.
  • Clean high-touch surfaces daily.
  • It is safe to return to public spaces if you have been three days without a fever and symptoms have improved and ten days have passed since symptoms first appeared.

Pool Safety:

Some tips by the CDC specific to staying safe from COVID-19 in public swimming pools include:

  • Wash your hands before entering the facility and often during your visit.
  • Use facial coverings when possible (but do NOT use them while in the water, as it is difficult to breath through them when they are wet).
  • Although it has been shown COVID-19 cannot be spread through water, maintain a 6-foot distance from those in pools with whom you do not live.

Do not forget about other pool safety tips such as maintaining adequate hydration and protecting yourself from harmful UV radiation.

Ways to protect yourself from UV radiation include:

  • Cover your skin with clothing when possible. Darker colors may offer more UV protection than lighter colors.
  • When you cannot cover areas of the skin, use broad spectrum sunscreen of SPF 15 or higher. Reapply sunscreen every two hours or sooner if swimming or sweating. Some makeup and lip balms may also contain sun protective properties.
  • Wear a wide-brimmed hat that shades your face, ears, and back of neck. Darker colored hats may offer more protection. Avoid straw hats as they have holes that can permit sunlight to penetrate.
  • Wear sunglasses that block both UVA and UVB rays.


Outdoor Safety:

Physical activity is still very important to engage in despite the pandemic because of the positive effects associated with physical and mental health.

Some tips by the CDC specific for staying safe in parks and other outdoor recreational facilities include:

  • Visit parks close to your home to cut down on any unnecessary travel breaks which could put you at risk of encountering facilities or people who may be infected with COVID-19.
  • Before you leave, check if the park you are planning to visit has restroom facilities open. Regardless, use the restroom at your home before traveling to decrease contact with surfaces in public places. Carry hand sanitizer and disinfecting wipes into these public facilities whenever possible.


In addition to the sun protection methods above, when visiting outdoor recreational facilities, such as parks, it is important to protect yourself against bugs that can transmit disease such as mosquitos and ticks.

Ways to protect yourself include:

  • Cover your skin as much as possible.
  • Use an EPA-approved insect repellant.
  • Pre-treat clothing with permethrin.

Your community pharmacist is a great resource for more information regarding safety against COVID-19, UV radiation, and protection from mosquitos and ticks. Stop by one of our locations for more information and assistance in over-the-counter (OTC) product selection for your upcoming activities.





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