MO Pharmacist August 2022

THE FELLOWS CORNER

by JOSH BERRY, PharmD, Executive Fellow P h a r m a c i s t P r e s c r i b i n g P a x l o v i d : now what? On July 6, the FDA put another foot forward for pharmacy advancement and the important role we play in the Covid 19 pandemic by authorizing pharmacists to prescribe Paxlovid through the Emergency Use Authorization (EUA). This advances our patient care, reducing the time between diagnosis and treatment, especially when pharmacies are often open longer hours than physician offices. While it is usually simple to access a patient’s medication list, lab work is much more difficult. Implementing

Paxlovid prescribing will be easiest for the patients that can look at their patient portal to find their own lab work. Those who don’t have access we can request that information from the patient’s doctor. While this may slow things down, it can often be faster than the patient waiting for an appointment.

Paxlovid is nirmatrelvir 150 mg tablets co-packed with ritonavir 100 mg. Patients take the medication twice daily for 5 days, with dose adjustments based on renal function. State-licensed pharmacists are able to prescribe under the following circumstances: • Positive SARSCoV-2 tested. Home test is sufficient. • Electronic or printed health records less than 12months old withmost recent lab work to verify kidney or liver problems. Informationmay also be provided by the patient's provider. • A list of medications, prescription andOTC, the patient is taking to screen for potential serious interactions. Ritonavir is a strong CYP3A4 inhibitor and P-glycoprotein inhibitor. Whether prescribing or receiving a prescription order from an office, pharmacists play an important role in safe Paxlovid use. Lisa Cillessan, Clinical Associate Professor at UMKC and Clinical Pharmacist at Jordan Valley CHC, has verified many Paxlovid orders and notes that drug-drug interactions are a key factor to review closely before approving. “The Paxlovid fact sheet has all the interactions listed, but requires some interpretation. I typically utilize the NIH’s Paxlovid interaction guidance, as they do a better job stating if you need to hold a medication, decrease, monitor the patient, or if a different Covid therapy would be recommended,” Lisa said. She also adds that knowing the availability of other treatment options in your local community is important to ensure your patients get the care they need.

Josh Berry, PharmD, is a Executive Fellow at the Missouri Pharmacy Association.

Just as we have capitalized on the momentum of widespread pharmacy vaccination, the ability to prescribe Paxlovid highlights how the sharing of health records, especially lab work, would be beneficial in the pharmacy. While I would love to have access to all labs, one that would be most helpful is kidney function. For instance, if the office sends creatinine clearance with Mr. Smith’s new gabapentin prescription then we could alert the office the dose is too high. We could also find out that Mr. Smith’s Januvia 100 mg that he has been on for years now needs to be reduced.

RK

Paxlovid prescribing is not just a win, but also an opportunity for the profession to show that there are more ways we can be utilized.

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