COVID-19 Antiviral (Paxlovid, Remdesivir) Orders

NOTE: supply of these medications can vary week to week and facility to facility. It is important to follow local updates about medication availability and the latest recommendations for preferred medications.

Paxlovid (ritinovir & nirmatrelvir)

Paxlovid (5 day oral course) may be appropriate for the treatment of COVID-19 patients with mild to moderate symptoms when administered within 5 days of symptom onset. Supplies are prioritized for patients most likely to develop severe COVID-19 illness and at increased risk of adverse outcomes, including hospitalization and death.

Clinical Requirements

  • Outpatients or inpatients admitted for non-COVID-19 reasons or inpatients with hospital-acquired COVID-19 with ALL of the following criteria:

    • Have not received any doses of a COVID-19 vaccine or have received only one dose of a COVID-19 vaccine OR are residents of long-term care or designated supportive living sites (DSL4, 4D) regardless of vaccination status

    • Positive COVID-19 PCR test result

    • Able to receive treatment within 5 days of symptom onset

AND

  • Meet 1 of the following 2 criteria:

    • One or more of:

        • Age 55 and over regardless of other health conditions

        • Indigenous and age 45 or older regardless of other health conditions

        • Age 18 and over with at least 1 of the following comorbidities:

          • Diabetes requiring medication

          • Obesity with BMI > 30 kg/m2

          • Chronic Kidney Disease (eGFR < 60 ml/min/1.73 m2)

          • Congestive Heart Failure (NYHA class II, III or IV)

          • COPD

          • Moderate to severe asthma

          • Pregnancy (if potential benefits outweigh potential risks for the fetus)

    • Immunocompromised regardless of immunization status

      • Transplant (solid organ or stem cell) recipients

      • Oncology patients receiving any chemotherapy or immunosuppressive therapy since December 2020

      • Inflammatory conditions (e.g., RA, Lupus, IBD, etc.) receiving any systemic immunosuppression since December 2020

Patients must be referred to the AHS Monoclonal Antibody Program via Health Link (1-844-343-0971) for review, triage and possible direction to a participating pharmacy.

Drug-drug interactions are common and prescribing physicians should seek a full review for indications of home medication adjustments during the 5 day paxlovid course.

Resources

Remdesivir

Remdesivir may be appropriate for the treatment of COVID-19 patients early (within 7 days of symptom onset) to aid in the prevention of progression to severe outcomes in high-risk patients.

Early Onset COVID-19 for Prevention of Progression

Use is restricted to a 3-day intravenous course for treatment of outpatients, inpatients admitted for non-COVID reasons, inpatients with hospital-acquired COVID-19 and confirmed COVID-19 in hospitalized patients. The following criteria must be met:

  • Outpatients or inpatients admitted for non-COVID-19 reasons or inpatients with hospital-acquired COVID-19 with ALL of the following criteria:

    • Have mild to moderate COVID-19 symptoms

    • Have an AHS confirmed positive COVID-19 test result

    • Able to receive treatment within 7 days of symptom onset

AND

  • Meet 1 of the following 2 criteria:

    • Unvaccinated or under-vaccinated (one dose) and one or more of:

        • Age 55 and over regardless of other health conditions

        • Indigenous and age 45 or older regardless of other health conditions

        • Age 18 and over with at least 1 of the following comorbidities:

          • Diabetes requiring medication

          • Obesity with BMI > 30 kg/m2

          • Chronic Kidney Disease (eGFR < 60 ml/min/1.73 m2)

          • Congestive Heart Failure (NYHA class II, III or IV)

          • COPD

          • Moderate to severe asthma

          • Pregnancy

    • Immunocompromised regardless of immunization status

      • Transplant (solid organ or stem cell) recipients

      • Oncology patients receiving any chemotherapy or immunosuppressive therapy since December 2020

      • Inflammatory conditions (e.g., RA, Lupus, IBD, etc.) receiving any systemic immunosuppression since December 2020

Treatment of confirmed COVID-19 pneumonia in hospitalized patients

Use is restricted to a 5-day intravenous course for hospitalized patients meeting the following criteria:

  • Inpatients with confirmed COVID-19 pneumonia defined as having oxygen requirements above pre-hospitalization baseline (SpO2 less than 94% on room air, or requiring oxygen supplementation to maintain SpO2 greater than 94%) and/or new infiltrates on chest X-ray not caused by other health conditions

    AND

  • Are NOT invasively mechanically ventilated

COVID-19 pneumonia considerations:

  • For highly immunocompromised patients, consultation with experts in the field (e.g. Infectious Diseases or experienced individuals in other disciplines such as Respirology) is required (in person or by phone) where multi-agent therapy including remdesivir, or extended duration remdesivir treatment is being considered.

  • Pediatric use should be pursuant to a Pediatric Infectious Diseases consult.

Resources

Resources