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Pharmacy Spotlight: Managing viral illnesses during cold and flu season

Date: 09/20/24

The Centers for Disease Control and Prevention (CDC) estimates that for the 2023-2024 season, approximately 830,000 people were hospitalized and 72,000 died from influenza.1 COVID-19 remained among the top 10 causes of mortality in 2023.2 And this season, one billion colds are estimated to afflict people in the U.S.3

There are a variety of treatment options to aid in preventing the transmission of viruses like influenza and COVID-19 and managing patients’ symptoms. Prepare for this cold season by reviewing the guidance from our Pharmacy team below.

Preferred Products for Symptom Management

Several over-the-counter (OTC) medications are available to manage symptoms of viral infections in lower-risk groups. The CDC recommends that for those with mild-moderate COVID-19 infections, symptom management should be initiated. Refer to Meridian’s Preferred Drug List (PDL) for treatment options.

Outpatient Treatment Options for Higher-Risk Groups

Influenza

The CDC recommends individuals at a higher risk of complications such as adults 65 years and older, children younger than five years, pregnant people, and those with certain chronic conditions with influenza or suspected influenza be treated promptly.4

For patients with suspected or confirmed influenza and those with complications or progressive disease, treatments should be initiated with oseltamivir. For those with uncomplicated influenza, treatment can be initiated with oseltamivir, zanamivir, peramivir, or baloxavir. Refer to the National Foundation for Infectious Diseases resource for clinicians, including antiviral treatment options on Meridian’s PDL listed in the table below.5

COVID-19

Antiviral therapy is available for those at high risk of progressing to severe COVID-19. Review the most current CDC recommendations and Infectious Disease Society of America (IDSA) practice guidelines for more information about risk factors for severe outcomes of COVID-19 and clinical management.6,7

Paxlovid® can be initiated orally for those with a symptom onset less than or equal to 5 days. It can be given to adults and children aged 12 years and older and at least 40kg (88 lbs.). Veklury® is an IV infusion that can be initiated for those with a symptom onset less than or equal to 7 days. It can be given to adults and children aged 28 days and older and at least 3kg (7.7 lbs.).6,7 Lagevrio™ is recommended when Paxlovid® and Veklury® are unavailable. Consult the table below for additional information about these medications and their status on Meridian’s PDL.

Meridian’s PDL

Drug

Indication/EUA

Dose

Notes

Status

Paxlovid® (nirmatrelvir (150mg)-ritonavir (100mg))

Mild to moderate COVID-19 in adults who are at risk to progressing to severe COVID-19

1 dose PO twice daily for 5 days

  • Have symptoms for ≤5 days.
  • Renal dosing use reduced dose pack
  • Refer to important drug interactions https://paxlovid.pfizerpro.com/drug-interactions (i.e., If the patient is taking common statin medications such as atorvastatin or rosuvastatin, these drugs can be temporarily discontinued to allow Paxlovid use.)

Preferred

Veklury® (remdesivir)

Mild to moderate COVID-19 in adults who are at risk to progressing to severe COVID-19

200 mg IV x 1, then 100 mg IV every 24 hours for 5 days

  • Initiate as soon as possible after diagnosis of symptomatic COVID-19 has been made and within 7 days of symptom onset

Non-preferred

Lagevrio™ (molnupiravir)

Adults with Mild to moderate COVID-19 who are at risk for progression to severe COVID-19

800 mg PO every 12 hours x 5 days

  • Not for use in hospitalized patients
  • Recommended if Paxlovid or Veklury unavailable.

Non-preferred

Tamiflu® (oseltamivir)

Influenza A and B treatment (uncomplicated)

75mg PO twice daily for 5 days

  • Preferred for pregnant patients

Generic Preferred

Influenza A and B prophylaxis (uncomplicated)

75mg daily for 7 days

Relenza® (zanamivir)

Uncomplicated influenza

2 puffs inhaled q12h x5 days

  • Not recommended for asthma or COPD patients

Preferred

Rapivab®(peramivir)

Uncomplicated influenza

600mg IV x1

  • Not for use for hospitalized patients

Non-preferred

Xofluza® (baloxavir)

Uncomplicated influenza

20-79kg: 40mg x1
>80kg: 80mg x1

  • For patients who have been symptomatic not more than 48 hours

Non-preferred

 

Vaccination Guidance

Review vaccination guidance for COVID-19, influenza, and respiratory syncytial virus (RSV) in our July Pharmacy notice.

 

References

  1. Influenza (Flu). Accessed August 9, 2024.
  2. Mortality in the United States- Provisional Data, 2023. Accessed August 9, 2024
  3. Common Cold Overview. Accessed August 9, 2024.
  4. Influenza Antiviral Medications: Summary for Clinicians. Accessed August 13, 2024.
  5. Influenza (Flu) Accessed August 12, 2024.
  6. COVID-19 Treatment Clinical Care for Outpatients. Accessed August 13, 2024.
  7. IDSA guidelines on the Treatment and Management of Patients with COVID-19. Accessed August 14, 2024.