Please read the Paxlovid® Consumer Medicine Information (CMI) summary on the TGA website.
"Paxlovid Mouth" (dysgeusia) is a somewhat common but thankfully short-lived side effect of Paxlovid®. Data from the initial clinical trial showed that 5.6% of patients taking Paxlovid® had reported disturbances in taste, while post-market pharmacovigilance studies such as this one suggest its frequency is closer to 20% in the real world. The exact cause/mechanism of this side effect remains unknown, but experts have come up with two main hypotheses, nicely summarised in this educational article in The Conversation and this interesting article in The Atlantic (USA).
Although there is currently no evidence-based treatment that has been recommended, you might find one or more of the following helpful:
Please read the Lagevrio® Consumer Medicine Information (CMI) summary on the TGA website.
COVID-19 rebound has been reported to occur between 2 and 8 days after initial recovery, and is characterised by a recurrence of COVID-19 symptoms or a new positive RAT test after having tested negative a few days prior. Initial reports had linked rebound to the use of Paxlovid®, however later studies (such as this meta-analysis in the Journal of Infection, and this retrospective cohort study in the Lancet Infectious Diseases) have demonstrated that COVID-19 rebound occurred at similar frequencies in patients who were not treated with any antivirals, as well as those who were treated with Lagevrio®.
Re-treatment with Paxlovid® or other antiviral therapies is not routinely recommended in cases of COVID-19 rebound, as there is currently no evidence to suggest that rebound cases are at risk of progression to severe disease. The Australian COVID-19 Clinical Guidelines have not made specific treatment recommendations for COVID-19 rebound. In exceptional cases (highly immunocompromised inpatients who are under the care of a hospital specialist) re-treatment may be considered on a case-by-case basis by the treating team, in consultation with an infectious diseases physician.
Am I infectious if my RAT is positive again?
The short answer is yes. RAT works by detecting antigen viral proteins from the virus, and is likely to correlate with infectiousness. If you have COVID-19 rebound with symptoms and/or test positive on RAT again after a brief period of testing negative, it is possible that you are infectious again. Data is limited but the current advice for people experiencing rebound is to avoid contact with others until rebound symptoms have resolved and RAT has become negative again.
This is often a very difficult question to answer with certainty! COVID symptoms are so wide and varied, often involving multiple body systems and organs in additional to the respiratory system, for example, nausea, vomiting and diarrhoea, headache and dizziness, palpitations or other changes in heart rate - all of which are listed as possible side effects of antiviral medications as well.
Generally speaking, for short-acting medications such as the two COVID-19 oral antivirals, if a new symptom occurs within hours of a first dose of the new medication being administered, or if the symptom is noticeably worse in the first few hours after each dose but improves in between doses, it is more likely than not that the new symptom is a medication side effect. Whereas if a new symptom develops many hours or several days after the first dose of the medication, it is less likely to be related to the medication (although not impossible).
In cases where it is neither clear nor likely that the new symptom is a side effect of the medication, it is advisable to continue taking the medication and to monitor the symptom closely, provided it is not causing intolerable discomfort or posing a significant risk of harm (e.g. falling over due to severe dizziness). For nausea in particular, common antiemetics (either over the counter or prescription medications) can be very useful in relieving the symptom, regardless of whether it is a side effect or a new symptom of COVID-19, or in some cases a combination of the two.
If you believe you have suffered a significant side effect of a medication, a medical review with your doctor is always warranted, and an adverse events report should be lodged with the TGA regardless of whether it is later determined that the symptom was indeed caused by the particular medication in question.
The Product Information for Paxlovid® states that the tablets should be swallowed whole and not chewed, broken or crushed. However, in the unlikely event that you have commenced Paxlovid® but later find you are unable to swallow the tablets whole for whatever reason, we believe it would still be preferable to take Paxlovid® as crushed tablets, than to not take the rest of the course at all.
For more information on the practical aspects of this advice, please refer to updated guidance from the Liverpool Drug Interactions Group, based at the University of Liverpool (UK), as well as Therapeutic Brief published by the British Columbia COVID Therapeutic Committee (CTC), based at the BC Centre for Disease Control (Canada).
The Product Information for Molnupiravir (Lagevrio®) states that it is a white to off-white solid that is soluble in water. While the official recommendation is to swallow Molnupiravir capsules whole, if you are unable to do so for whatever reason, it is safe to follow the instructions below to prepare an oral solution.
Dose Preparation & Administration of Molnupiravir as Oral Solution (based on the WA guidelines)
1. Open 4 capsules and transfer contents into a cup or syringe. Discard empty capsules.
2. Add approximately 40 mL of water to the cup or syringe.
3. Mix/stir the capsule contents and water for 3 minutes:
4. Ensure that administration occurs as soon as possible after the preparation, and no later than two hours after the preparation.
5. Stir the solution for 1 minute prior to administration to re-mix the suspension if there has been an unexpected delay between preparation and administration
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