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Newsletter #5: COVID Treatment Options

October 2021


Treatment Options for Active Covid-19

 

My office has now treated a large number of patients for Covid-19.  These patients have been both vaccinated and unvaccinated.  Generally, the vaccinated population has milder disease.  In patients who have more significant disease, but do not require hospitalization, there may be a few treatment options.  Listed below are the most commonly discussed outpatient options and my opinions regarding each. 


Monoclonal  antibodies: Monoclonal antibodies are available as an IV infusion at most  hospital infusion centers.  A doctors order is required. These are antibodies directed at the Covid-19 virus.  The infusion takes only a few minutes and is performed as an outpatient.  It is used primarily in high-risk patients who have had symptoms less than 10 days.  My experience is that monoclonal antibodies work extremely well and I would encourage anyone who is at high risk for Covid complications, whether immunized or not, to consider receiving monoclonal antibodies. This is especially true if they have active Covid disease that seems to be worsening.  The cost of a monoclonal antibody infusion is about $2000 with the federal government currently covering the cost (which means you and I are covering the cost). 


MOLNUPIRAVIR . The antiviral drug molnupiravir could become the first FDA approved  oral method for the treatment for COVID-19, after studies showed it can reduce the risk of hospitalization or death in newly diagnosed patients. It is a five day course that must be administered within 5 days of symptoms. Merck, its manufacturer, has applied for emergency authorization. The cost has not been announced. 

 

BUDESONIDE.  Budesonide is an inhaled steroid frequently used to treat asthma. It has potent anti-inflammatory properties. Studies have supported its use in early Covid-19 infections. It is available by prescription, brand name Pulmicort, or as generic ampules used though a nebulizer. Cost for a 10 day nebulizer treatment is about $50.  https://www.sciencedirect.com/science/article/abs/pii/S2213260021001600 

 

HYDROXYCHLOROQUINE:  Hydroxychloroquine received a lot of press early in the Covid pandemic.  There was a lot of anecdotal evidence that it was helpful.  However, there have now been several studies to look at HYDROXYCHLOROQUINE and the general feeling is that it is minimally helpful.  In hospitalized patients, it might actually be harmful. (https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(20)30505-X/fulltext) 

However, it may still have a role in early prevention (https://www.talkingaboutthescience.com/studies/HCQ/Meo2020.pdf). 


IVERMECTIN.  Ivermectin is an antiparasitic drug that has been used throughout the world as a treatment for a variety of pandemic parasites.  It may work to prevent/treat Covid-19 disease by inhibiting the host importin alpha/beta-1 nuclear transport proteins, which are part of a key intracellular transport process that viruses hijack to enhance infection by suppressing the host's antiviral response.  While current studies available are small, many are positive in their ability to reduce serious disease. Some studies have shown no benefit. The average cost of treatment is about $40. More studies are underway.  I would consider it safe when prescribed in the appropriate doses.  However, due to the current political climate, you may have difficulty getting a doctor to prescribe it. https://onlinelibrary.wiley.com/doi/full/10.1002/rmv.2265  

 

A word about "HORSE DE-WORMER".  The mainstream media has frequently mischaracterized  IVERMECTIN and criticized patients who have used it as taking “horse de-wormer”. One thing should be clear:  It is never okay to take any drug that was originally manufactured for any animal other than humans.  These drugs frequently contain concentrations that are potentially harmful to humans.  With that said, it is quite common for drugs that are often prescribed in humans to also be used to treat disease in other animals.  For instance, PENICILLINS are commonly used to treat infections in other mammals.  Does this mean when you take PENICILLIN for your strep throat that you are taking COW ANTIBIOTIC?   

 

FLUVOXAMINE.  Fluvoxamine is a prescription medication that has been available in the United States for many years. It is used primarily to treat obsessive-compulsive disorder.  It also seems to have properties that can interrupt cytokine production, which is the main source of inflammation in Covid-19 disease. Several small studies suggest that Fluvoxamine, even in relatively small doses, can reduce the risk of severe Covid-19 illness.  A 10-day course runs about $20.  This has become one of my favorite's, along with monoclonal antibodies, due to its excellent safety profile. https://academic.oup.com/ofid/article/8/2/ofab050/6124100?login=true 

 

HYDROGEN PEROXIDE.  Hydrogen peroxide has been advocated by many complementary physicians in an inhaled form through a nebulizer to treat and prevent Covid-19. It is also been used as a nasal spray and mouthwash.  I have been unable to find quality studies that support its use, but only anecdotal evidence.  My concern here is for the potential for significant respiratory reactions from the inhalant form. The Asthma and Allergy Foundation of America has come out against the use of hydrogen peroxide for this reason.  I believe the nasal spray and mouthwash are safe. While I think this may have some promise, more safety studies are needed before I can endorse this treatment for inhalation. 


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