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Strategies & Market Trends : 2026 TeoTwawKi ... 2032 Darkest Interregnum -- Ignore unavailable to you. Want to Upgrade?


To: TobagoJack who wrote (182171)12/31/2021 5:56:23 AM
From: Pogeu Mahone  Respond to of 218044
 
Do Not Worry JUST POP A PILL....... LOL

So basically anyone on a blood thinner (most old people) don’t take this drug….
====================================

The COVID-19 Treatment Guidelines Panel's Statement on Potential Drug-Drug Interactions Between Ritonavir-Boosted Nirmatrelvir (Paxlovid) and Concomitant MedicationsLast Updated: December 30, 2021

On December 22, 2021, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for ritonavir-boosted nirmatrelvir (Paxlovid) for the treatment of patients with mild to moderate COVID-19 who are within 5 days of symptom onset and at high risk of progression to severe disease.1,2 The dose for patients with normal renal function is nirmatrelvir 300 mg (two 150 mg tablets) plus ritonavir 100 mg (one 100 mg tablet) orally twice daily for 5 days. For more information, see the COVID-19 Treatment Guidelines Panel’s (the Panel) statement on treatment options for nonhospitalized patients with mild to moderate COVID-19.

Ritonavir-boosted nirmatrelvir (Paxlovid) has significant and complex drug-drug interaction potential, primarily due to the ritonavir component of the combination. Boosting with ritonavir, a strong cytochrome P450 (CYP) 3A inhibitor, is required to increase the exposure of nirmatrelvir to a concentration that is effective against SARS-CoV-2. Ritonavir is an FDA-approved drug that has been used for more than 2 decades as a pharmacologic boosting agent for certain anti-HIV medications; therefore, there is a large body of literature describing its use with other drugs and its potential for serious and sometimes life-threatening drug-drug interactions. Clinicians who are not experienced in prescribing ritonavir-boosted drugs should refer to resources such as the EUA fact sheet for ritonavir-boosted nirmatrelvir (Paxlovid) and the Liverpool COVID-19 Drug Interactions website for additional guidance. Consultation with an expert (e.g., clinical pharmacist, HIV specialist, and/or the patient’s specialist provider[s], if applicable) should also be considered.

Ritonavir is an inhibitor, inducer, and substrate of various drug-metabolizing enzymes and/or drug transporters. Most notably, as a strong inhibitor of CYP3A, it may increase concentrations of certain concomitant medications, thereby increasing the potential for significant drug toxicities. CYP3A inhibition by ritonavir typically resolves 3 to 5 days after the drug is discontinued. When ritonavir is used for a treatment duration of 5 days, its induction properties are less likely to be clinically relevant than when the drug is used chronically for HIV. In addition, both nirmatrelvir and ritonavir are substrates of CYP3A; thus, administration of this treatment with or immediately after discontinuing medications that are strong inducers of CYP3A4 (e.g., rifampin) can lead to significant reductions in nirmatrelvir and ritonavir concentrations, which may decrease nirmatrelvir’s effectiveness against SARS-CoV-2.

Assess for Potential Drug-Drug InteractionsBefore prescribing ritonavir-boosted nirmatrelvir (Paxlovid), clinicians should carefully review concomitant medications, including over-the-counter medicines and herbal supplements, to evaluate the potential for drug-drug interactions.The EUA fact sheet for ritonavir-boosted nirmatrelvir (Paxlovid) and the Liverpool COVID-19 Drug Interactions website are useful for identifying and managing drug-drug interactions.Drug classes of particular concern are those that include drugs that are prone to concentration-dependent toxicities, including (but not limited to) certain antiarrhythmics, oral anticoagulants, immunosuppressants, anticonvulsants, antineoplastics, and neuropsychiatric drugs.If a significant drug-drug interaction is identified, clinicians should consider the risks and benefits of using ritonavir-boosted nirmatrelvir (Paxlovid). Expert consultation (e.g., with a clinical pharmacist, HIV specialist, and/or the patient’s specialist provider[s], if applicable) should be considered, especially for patients receiving highly specialized therapies, such as antineoplastics, neuropsychiatric drugs, and certain immunosuppressants.Potential management strategies to facilitate the use of ritonavir-boosted nirmatrelvir (Paxlovid) may differ depending on the magnitude and significance of the interaction. Potential strategies include:Dose adjustment of the concomitant medicationUse of an alternative to the concomitant medicationIncreased monitoring for potential adverse reactions to the concomitant medicationIn some instances, temporary withholding of the concomitant medicationThe dose of ritonavir-boosted nirmatrelvir (Paxlovid) should not be adjusted to avoid or mitigate a drug-drug interaction with a concomitant medication.Patients should be informed of ritonavir-boosted nirmatrelvir’s (Paxlovid) drug-drug interaction potential. If a drug-drug interaction is identified, the patient should be informed and advised of the signs and symptoms of potential adverse effects.These strategies should be considered for the 5-day duration of ritonavir-boosted nirmatrelvir (Paxlovid) treatment and for at least 3 to 5 days after treatment completion, and for potentially longer if ritonavir-boosted nirmatrelvir (Paxlovid) is administered with an interacting concomitant medication that has a long half-life.In settings where these management strategies are not feasible or where the effectiveness of ritonavir-boosted nirmatrelvir (Paxlovid) may be compromised, consider using alternative COVID-19 therapies (see the Panel’s statement on treatment options for nonhospitalized patients with mild to moderate COVID-19 for more information).The EUA for ritonavir-boosted nirmatrelvir (Paxlovid) suggests that individuals who use products containing ethinyl estradiol for contraception should use a backup, nonhormonal contraceptive method because ritonavir-boosted nirmatrelvir (Paxlovid) has the potential to decrease ethinyl estradiol levels. However, the enzyme-inducing effects of ritonavir-boosted nirmatrelvir (Paxlovid) that would lead to lower hormone exposure are not expected to be clinically significant during 5 days of therapy and, therefore, would not be expected to decrease contraceptive effectiveness. In addition, ethinyl estradiol is always combined with a progestin for contraception. Progestin concentrations are expected to remain similar or increase when ritonavir-boosted nirmatrelvir (Paxlovid) is used concomitantly with combined hormonal contraception, which maintains the effectiveness of the oral contraceptive.

Medications That Are Contraindicated or Should Not Be Coadministered With Ritonavir-Boosted Nirmatrelvir (Paxlovid)This table is a guide and not a comprehensive list of all possible drugs that may interact or should not be coadministered with ritonavir-boosted nirmatrelvir (Paxlovid). For example, many drugs that may require dose adjustment or increased monitoring when coadministered with ritonavir-boosted nirmatrelvir (Paxlovid) are not listed in this table. The EUA fact sheet for ritonavir-boosted nirmatrelvir (Paxlovid) and the Liverpool COVID-19 Drug Interactions website should be used to identify and manage drug-drug interactions. Before prescribing ritonavir-boosted nirmatrelvir (Paxlovid) for patients receiving highly specialized drugs, such as antineoplastics, consultation with the appropriate specialist providers is recommended.

Deviation from these recommendations may be appropriate in certain clinical scenarios. Providers should exercise clinical judgment when assessing the risks and benefits of ritonavir-boosted nirmatrelvir (Paxlovid) and determine the most appropriate strategy for managing drug-drug interactions between ritonavir-boosted nirmatrelvir (Paxlovid) and concomitant medications. This is particularly important in the outpatient setting, where close monitoring may not be feasible. Expert consultation should be considered.

In situations where drug-drug interaction risks cannot be mitigated or where the effectiveness of ritonavir-boosted nirmatrelvir (Paxlovid) may be compromised, consider using alternative COVID-19 therapies (see the Panel’s statement on treatment options for nonhospitalized patients with mild to moderate COVID-19 for more information).

Prescribe an alternative COVID-19 therapy for patients who are receiving any of the medications listed.Before prescribing ritonavir-boosted nirmatrelvir (Paxlovid), determine whether the patient is receiving any of the medications listed.If the patient is receiving any of these medications, withhold the medication if clinically appropriate.If withholding is not clinically appropriate, use an alternative concomitant medication or COVID-19 therapy.a
Amiodarone
Apalutamide
Bosentan
Carbamazepin
Cisapride
Clopidogrel
Clozapine
Colchicine in patients with renal and/or hepatic impairment
Disopyramide
Dofetilide
Dronedarone
Eplerenone
Ergot derivatives
Flecainide
Flibanserin
Glecaprevir/pibrentasvirIvabradine
Lumateperone
Lurasidone
Mexiletine
Phenobarbital
Phenytoin
Pimozide
Propafenone
Quinidine
Ranolazine
Rifampin
Rifapentine
Rivaroxaban
Sildenafil for pulmonary hypertension
St. John’s wort
Tadalafil for pulmonary hypertension
Ticagrelor
Vorapaxar
AlfuzosinAlprazolamAtorvastatinAvanafilClonazepamCodeineCyclosporinebDiazepamEverolimusbFentanylHydrocodoneLomitapideLovastatinMeperidine (pethidine)Midazolam (oral)OxycodonePiroxicamPropoxypheneRosuvastatinSalmeterolSildenafil for erectile dysfunctionSilodosinSimvastatinSirolimusbSuvorexantTacrolimusbTadalafil for erectile dysfunctionTamsulosinTramadolTriazolamVardenafil


AcknowledgmentsThe Panel would like to express their appreciation to the following clinical pharmacology experts for their contributions to this statement:

Sarita Boyd, PharmD, of the Food and Drug Administration, Jomy George, PharmD, of the National Institutes of Health, and Kimberly Scarsi, PharmD, of the University of Nebraska

References



To: TobagoJack who wrote (182171)12/31/2021 6:49:42 AM
From: Pogeu Mahone  Read Replies (1) | Respond to of 218044
 
Live updates: Hong Kong reports cases of omicron spreading

Hong Kong has confirmed the first cases of community transmission of the omicron variant of COVID-19, tied to an airline crew member who had returned from the United States and lunched at a restaurant two days later

By The Associated Press

December 31, 2021, 6:03 AM
• 10 min read



The Associated Press

People wear face mask as they stand in line for a free COVID-19 test outside the Lincoln...

HONG KONG — Hong Kong has confirmed the first cases of community transmission of the omicron variant of COVID-19, tied to an airline crew member who had returned from the United States and lunched at a restaurant two days later.

Two other people eating at the Moon Palace restaurant on Monday were infected. One was the father of the Cathay Pacific crew member and the other was a construction worker dining 10 meters (30 feet) away.

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Health Secretary Sophia Chan said at a news conference Friday that city leader Carrie Lam had expressed her strong dissatisfaction to the airline’s chairman and its CEO that some staff had violated a 3-day self-isolation rule after their return. The health secretary called their actions “irresponsible.”

Cathay Pacific said in a statement that five crew members had tested positive for omicron recently, and some had not followed regulations. It apologized and said they would be disciplined.

Hong Kong has recorded 81 omicron cases. The others were among people who had arrived from overseas.

———

HERE’S WHAT YOU NEED TO KNOW TODAY ABOUT THE CORONAVIRUS PANDEMIC:

— US children hospitalized with COVID in record numbers

— U.S. health officials press nursing home workers to get booster shots

— New COVID-19 cases in US soar to highest levels on record

— Do at-home COVID-19 tests detect the omicron variant?

— Canadian provinces adopt restrictions amid daily case records

———

Follow AP’s pandemic coverage at apnews.com

———

HERE’S WHAT ELSE IS HAPPENING TODAY:

SYDNEY — New coronavirus infections soared again in Australia on Friday to a record of more than 32,000, just days after surpassing 10,000 for the first time.

Experts say the explosion is being driven by the highly contagious omicron variant and a recent relaxation of restrictions in Sydney and other areas.

More than 15,000 of the new cases were reported in Sydney. Another 5,000 cases came from elsewhere in New South Wales state, while almost 6,000 were confirmed in Victoria state, home to Australia’s second largest city, Melbourne.

While hospitalizations and deaths have been increasing from the surge, so far they haven’t reached comparative levels seen in previous outbreaks. And many cities are planning to go ahead with New Year’s Eve celebrations, including the famous fireworks display from the Sydney Harbor Bridge and Sydney Opera House.

———

JERUSALEM — Israel has begun delivering a fourth vaccine dose for people most vulnerable to coronavirus, becoming one of the first countries to do so as it prepares for a wave of infections driven by the omicron variant.

Israel, which led a world beating vaccination program in 2020, will administer a fourth dose of the vaccine to individuals with weakened immune systems along with elderly residents and employees in care homes.

The rollout of the fourth dose began at Israel’s Sheba Medical Center Friday morning and was administered to heart and lung transplant patients.

The country is currently experiencing a new wave of infections fueled by the transmissible omicron variant. There were 4,085 new cases recorded on Thursday, the highest daily count of infections Israel has seen since late September.

In response, Israel introduced new restrictions late Thursday in a bid to curb rising infection rates ahead of new year’s eve celebrations. These include a Green Pass, given to fully vaccinated individuals or those who have recently recovered from coronavirus, for outdoor events of more than 100 people and mandatory mask-wearing in outdoor events of more than 50 people.

Israel, a country of 9.3 million people, has reported 8,243 deaths from the coronavirus since the start of the pandemic. Most of its population — more than 6.5 million people — has received at least one dose of the Pfizer/BioNTech vaccine, and more than 4.2 million Israelis have received two doses and a booster.

———

SEOUL, South Korea — South Korea says it’ll extend the toughest social distancing rules for another two weeks to try to lower critical cases and guard against the omicron variant.

The government said Friday the current restrictions such as a four-person limit on private gatherings and a 9 p.m. curfew on restaurants and cafes will continue until Jan. 16.

Health Minister Kwon Deok-cheol says South Korea’s daily caseload has recently dropped to the 5,000s from the previous 8,000s thanks to the current distancing guidelines enforced two weeks ago.

But he says the number of critically or seriously ill patients remains above 1,000. Kwon says the omicron variant also continues to spread throughout South Korea and that it’s difficult to prevent it from becoming the dominant strain in South Korea.

On Friday, South Korea added 4,875 new COVID-19 cases, pushing the national tally to 630,838. Health authorities said they’ve also confirmed 269 new cases of the omicron variant, taking the country’s total to 894.

———

NEW YORK — A coronavirus surge has upended plans to hold a major nuclear treaty conference at the United Nations next month, with participants agreeing Thursday to postpone the meeting days before its scheduled start.

After nearly two years of pandemic delays, delegations from around the world were due to converge Tuesday on U.N. headquarters to take stock of the 1970 Non-Proliferation Treaty, a pillar of nuclear arms control.

But organizers are now penciling in an Aug. 1 start date, according to an email Thursday from the U.N. disarmament office to entities involved. The conference was initially scheduled for spring 2020.

As coronavirus cases spike again in the U.N.’s host city of New York and a growing number of staffers are sick or or quarantined, the world body told the conference leader Monday that it couldn’t accommodate a big gathering now.

The NPT is the world’s most widely ratified nuclear arms control agreement, with 191 participating countries. Nations without atomic weapons committed not to acquire them and to allow verification that nuclear energy programs weren’t morphing into weaponry. Countries that had nukes when the treaty was signed — the United States, Russia, Britain, France and China -- agreed to move toward eliminating them.

———

TORONTO — Quebec is reimposing a nighttime curfew beginning New Year’s Eve, and Ontario has delayed the resumption of school by two days as several Canadian provinces report new highs for COVID-19 infections.

Quebec Premier Francois Legault says the curfew will be in effect 10 p.m. to 5 a.m. as of Friday night and will run for an indefinite period.

Quebec imposed a pandemic-related nightly curfew last Jan. 9 and did not lift the measure until May 28. It has been the only Canadian province to order a curfew over the coronavirus.

In Ontario, classes had been scheduled to resume Monday but that has been pushed back to Wednesday. Officials say that will give schools time to provide N95 masks to staff and deploy more HEPA filter units.

———

HONOLULU — Hawaii set an all-time record for new coronavirus cases on Thursday as the state of about 1.5 million people reported nearly 3,500 new infections.

The daily total of new cases reported by health officials was 3,484, topping the record of 2,205 cases set the day after Christmas. The state was averaging just over 100 new cases a day at the beginning of the month.

The latest surge came about two weeks after the first omicron variant case was confirmed in Hawaii.

Honolulu Mayor Rick Blangiardi said there would be no new restrictions on Oahu over the New Year holiday. He said people should take personal responsibility to curb the disease.

———

SANTA FE, N.M. — New Mexico is running short of free at-home rapid tests to detect COVID-19 infections as the state struggles with the spread of the omicron variant of the coronavirus.

The company that runs the state’s program said Thursday that the state’s supply of tests was overstretched. The announcement came hours after Democratic Gov. Michelle Lujan Grisham wrote that residents could “order a testing kit today.”

By afternoon “all available tests have been shipped” and Vault Health was offering paid testing instead. The state reported an additional 2,209 cases of COVID-19 on Thursday and 26 additional deaths.

———

NEW ORLEANS -- Louisiana is setting records for new COVID-19 diagnoses, and the state’s omicron variant surge is just beginning, Gov. John Bel Edwards said Thursday.

Thursday’s 24-hour total of 12,467 new cases was more than a third above Wednesday’s 9,378, Edwards said during a news conference livestreamed on Zoom.

He said the U.S. Centers for Disease Control and Prevention said Wednesday’s figure was itself a state record, topping 7,548 set in August, during the delta variant surge.

Edwards says the number of people hospitalized with the virus has risen 268% since Dec. 17, to 762.

The governor said he would not mandate masks unless such an order is needed to keep hospitals from being overwhelmed. But he said people should heed masking recommendations from both the CDC and the state Department of Health.

Wearing a mask is a minor inconvenience “compared to being in a hospital struggling to get oxygen or watching a loved one struggling to get oxygen,” he said.

He and other state and hospital officials around south and central Louisiana repeatedly urged everyone to take precautions such as getting vaccinations and booster shots.

———

JACKSON, Miss. — Mississippi’s Supreme Court chief justice issued an emergency order Thursday allowing judges to postpone jury trials through mid-January because of the recent surge in COVID-19 cases.

Mississippi Supreme Court Chief Justice Mike Randolph’s order also allows courts to use teleconferencing, videoconferencing and electronic filing to limit in-person contact in courts. Felony plea, felony sentencing and probation violation hearings can be conducted remotely.

The order is an extension of safety regulations that were already in place. Emergency Administrative Order 25 is the fourth emergency order issued by the chief justice since August which allows judges to postpone jury trials.

In his most recent order, Randolph cited the recent uptick in cases — especially the highly contagious omicron variant.

As of Dec. 14, there were 575 new COVID-19 confirmed infections in Mississippi. Approximately two weeks later, the number of confirmed cases increased more than eightfold, to 4,885 cases, Randolph said.

———

SACRAMENTO, Calif. — With a new and more infectious coronavirus variant sweeping California, attorneys representing inmates say violations of health orders by prison staff risk a repeat of the outbreaks that killed dozens in the first year of the pandemic.

The most recent statistics show large percentages of employees who are required to be tested twice weekly aren’t doing so, and most face no consequences.

Corrections officials say they are updating those figures but have not yet provided new data.

Officials are temporarily shutting down admissions to Wasco State Prison in the San Joaquin Valley where there have been more than 150 new infections in the past two weeks. Starting Monday, officials say inmates statewide must be fully vaccinated to have in-person or family visits, unless they have approved religious or medical exemptions.

The actions come as new cases soar across California and state models predict a gradual increase in hospitalizations and intensive care admissions over the next month.

———

SEATTLE — A Seattle-area medical system says it will soon limit COVID-19 testing appointments at its community testing sites because of an “astronomically high” positivity rate.

The Seattle Times reports UW Medicine said Thursday appointments will be limited to only those with symptoms or known exposures. Of UW Medicine’s 12 community testing sites, nine will soon start limiting appointments. Three will close temporarily.

The positivity rate is measuring more than 40% at some South King County testing sites and the high rate is slowing scientists’ ability to parse out which samples are actually positive.