Tackling Viral Respiratory Ailments This Fall

By Jamie Bussin and Andy Donald

A relative of mine has been suffering with coughing fits since contracting Covid-19 months ago. He’s not alone. Persistent coughing is a common symptom of ‘Long Covid’. But there are other viral respiratory ailments that can impact us as the weather worsens in fall and winter.  On Episode #317 of the Tonic Talk Show/Podcast I spoke to Clinical Pharmacist Andy Donald about the nature and treatment of viral respiratory ailments. This is a digest of that conversation.

Paxlovid, which many people know has been used to treat the symptoms of Covid-19, is a protease inhibitor, which acts to prevent the virus from replicating. Viruses aren’t living things. They are microscopic layers of protein containing one genetic code that infiltrates and hijacks our cells to replicate the virus and spread. Paxlovid prevents the virus from ‘repackaging’ itself to leave your cell and thus prevents replication. Paxlovid must be taken within 5 days of the start of symptoms or it isn’t effective.

Tamiflu (generically known as Osiltamivir) can be taken to treat viral influenza. It traps a protein called neuraminidase, found in H1N1 or H3N1 virus on the outside edge of your cells and lets your body attack the virus before it spreads off your cells to other cells. This medication must be used within 48 hours of the start of symptoms or it isn’t effective.

Pharmacists, as well as doctors are permitted to prescribe Paxlovid or Tamiflu. Paxlovid is covered under government programs such as OHIP but Tamiflu is not. However, some private insurers will cover the cost of Tamiflu.

The difficulty for pharmacists and doctors is that the symptoms of Covid-19 have become more similar to influenza as the mutations have become less severe but more spreadable. So rapid swab testing should be done to confirm whether you’re suffering from Covid-19. Which if the rapid test shows negative for Covid-19, presumes the symptomatology is probably influenza.

Before prescribing either drug, there should be a medication review, as both (especially Paxlovid) have drug interactions. Some of your existing medications may need to be stopped, others might need to be reduced.  Generally what happens with these drugs (again, especially Paxlovid) is that your liver enzymes slow down and your medications will stay in your system longer. 

Similarly your kidney function, or renal (creatinine) clearance, should be considered by your doctor or pharmacist before prescribing either Paxlovid or Tamiflu. 

Fortunately there are limited side effects of either Paxlovid or Tamiflu. Some people might experience dizziness or an upset stomach. 

There are contraindications for both Paxlovid or Tamiflu – which your doctor or pharmacist should review with you before prescribing the drug.