Fluvoxamine Question

[TCABM]

I’m not trying to touch the third rail of COVID with this. The Lancet published this article, Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among patients with COVID-19: the TOGETHER randomised, platform clinical trial

https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00448-4/fulltext

Knowing the FAAs position on SSRIs in general, and fluvoxamine specifically, I assume that even if there was FDA approval, this is not a treatment path an aviator would not want to take.

Curious to hear thoughts from @bbchien or @lbfjrmd.

 

[GaryM]

I’m not trying to touch the third rail of COVID with this. The Lancet published this article, Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among patients with COVID-19: the TOGETHER randomised, platform clinical trial

https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00448-4/fulltext

Knowing the FAAs position on SSRIs in general, and fluvoxamine specifically, I assume that even if there was FDA approval, this is not a treatment path an aviator would not want to take.

Curious to hear thoughts from @bbchien or @lbfjrmd.

Curious too.

I read the article earlier this morning. It's not one of the more effective treatments, but the trial was quite large and seemed well-designed, so the results look fairly solid. It would certainly win on cost, and if approved, it will probably trip up some pilots who accept it as a Covid treatment without realizing the chemical class to which it belongs.

As an aside, Merck/Ridgeback announced yesterday that they will offer royalty-free licensing to other companies in much of the world that want to manufacture molnupiravir, the antiviral expected to gain EUA approval in the near future.

 

[Capt. Geoffrey Thorpe]

Snorting milk up your nose twice a day is much better at preventing the virus from gaining a foothold by coating the nasal passages.

 

[TCABM]

Snorting milk up your nose twice a day is much better at preventing the virus from gaining a foothold by coating the nasal passages.

Thanks, but what does that have to do with a question about an SSRI?

 

[4CornerFlyer]

There is a long list of drugs which have no antiviral properties being touted as useful for COVID-19. Exactly none have stood up to extended analysis. How an SSRI drug would be of benefit is a mystery to me.
Jon

 

[GaryM]

There is a long list of drugs which have no antiviral properties being touted as useful for COVID-19. Exactly none have stood up to extended analysis. How an SSRI drug would be of benefit is a mystery to me.
Jon

Quite true, drug repurposing efforts for other indications don't work all that often, and haven't worked for COVID.

The Lancet paper only speculates on possible mode of action (see below), but correctly notes that more research is needed.

Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) and a σ-1 receptor (S1R) agonist.
There are several potential mechanisms for fluvoxamine in treatment of COVID-19 illness, including anti-inflammatory and possible antiviral effects.
A small placebo-controlled, randomised trial has raised the possibility that fluvoxamine might reduce the risk of clinical deterioration in outpatients with COVID-19, suggesting the need for larger randomised, placebo-controlled studies.​

 

[Stan Cooper]

An excellent four minute read on Fluvoxamine published in Nature yesterday.

Common antidepressant slashes risk of COVID death (nature.com)

A cheap, widely available drug used to treat mental illness cuts both the risk of death from COVID-19 and the need for people with the disease to receive intensive medical care, according to clinical-trial results.

The drug, called fluvoxamine, is taken for conditions including depression and obsessive–compulsive disorder. But it is also known to dampen immune responses and temper tissue damage, and researchers credit these properties for its success in the recent trial. Among study participants who took the drug as directed and did so in the early stages of the disease, COVID-19-related deaths fell by roughly 90% and the need for intensive COVID-19-related medical care fell by roughly 65%.

The team’s study included 1,497 people in Brazil who had COVID-19 and were at high risk of severe disease. Roughly half received fluvoxamine, and the rest received a placebo.

 

[bbchien]

This the first follow up study to a speculative try by iirc a Calif. Racetrack doc, to protect the employees cheaply, a year ago.

This falls into “science” and what role/flavor Fluvox has on the angiotensin receptors in the lung ( a known binding site for Coronaviruses. It’s fascinating but this is definitely not for pilots.....

 

[bflynn]

Many of the “that drug can’t possibly work” fall into that same category. Every drug has side effects and sometimes a drug that is not remotely related to respiratory issues can have an impact. The human body is incredibly subtle and too varied for us to fully understand everything. Yet.

 

[benyflyguy]

They are starting to add that on to some of the patients in our local facility as part of inpatient regimen. Falls under the probably won’t hurt in the short term. Might help.
Pretty interesting to see how the FAA would react to the use of something like this for very short term use for non psych.

 

[weilke]

Pretty interesting to see how the FAA would react to the use of something like this for very short term use for non psych.

A few years ago I sent an airman to Bruce to figure out how to convince the FAA that his off-label prescription of fluoxetine for 'gastric reflux' was not disqualifying. He prevailed but it is not trivial.

 

[Lindberg]

They are starting to add that on to some of the patients in our local facility as part of inpatient regimen. Falls under the probably won’t hurt in the short term. Might help.
Pretty interesting to see how the FAA would react to the use of something like this for very short term use for non psych.

Let's play what would you have to disclose on your next medical:

That you were admitted to the hospital for covid, and any other diagnoses; yes.

That you were treated with fluvoxamine; no.

Don't fill out the form while you're still taking it....

If the FAA decides to request and review the complete medical records of every airman treated for covid, they're going to need a bigger building in Oklahoma.

 

[steingar]

So far exactly none of these treatments has stood up to scrutiny including remdesivir, which was a real surprise since it has demonstrated antiviral properties. Fact of the matter is it is exceedingly difficult to medicate against viruses, and there are very very few drugs able to do so.

 

[benyflyguy]

So far exactly none of these treatments has stood up to scrutiny including remdesivir, which was a real surprise since it has demonstrated antiviral properties. Fact of the matter is it is exceedingly difficult to medicate against viruses, and there are very very few drugs able to do so.

When used early the success of monoclonal antibody therapy is amazing. But not indicated once admitted. That’s where the remdesivir comes in.
Interestingly steroids are playing a big role as well part of the usual regimen. In the beginning we thought the use fo steroids were taboo and contributed to rapid disease progression. Hence real bad outcomes once admitted. Now we bomb with steroids because it’s not covid that kills ya-it’s your immune system going buck wild.

 

[TCABM]

This the first follow up study to a speculative try by iirc a Calif. Racetrack doc, to protect the employees cheaply, a year ago.

This falls into “science” and what role/flavor Fluvox has on the angiotensin receptors in the lung ( a known binding site for Coronaviruses. It’s fascinating but this is definitely not for pilots.....

Thanks for the insight.

 

[steingar]

When used early the success of monoclonal antibody therapy is amazing. But not indicated once admitted. That’s where the remdesivir comes in.

A monoclonal cocktail can be effective. You're basically flooding your blood system with antiCOVID antibodies. I think it has to have its effect very quickly indeed, those will be targets of the immune system themselves unless they've been humanized. I've yet to hear of remdisivir having any efficacy against COVID19. That came as a huge surprise, but the data is always right.

Interestingly steroids are playing a big role as well part of the usual regimen. In the beginning we thought the use fo steroids were taboo and contributed to rapid disease progression. Hence real bad outcomes once admitted. Now we bomb with steroids because it’s not covid that kills ya-it’s your immune system going buck wild.

Yup. The called it a cytokine storm, immune messengers sending immune cells into a frenzy. Only drug I know of that works on COVID. There are some new medications on the horizon that I think will show some efficacy. That said the absolute best drug is a vaccine, don't get it in the first place or ameliorate it if you do.

 

[rwellner98]

Some potentially very good news on this front:
Pfizer antiviral pill reduced risk of covid hospitalization and death by 89 percent in high-risk people


"

In a clinical trial, participants at high risk of developing severe illness were given the drug regimen — a combination of three pills, taken twice a day — within three days of their covid-19 symptoms beginning. Half received the experimental drug and half received a placebo. Paxlovid was 89 percent effective in reducing risk of hospitalization and death. Among 389 people who received the drug, three hospitalizations and no deaths were reported. Among 385 people who got a placebo, 27 hospitalizations were reported, with seven subsequent deaths.


"

https://www.washingtonpost.com/health/2021/11/05/pfizer-covid-pill/

 

[write-stuff]

Snorting milk up your nose twice a day is much better at preventing the virus from gaining a foothold by coating the nasal passages.

Snort Ivermectin. Works even better.