By Michael Roizen, MD
Q: Is it safe to have my pharmacist prescribe a COVID-19 antiviral medication? Seems a bit wobbly. — Alan R., Topeka, Kansas
There are around 60,000 pharmacies in the United States. They provide clients with many of the 4 billion doctor’s prescriptions written annually in this country. But now pharmacists can prescribe and fill out a prescription for the COVID-19 antiviral drug Paxlovid. This way you can get immediate treatment if you are at high risk of severe COVID-19 disease. The antiviral must be taken within five days of your first symptoms and is approved for adults and children 12 and older.
The Food and Drug Administration approved pharmacists as prescribers – with several important guidelines:
— Take your health records from the past year and any blood test results with you for your pharmacist to check.
— Make a list of your medications and supplements. Ask your pharmacist to look up possible drug-drug interactions between your medications and Paxlovid.
— Any past or present problems with your liver or kidney function must be presented for evaluation. If there is no clear evidence that your liver and kidneys are healthy, you must see your doctor to receive Paxlovid.
— If you receive Paxlovid from a pharmacist, you should inform your doctor immediately. The disease often recurs after Paxlovid and can even turn into a long COVID-19, so additional treatments may be needed.
The American Medical Association doesn’t endorse the program, saying “prescribe it [Paxlovid] requires knowledge of a patient’s medical history, as well as clinical monitoring for side effects and follow-up to determine if a patient is improving.” But given the difficulties so many people have in accessing healthcare, I think it can be life-saving if the guidelines are followed. A study in the New England Journal of Medicine found that the drug reduced the risk of hospitalization or death from COVID-19 by 89% in high-risk patients. Q: My doctor says mine
Cholesterol levels and blood pressure mean I’m not heart healthy. At 52 I don’t want to end up with a heart attack or worse. Can you give me a list of steps? – Ernie T., Annapolis, Maryland
A: First let me say bravo! You want to improve your heart health and reduce your risk of everything from dementia and heart attack to peripheral artery disease and stroke – and you can.
I hope your ambition inspires others. A study in the Journal of the American College of Cardiology shows that nearly 93% of your fellow Americans are also not in good cardiometabolic condition. The researchers defined optimal cardiometabolic health as the absence of a clinical history of cardiovascular disease and optimal levels of obesity (a waist circumference of 40 or less for males, 35 or less for females); blood sugar (less than 100 mg/dL after not eating for at least eight hours); blood pressure (below 120/80); and blood lipids (an LDL less than 100). I believe LDL should be below 70, and knowing your apolipoprotein levels is an even more accurate risk indicator.
The researchers found that only 6.8% of people met their standard. For a short list of steps you and others can take to regain heart health and prevent, control, or reverse diabetes, the American Heart Association’s newly expanded guidelines are a good place to start. Life’s Essential 8 includes:
1. Healthy Eating: My advice is to enjoy a plant-based diet, avoid red and processed meats and highly processed foods, egg yolks, added sugars and syrups, and fried foods.
2. Fitness: 150 minutes of interval aerobic activity per week and strength training twice per week.
3. Quitting nicotine.
4. Sleep: Get 7-8 hours of restful sleep every night.
5. Lose Weight: Visit my.clevelandclinic.org for help. Search for “healthy-weight-is-healthy-heart.”
6. Cholesterol: My advice is LDL levels below 70 and triglycerides below 50 mg/dL.
7. Diabetes: Glucose levels of 140 mg/dL two hours after eating or 100 mg/dL after eight hours of not eating.
8. Blood Pressure – 120/80 or lower.
Health pioneer Michael Roizen, MD, is the Chief Wellness Officer Emeritus at the Cleveland Clinic and the author of four New York Times #1 bestsellers.
(c)2022 Michael Roizen, MD
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