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Dr KK Aggarwal 24 June 2020
With inputs from Dr Monica Vasudev
954: Favipiravir update
Frequency not defined:
Gastrointestinal: Decreased appetite, diarrhea, nausea, vomiting
Endocrine & metabolic: Hyperuricemia
Hematologic & oncologic: Decreased neutrophils
Hepatic: Hepatic injury, increased serum transaminases
Influenza Virus Vaccine (Live/Attenuated): Antiviral Agents (Influenza A and B) may decrease the therapeutic effect of Influenza Virus Vaccine (Live/Attenuated). Avoid anti-influenza antivirals from 48 hours prior to and ending 2 weeks after live influenza virus vaccine administration. Risk D: Consider therapy modification
Pyrazinamide: Favipiravir may increase the adverse/toxic effect of pyrazinamide. The risk for increased uric acid concentrations may be increased. Risk C: Monitor therapy
Repaglinide: CYP2C8 Inhibitors (Weak) may increase the serum concentration of repaglinide. Risk C: Monitor therapy
Favipiravir is not approved for use in the United States. On the basis of data obtained from animal reproduction studies, its use is contraindicated in females who may become pregnant in countries where it is approved for the treatment of influenza.
Pregnancy status must be evaluated before use in females of reproductive potential. Females of reproductive potential should use effective contraception during therapy and for 1 week after the last favipiravir dose. Additionally, males with female partners of reproductive potential should use effective contraception during therapy and for 1 week after the last dose of favipiravir.
Favipiravir is not approved for use in the United States. Based on data from animal reproduction studies, its use is contraindicated in pregnant patients in countries where it is available for the treatment of influenza.
The drug is under study for the treatment of COVID-19; however, pregnant patients were not included in the initial clinical trials. The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) have devised an algorithm to assist practitioners in assessing and managing pregnant women with suspected or confirmed COVID-19 (https://www.acog.org/topics/covid-19; https://www.smfm.org/covid19). The CDC has also issued interim guidance for pregnant women who are diagnosed with COVID-19 (https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html).
Data collection to monitor maternal and infant outcomes after exposure to COVID-19 during pregnancy is underway. Healthcare providers should enrol females exposed to COVID-19 during pregnancy in the Organization of Teratology Information Specialists (OTIS) pregnancy registry (877-311-8972; https://mothertobaby.org/join-study/) or the PRIORITY (Pregnancy CoRonavIrus Outcomes RegIsTrY) (415-754-3729, https://priority.ucsf.edu/).
It is not known if favipiravir is present in breast milk.
According to data from animal studies, breastfeeding is contraindicated during favipiravir therapy.
Favipiravir is being investigated for the treatment of COVID-19; however, lactating women were not included in the initial clinical trials. Interim guidance is available from the Centers for Disease Control and Prevention for lactating women who are diagnosed with COVID-19 (https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html). Information related to COVID-19 and breastfeeding is also available from the World Health Organization (https://www.who.int/docs/default-source/maternal-health/faqs-breastfeeding-and-covid-19.pdf?sfvrsn=d839e6c0_1).
[Source: Uptodate; Medscape]
Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA
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