Pharmacists versus the flu
Have you gotten your flu shot yet? If you’re a pharmacist, of course you have, and you probably have administered them to dozens, if not hundreds, of individuals who come to your pharmacy.
According to the Centers for Disease Control and Prevention, more than 80,000 Americans died from the flu during the last flu season — the highest death toll from the flu in four decades — and 900,000 were hospitalized. However, in spite of these statistics, a survey conducted in mid-November by researchers at the University of Chicago determined that 41% of adults responded that they had not been vaccinated and had no plans to do so. This situation is of great concern and would be even more threatening if pharmacists were not authorized to provide immunizations against the influenza virus, and now vaccinate millions of people each year.
Vaccinated or not, those who have the misfortune of experiencing the flu have a rapid onset of miserable and even life-threatening symptoms. Pharmacists have the expertise to recognize flu symptoms. We need to state that more boldly — we can diagnose the flu. Pharmacists can distinguish between flu symptoms and symptoms of the common cold, allergic rhinitis and most other conditions with respiratory and other symptoms. Pharmacists know that young children, the elderly, pregnant women, those with preexisting pulmonary conditions, and patients who are immunocompromised are at the highest risk of complications from the flu.
The most widely used treatment for the flu is oseltamivir, or the brand name Tamiflu. It inhibits influenza neuraminidase and reduces replication of the virus. It is administered twice a day for five days, but treatment must be initiated within 48 hours following the onset of symptoms if it is to be effective. It reduces the severity of symptoms and their duration by approximately one day.
The newest treatment, Xofluza, or baloxavir marboxil, was approved in October 2018 by the Food and Drug Administration to treat acute uncomplicated influenza in patients age 12 years old and older. It is a single-dose treatment that like oseltamivir must be initiated within 48 hours of the onset of symptoms, and it is well tolerated.
I commend the FDA for its actions that have accelerated the review, approval and availability of baloxavir. However, for faster and more extensive availability and benefit, baloxavir and oseltamivir should be available without a prescription from a pharmacist, and I partially fault the FDA for continuing to refuse to permit selected, safe medications that must be administered on a timely/urgent basis to be available in this manner. The pharmaceutical companies marketing baloxavir and oseltamivir also are at fault for not being proactive in requesting faster and more extensive availability of these medications from pharmacists. But the most important question is: How many of the individuals who will die of complications from influenza during this flu season could have been spared that fate had they been treated with baloxavir or oseltamivir on a timely basis?
In the meantime, pharmacists should establish collaborative working relationships with local physicians to obtain the authority to provide baloxavir to patients with flu symptoms.
Pharmacists should provide documentation of their assessment and services to the patients’ physicians, and both pharmacists and physicians should be paid for their services.
If the FDA continues to require a prescription for baloxavir and oseltamivir, pharmacists should pursue action at the state level to obtain legislation and/or a standing order to receive the authority to provide baloxavir and oseltamivir to patients without a prescription, in a manner similar to the ones through which naloxone is now widely available.
Daniel Hussar is dean emeritus and Remington professor emeritus at Philadelphia College of Pharmacy University of the Sciences
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