@PaulSaxMD We will be making this very recommendation in Ontario very shortly. @COVIDSciOntario @MPaiMD

@ASPphysician @COVIDSciOntario @MPaiMD Very interesting! Hope we do the same in the USA.

@PaulSaxMD This is good to know, thank you.

@PaulSaxMD Actually one of the first SSRI..,

@PaulSaxMD Yes, it would seem to be a good bridging strategy till Paxlovid and Sotrimivab becomes available at scale.

@PaulSaxMD I really think so… can still refer pt to mab infusion but while waiting (anticipate there might be shortage of sotrov soon for obvious reason?)

@PaulSaxMD Yes. I'd look at fluvoxamine, inhaled steroids or colchicine in that order and depending on patient factors like drug interactions and comorbidities

@PaulSaxMD Fluvoxamine seems at least as effective as molnupiravir and with fewer potential side effects. And of course, available now.

@PaulSaxMD Why not inhaled budesonide??

@PaulSaxMD Does the FDA even have this on the docket?

@PaulSaxMD YES - NOW - and people may be able to get it and have it on a shelf without declaring bankruptcy

@PaulSaxMD NIH guideline recs & summary on fluvoxamine and inhaled steroids certainly no ringing endorsement and points out important limitations of the studies:

@PaulSaxMD While the effects where modest both trials - showed benefit although with some less than key endpoints. The downside risk is low and there is not an interaction with ritonavir if that becomes available in the paxlovid regimen.

@PaulSaxMD Fluvoxamine belonging to the class of SSRI’s is a potent CYP 3A4 inhibitor, which can cause an increase in the levels of many other meds not to mention QT prolongation. Also has a black box warning for risk of suicide in adolescents. Would have to use extreme caution .

@PaulSaxMD @pash22 More recent RCTs confirm that high titer CP given early works, Hybrid plasma from those who have been infected & vaxed covers variants. There will more data early this week.

@PaulSaxMD Yes, and redirect infusion center efforts from mabs to remdesivir based on PINETREE?

@PaulSaxMD Tell me why doctors didn't tell HTLV-III/AIDS patients alcohol in a small amount can keep you alive? Instead, it was said nothing on shelves worked.

@PaulSaxMD Available in India and with the unavoidable surge from Omicron soon consider having on hand for those with underlying disease. Screenshot of the TOGETHER trial website page with dealing with results of Fluvoxamine in early COVID-19.