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Are ACE inhibitors and ARBs safe to use in patients with coronavirus (COVID-19)?
- There have been some concerns internationally about a possible link between ACE inhibitor medications (angiotensin converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers) and increased risk of infection with coronavirus (COVID-19) and worsened outcomes.
- At this stage, peak international and Australian cardiology bodies strongly recommend that patients stay on their current anti-hypertensive therapy.
- See the Heart Foundation website for further information.
Use of Sotrovimab
In August 2021, the Therapeutic Goods Administration provisionally approved the use of Sotrovimab for the treatment of COVID-19 in adults. This drug is for the treatment of mild COVID-19 that is likely to progress to severe disease. It is available in limited supply.
For guidance and eligibility requirements, please see our Sotrovimab factsheet for clinicians (Word).
As per the National Taskforce Guidelines, Sotrovimab is appropriate for use in adults with the following:
- COVID-19 positive with symptom onset less than 5 days
- 0 or 1 dose of COVID-19 vaccination
- No oxygen therapy or ventilation required
and include the presence of at least one of the following:
- Immunosuppressed (irrespective of vaccination status)
- Age ≥ 55 years
- Diabetes (requiring medication)
- Obesity (BMI > 30 kg/m2)
- Chronic kidney disease (i.e. eGFR < 60 by MDRD)
- Congestive heart failure (NYHA class II or greater)
- Chronic obstructive pulmonary disease (history of chronic bronchitis, chronic obstructive lung disease, or emphysema with dyspnoea on physical exertion)
- Moderate-to-severe asthma (requiring an inhaled steroid to control symptoms or have been prescribed a course of oral steroids in the previous 12 months).
The National COVID-19 Clinical Taskforce brings together the peak health professional bodies across Australia whose members are providing clinical care to people with COVID-19 and provide guidance on treatments and medications. The Taskforce undertakes continuous evidence surveillance to identify and rapidly synthesise emerging research in order to provide national, evidence-based guidelines for the clinical care of people with COVID-19. Their guidelines address questions that are specific to managing COVID-19 and cover the full disease course across mild, moderate, severe and critical illness.
Can hydroxychloroquine be used for prophylaxis?
- There is no clinical evidence that hydroxychloroquine is effective as prophylaxis against coronavirus (COVID-19).
- Hydroxychloroquine is in short supply and should be prioritised for use in recognised indications including autoimmune conditions and Q-fever endocarditis.
- The Pharmaceutical Society of Australia (PSA) have advised pharmacists to refuse the dispensing of hydroxychloroquine unless it is for a recognised indication.
Are ibuprofen and other non-steroidal anti-inflammatories safe to use in patients infected with coronavirus (COVID-19)?
- There have been some concerns internationally that use of ibuprofen, or other non-steroidal anti-inflammatories (NSAIDs) during coronavirus (COVID-19) infection may lead to an increased risk of complications or death.
- There is currently no published peer-reviewed scientific evidence to support a direct link between use of ibuprofen and more severe infection with coronavirus (COVID-19).
What are the recommendations for influenza vaccination?
With coronavirus (COVID-19) spreading across Australia, this year it is more important than ever to ensure that patients receive the seasonal influenza vaccination. Influenza vaccination should be given as soon as possible. The regular influenza season may coincide with the peak of the current coronavirus (COVID-19) pandemic, potentially placing additional burden on the Australian health system.
- Influenza vaccine distribution to immunisation providers has commenced. Adjuvanted influenza vaccines are available for people aged 65 years and over.
- Claims that influenza vaccination may increase the risk of coronavirus (COVID-19) infection have been circulating on social media. There is no convincing evidence to support these claims.
- For guidance and service delivery models for providing immunisation services, please see our Victorian immunisation services factsheet (Word).
Can Tamiflu still be given to patients with mild flu-like symptoms?
The antiviral medication Tamiflu (oseltamivir) is not effective against coronavirus (COVID-19). Tamiflu is used to treat influenza. In otherwise healthy adults who have a low risk of complications, treatment with a neuraminidase inhibitor (such as Tamiflu) reduces duration of influenza symptoms by less than one day on average, when treatment is started within 48 hours of symptom onset. Such limited benefit must be balanced against the potential adverse effects of antiviral treatment, including nausea, vomiting, headaches and neuropsychiatric events.
It is recommended that Tamiflu be reserved for use in patients:
- Who need to be admitted to hospital for management of influenza.
- With moderate-severity or high-severity community-acquired pneumonia, during the influenza season.
- Who are at higher risk of poor outcomes from influenza (for example, pregnant women).
Information about COVID-19 vaccines
Information about the COVID-19 vaccine can be found on the Victorian Coronavirus website, including:
- information about the COVID-19 vaccines available in Australia
- training for COVID-19 vaccine providers
- site readiness for COVID-19 vaccination clinics
- administering the vaccines and managing side effects
- supporting COVID-19 vaccine recipients
- information hub.