COVID-19 OTC Case Studies

Case 1: Vaccine Booster

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Q: JM is a 20-year-old woman inquiring about receiving a COVID-19 vaccine booster and an annual influenza vaccine before going back to college. She has no known allergies and no significant medical history. JM has never had COVID-19 or influenza. She received an annual influenza vaccine 1 year ago and 2 doses of the monovalent COVID-19 vaccine (Pfizer) approximately 2 years ago. What should the pharmacist recommend to JM?

A: Based on JM’s age and when she last received her vaccines, the pharmacist should recommend JM receive both the annual influenza vaccine and the bivalent mRNA COVID-19 vaccine booster during this visit.^1,2 She may receive any FDA-authorized bivalent mRNA COVID-19 vaccine, regardless of what was administered during her primary series, based on CDC recommendations.¹ CDC recommendations also advise annual influenza vaccination for all individuals aged 6 months and older.² The pharmacist should let JM know that coadministration of the COVID-19 and influenza vaccines is safe.

Case 2: Fever Management

Q: KS is a 47-year-old woman who has tested positive for COVID-19 and is experiencing mild symptoms, including persistent fevers and a temperature of up to 101 ̊F for the past 12 hours. She called the pharmacy to ask whether it is safe to take the regular-strength acetaminophen she has at home. KS does not have drug allergies or a significant medical history and takes no medications. She received her COVID-19 bivalent booster 2 months ago. What should the pharmacist advise?

A: Because KS has a mild case of COVID-19 that can be managed at home, the CDC recommends that fevers associated with the disease be managed with OTC antipyretics, such as acetaminophen or ibuprofen.³ KS can take 2 tablets of acetaminophen every 4 to 6 hours while symptoms last.⁴ The pharmacist should advise her that the maximum recommended dose is 3000 mg of acetaminophen for patients taking it at home without the supervision of a health care professional.⁵ If KS needs more than 3000 mg, she should alternate with other fever-reducing medications, such as ibuprofen. Additionally, the pharmacist should let KS know that many cough and cold medication products contain acetaminophen and thus should be included in the 3000 mg total.

Case 3: Cough Management

Q: LF is a 39-year-old man who recently tested positive for COVID-19 and is at home with mild symptoms of cough and no fever. He has no drug allergies and no medical conditions. LF’s wife is looking for a recommendation for an OTC product to manage his chest cough, which is wet though not productive. She said the cough has woken LF up the past 2 nights, and she wants something to loosen the mucus in his chest. What should the pharmacist recommend?

A: Because LF has a mild case of COVID-19, he can manage his symptoms at home. An expectorant, such as guaifenesin (Mucinex or Robitussin), may help loosen and thin the mucus.⁶ Depending on the product, LF can take it every 4 to 12 hours to loosen his chest congestion. As guaifenesin does not help with sleeping at night, LF may need to add either dextromethorphan, a cough suppressant, or diphenhydramine, to help dry the wet cough. It is not recommended to take dextromethorphan with guaifenesin regularly, because dextromethorphan will prevent the coughing up of the mucus. However, for bedtime, LF should consider adding it so he can get a good night’s sleep.

Case 4: At-Home Test

Q: DF is a 58-year-old man who calls the pharmacy for advice on COVID-19 at-home test kits. He has been experiencing body aches, a fever, and a sore throat for the past 24 hours. Prior to the onset of his symptoms, DF attended a family gathering after which many other attendees tested positive for COVID-19. As DF’s primary-care physician is unable to test him at this time, DF is planning to use a home test kit but is concerned about its accuracy compared with that of tests administered by health care providers. What advice should the pharmacist provide about using COVID-19 at-home tests?

A: DF should use an at-home test immediately. CDC recommends that symptomatic patients use such tests immediately and that asymptomatic patients use them at least 5 days after exposure.⁷ At-home COVID-19 tests are different from the laboratory-based tests typically used by health care providers. However, they are still considered to be at least 80% effective in identifying COVID-19 in infected individuals.⁸ Positive results on at-home tests are considered accurate representations of an active COVID-19 infection, for which individuals should follow updated recommendations for isolation and symptom management.

References

1. 1. Use of COVID-19 vaccines in the United States. CDC. April 22, 2023. Accessed May 4, 2023. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html Adult immunization schedule by age. CDC. April 27, 2023. Accessed May 4, 2023.
2. Interim clinical considerations for COVID-19 treatment in outpatients. CDC. Updated February 10, 2023. Accessed February 24, 2023. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/outpatient-treatment-overview.html
3. Regular strength Tylenol tablets. Johnson & Johnson Consumer Inc. Accessed February 28, 2023. https://www.tylenol.com/products/tylenol-regular-strength-tablets
4. Over-the-counter pain relievers. MedlinePlus. Accessed February 24, 2023. https://medlineplus.gov/ency/article/002123.htm
5. Guaifenesin tablet, extended release. DailyMed. Updated December 3, 2022. Accessed May 4, 2023. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ad67e6fd-a68f-44db-9718-84a2cef86e09
6. Self-testing at home or anywhere: for doing rapid COVID-19 tests anywhere. CDC. Updated April 25, 2023. Accessed February 24, 2023. https://www.cdc.gov/coronavirus/2019-ncov/testing/self-testing.html
7. At-home COVID-19 antigen tests-take steps to reduce your risk of false negative results: FDA safety communication. FDA. Updated November 17, 2022. Accessed February 24, 2023. https://www.fda.gov/medical-devices/safety-communications/home-covid-19-antigen-tests-take-steps-reduce-your-risk-false-negative-results-fda-safety

About the Authors

Kylie Helfenbein, PharmD, is a PGY-1 pharmacy resident at Atlantic Health System in Morristown, New Jersey.

Rupal Patel Mansukhani, PharmD, FAPhA, NCTTP, is a clinical associate professor of pharmacy practice and administration at Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey in Piscataway, and a transitions-of-care clinical pharmacist at Morristown Medical Center.