Ensitrelvir's 72-Hour Window: What Pharmacists Need to Know About COVID-19 PEP

In an interview with Pharmacy Times, Jerry P. Abraham, MD, MPH, CMQ, a prominent family medicine physician, public health advocate, and leader in mobile street medicine connected with Charles R. Drew University of Medicine and Science (CDU) and Kedren Community Health Center in Los Angeles, discussed why COVID-19 prevention remains a critical public health priority even 6 years into the pandemic, and how the recent approval of ensitrelvir (Xocova; Shionogi & Co, Ltd) for post-exposure prophylaxis (PEP) expands the prevention toolkit available to clinicians and pharmacists.

Abraham explained that summer COVID-19 surges are not unusual, with case increases tied to travel, indoor gatherings, extreme heat, and school reopening, compounded by ongoing viral evolution; the CDC currently reports rising infections in 41 states. He emphasized that COVID-19 continues to carry serious consequences, particularly for immunocompromised patients, transplant recipients, individuals undergoing cancer treatment, and those with cardiovascular, respiratory, or renal conditions.

A central focus was household transmission, which Abraham linked to the multigenerational living arrangements common in the South Los Angeles communities he serves. He described ensitrelvir, now FDA-approved for individuals 12 and older, as filling a critical gap for patients who cannot be vaccinated or who face high exposure risk, such as students returning from a classroom exposure to a household member who is medically vulnerable. Abraham stressed that the drug must be started within 72 hours of exposure to be effective and cited trial data showing a 67% reduction in symptomatic infection risk.

Abraham highlighted pharmacists as central to this strategy, noting that community pharmacies are often the first point of contact for patients seeking prevention tools. He encouraged pharmacists to familiarize themselves with the PEP indication, as patients may begin asking about it directly or arriving with new prescriptions.

For pharmacists, Abraham's remarks underscore an expanding counseling role: identifying high-risk patients, recognizing the 72-hour treatment window, and positioning ensitrelvir alongside vaccination as part of a layered COVID-19 prevention strategy.