Does saying "this isn't medical advice" while giving implicit medical advice actually protect you legally? It seems like one of those myths that laymen believe about the law. Well, I've never heard of anyone being charged over this kind of post at least.
I suspect that if it would, this practice would soon spread to other kinds of illegal activities.
"Hands up! This is NOT a robbery!"
I guess what actually might protect you (other than "too many people saying stuff online, not enough prosecutors") is careful wording of the (non-)advice itself. Saying explicitly "this is not medical advice" is just the cherry on top; it may provide extra protection, but only when the rest of the text is written properly.
This is not a legal advice. ;)
You shouldn't take any of these results or pieces of news coverage as evidence that fluvoxamine works and that the benefits outweigh the costs.
Scientific studies are absolutely Bayesian evidence for or against drugs. (EDIT: Of course, that evidence may be hard or impractical to interpret, and it may not be sufficient to be confident one way or another.)
I'm not a fan of gatekeeping, especially where low-risk no-abuse-potential drugs are concerned, but I'd encourage people to try the open and honest strategy first. Doctors are legally allowed to prescribe things off-label once they're approved for any purpose, and their reaction to the idea will tell you a lot about whether they're a doctor you want to talk to again if you need a consultation about something else in the future.
Modafinil seems to require a prescription only in theory, not in practice. The overseas mail-order sellers don't ask, and US pharmacies aren't price-competitive with the mail-order sellers. Based on this research the risk of skipping the physician consult seems pretty negligible (provided you're competent enough to check for interactions and monitor side effects yourself). I make sure my medical records reflect the fact that I use it, so that I wouldn't eg lose access if I were in an ICU for some reason and out of a general policy of treating doctors like ally-consultants who are most useful if they have accurate information. But it would seem pretty wasteful to have an appointment just to generate a modafinil prescription and do nothing else.
You can buy fladrafinil or flmodafinil without any process (see reddit for reports, seems to work much better than adrafinil)
Might be hard on your liver?
I'm sure you've seen it before, but just in case anyone hasn't: https://www.gwern.net/Modafinil
As for other countries, in Russia fluvoxamine is by prescription only, but I guess it's not controlled very strictly, since it's easy to visit a few pharmacies until one of them seels it to you even though you say you forgot your prescription list at home.
Also in the realm of not medical advice: there are perhaps people for who fluvoxamine is safer than paxlovid if they have paxlovid contraindications and could get fluvoxamine instead. I found this article (recently posted elsewhere on Lesswrong) to be worthwhile.
https://theskepticalcardiologist.com/2022/01/07/the-new-covid-19-pill-paxlovid-interacts-with-many-medications-cardiac-patients-take-note/
Patients with hypertension, coronary artery disease, atrial fibrillation, and hyperlipidemia should pay close attention to what follows if they are considering starting the drug as they likely will need to stop or modify their cardiac medications and monitor their blood pressure and heart rates closely while taking it.
Paxlovid contains ritonavir-boosted nirmatrelvir.
Ritonavir has long been used to increase the levels of anti-HIV medications by strongly inhibiting the cytochrome P450 (CYP) 3A system which metabolizes many cardiac (and non-cardiac) drugs including nirmatrelvir, the active anti-SARS-CoV2 antiviral.
The EUA for Paxlovid makes it clear how important it is for patients and physicians to be aware of these powerful drug interactions:
Clinicians who are not experienced in prescribing ritonavir-boosted drugs should refer to resources such as the EUA fact sheet for ritonavir-boosted nirmatrelvir (Paxlovid) and the Liverpool COVID-19 Drug Interactions website for additional guidance. Consultation with an expert (e.g., clinical pharmacist, HIV specialist, and/or the patient’s specialist provider[s], if applicable) should also be considered.
Nice, that's cool to see.
FWIW I would personally totally take paxlovid over fluvoxamine if I could, but it seems to be in very short supply.
Do you currently have thoughts on dosage and duration? IIRC the TOGETHER study was 100mg 2x per day for like 14 days. I've seen others recommendation saying 50mg/day is sufficient.
P.S. I won't take your response as medical advice. Rather, I will interpret only as integers that are fun to type on the Internet.
It was 100mg 2x daily for 10 days.
On one hand: that's higher than a typical dose for depression. On the other hand, I'm tempted to take the maximum safe amount. I think up to 300mg / day is sometimes prescribed for depression, but I really don't know how the risk of various side effects increases with dosage.
So one option if you get Covid is to start at 50mg, see if you have any side effects, see how they compare to the severity of your Covid symptoms, and react accordingly. But in practice if I got Covid and had symptoms I would probably just do the 100mg 2x.
[TLDR: I paid $95 for a 10 minute video consultation with a doctor, told them I was depressed and wanted fluvoxamine, and got my prescription immediately.]
I'm not a doctor, and this isn't medical advice. If you want information on the status of fluvoxamine as a Covid treatment, you can see the evidence base in the appendix, but interpreting those results isn't my business.
I'm just here to tell you that if you want fluvoxamine, you can get it.
Years ago, some of my friends were into downloading apps that would get you a 10 minute consultation with a doctor in order to quickly acquire a prescription for medical marajuana. Today, similar apps exist for a wide range of medications, and with a bit of Googling, you can find one that will prescribe you fluvoxamine.
What's required on your end? In my case, $95, 10 minutes of my time, and some white lies about my mental health. Fluvoxamine is only prescribed right now for depression and anxiety, so if you want it, my advice is to say that:
And that's basically it. Because there are many other treatments for depression, you do specifically have to ask for Fluvoxamine by name. If they try to give you something else, say that you've tried it before and didn't like the side effects (weight gain, insomnia, headaches, whatever).
One more note, and this is critical: unless you are actually suicidal, do not tell your doctor that you have plans to commit suicide, to hurt yourself or others, or do anything that sounds like an immediate threat. This puts you at risk of being put involuntarily in an inpatient program, and you don't want that.
Finally, you might ask: isn't this super unethical? Aren't you not supposed to lie to doctors to get drugs? Maybe, I don't know, this isn't medical advice, and it's not really ethical advice either. I think the only real potential harms here are we consume so much fluvoxamine that there isn't enough for depressed people, or that doctors start taking actual depressed patients who want fluvoxamine less seriously. As far as I can tell, there isn't currently a shortage, as to the latter concern, I couldn't really say.
Again, this isn't medical advice. You shouldn't take any of these results or pieces of news coverage as evidence that fluvoxamine works and that the benefits outweigh the costs. I'm literally only adding this to cover my own ass and make the point that fluvoxamine is a normal mainstream thing and not some weird conspiracy drug.
Here's the Lancet article, and the JAMA article.
Here's Kelsey Piper at Vox:
One medication the TOGETHER trial found strong results for, fluvoxamine, is generally used as an antidepressant and to treat obsessive-compulsive disorder. But it appears to reduce the risk of needing hospitalization or medical observation for Covid-19 by about 30 percent, and by considerably more among those patients who stick with the 10-day course of medication. Unlike monoclonal antibodies, fluvoxamine can be taken as a pill at home --- which has been an important priority for scientists researching treatments, because it means that patients can take their medication without needing to leave the home and without straining a hospital system that is expected to be overwhelmed.
"We would not expect it to be affected by which variants" a person is sick with, Angela Reiersen, a psychiatrist at Washington University in St. Louis whose research turned up fluvoxamine as a promising anti-Covid candidate, told me.
And here's a Wall Street Journal article headlined "Is Fluvoxamine the Covid Drug We've Been Waiting For?" with subheading "A 10-day treatment costs only $4 and appears to greatly reduce symptoms, hospitalization and death.":
A small randomized control trial last year by psychiatrists at the Washington University School of Medicine in St. Louis was a spectacular success: None of the 80 participants who started fluvoxamine within seven days of developing symptoms deteriorated. In the placebo group, six of the 72 patients got worse, and four were hospitalized. The results were published in November 2020 in the Journal of the American Medical Association and inspired a real-world experiment.
....The three fluvoxamine trials were conducted while different variants were circulating, so there's no reason to think the drug wouldn't work as well against Omicron
It decreased COVID hospitalizations by about 30%... I and many others take Luvox pretty seriously. At this point I'd give it 60-40 it works.
And that's it. Again, not medical advice.