Warning about CYP3A inhibition, Paxlovid, and Corticosteroids ⚠️

Fri, 13 Mar 2026 00:00:00 +0000

TLDR

Probably shouldn’t have taken corticosteroids and Paxlovid; it can suppress the HPA axis and may cause secondary adrenal failure or secondary Cushing’s.

A few light bulbs go off

I had a few lightbulb moments recently. One specifically was seeing a cardiologist for a POTS test (which was negative with orthostatic testing). What triggered this is I was diagnosed with metabolic syndrome by my PCP and stage II hypertension despite still exercising, eating healthy, low stress, normal weight, and sleeping as best I can (it’s okay to good most nights with medication). This metabolic syndrome diagnosis came at 14 months in of long COVID.

Cardio said I’m fine, but I need to get my blood pressure under control. Turns out it’s masked; if I take my own blood pressure at the doctor, it’s stage II; if a nurse or doctor pushes the button, it’s stage I hypertension. This is essentially the opposite of white coat syndrome and inherently more dangerous. I know I’ve had masked hypertension for a long time but was told otherwise. This has finally been charted for my doctors to ignore now going forward (yes, I’m bitter, and more on this shortly).

Cardiology and the link

A very long story short, I did labs for cardio. I told her you don’t need to; they’re going to be normal, but in the interest of pacifying both of us, I agreed. Well, they were, except for one thing still in the normal range but on the low side: cortisol. My morning fasting cortisol was just 7.1. The cardiologist said everything is in the normal range, just like ‘you’ said.

Date	Value	Normal range
Feb 3, 2026	7.1mcg/dL	2.9 - 19.4 mcg/dL
Dec 27, 2024	17.4mcg/dL	2.9 - 19.4 mcg/dL

Lab results pre and post covid.

I started researching my charts over the past 15 months. One thing that stuck out was I was taking Paxlovid while on Flovent and then prescribed prednisone for my rebound covid. That right there should have never happened, and here is why: https://pubmed.ncbi.nlm.nih.gov/18459946/

I reached out to my inhaler and Xolair prescriber, Asthma and Allergy, and they said that never should have never happened either; it would have been flagged at the pharmacy, to say the least. The problem is, he was only prescribing my inhalers; Paxlovid and prednisone came from two different urgent care doctors—however, all of these people are in the same health care network and have access to my chart.

I have been taking Symbicort throughout this. I got steroid injections in my neck for pain repeatedly last year. Furthermore, I was scheduled to get steroid injections again at the end of this month (I have since cancelled this).

Endocrinology

Likewise, I reached out to my endocrinologist (whom I haven’t seen in 18 months) and told him my cortisol number and also my suspicions of HPA-axis suppression. Needless to say, I have had an urgent ACTH stimulation test scheduled for several weeks out 🙄

I wanted to put this out there if someone is in a similar boat as me, and hopefully it can help point others in the right direction.

Next Steps

Ultimately, there is more at play here than just this, and I do have more to say beyond this, which will be coming soon. I have opted to reactivate a trip to the Mayo, as I’ve come across this and other things that were clearly missed. At this point, I am my own doctor as a patient and telling doctors what to do.

A year later, here we go 🫁

Thu, 20 Nov 2025 00:00:00 +0000

Our meeting 👋

In a few short days, I’ll be one year in with long Covid. I started working on this blog in May of 2025 - yes, it’s November 2025 now. I have finally gotten things like worsened ADHD and brain fog somewhat managed these days. Let’s rewind to the beginning with this first post.

One of my greatest challenges has been worsened ADHD from this. Oh hey, I could use Hugo to make a blog, and it will be super easy if I pace myself and take my time. It is, but enter the state of brain fog and poor attention. I want to put up a featured image. Oh look, it’s not working for days because every inch of energy used is spent overthinking how this platform works and overcomplicating every darn thing.

Nothing here will be perfect (deep breaths), and there is more to come here, but I needed to get this started, so here we go!

The Courtship 💃

On November 28, 2024, I was enjoying Thanksgiving here in the US with friends and family. It was the second year back at this, as COVID had disrupted in-person gatherings for a few years. The group is COVID conscious, and no one was showing any symptoms. I didn’t see Rona, but a presence was felt. As the night went on, I started feeling more tired than usual. Caulked it up to playing outside with the kids before dinner. I drove my family home - I remember that drive for some reason in vivid detail. The streetlights seemed brighter than normal, and the dusting of light snowfall was bothering me a little bit more than it did before. Nothing I couldn’t handle, though.

At home, I felt pretty wiped out. Kids to bed, and I went to bed soon that night. I awoke the next morning feeling like garbage. My first thought was, this is COVID. I need to test. It was positive and would be my third known infection of COVID. I started Paxlovid, as I have asthma, like I did the first two times.

The Rebound 🪃

December 7, 2024: After six days of working here and there, resting, and taking it easy, I felt almost 100%. Sleep wasn’t great; I was waking up early but falling asleep fine late in the week. I took an at-home test, and it was negative (clear it was a single line). This seemed to track; I felt good, and like before, this was about the course of having COVID for me.

I had energy and played football outside on Sunday. Sunday night I felt odd, sore, and fatigued. Chalked it up to intense physical activity during football. I was able to get to sleep and deal with the pain with a dose of NyQuil Flu. The next morning, I awoke feeling awful, like I had COVID again. So, I took the lollipop at-home test (pictured), and to my confusion, it was positive again. I took another one, different brand, same result. I went to urgent care a few days later for a nasal swab test, and that was positive.

Component results

Component	Your value	Standard range	Result Date	Result Time
COVID-19 INTERPRETATION	Detected	Not Detected	12/10/2024	4:01 AM
SARS COV-2 SOURCE	Nasopharyngeal swab

Narrative
Test performed by Transcription Mediated Amplification. TMA has been shown to be equivalent to commercial real-time PCR tests. This test has been authorized by the FDA under Emergency Use Authorization (EUA) for use by authorized laboratories.

And so it begins

I followed up with Urgent Care again, as my kids ended up having strep concurrently with this (I did not test positive for that). Urgent Care had nothing to offer me about rebound infections but a 5-day course of prednisone, which I accepted. I was told not to do Paxlovid again. However, I did go down that rabbit hole of did Paxlovid cause a rebound potentially? The answer appears to be likely not (What Is Paxlovid Rebound? 9 Things to Know).

What follows next is a hell of neurological symptoms from COVID along with coronasomnia, short-term disability off work, and a low quality of life I have never experienced before in my life. I will have the symptoms page up soon.

Paxlovid on A long dance with Rona