Paxlovid: What you need to know

As COVID-19 cases continue to rise, you may have heard about Paxlovid, the latest COVID-19 treatment getting news coverage. Paxlovid is an oral antiviral pill that can be taken at home to help keep high-risk individuals from becoming sick enough with COVID-19 that they need hospitalization. The drug was granted an emergency use authorization (EUA) by the Food and Drug Administration (FDA) in December 2021 for anyone ages 12 and older who weighs at least 88 pounds and is at high risk for severe disease from COVID-19.

Paxlovid has many benefits. It showed an 89% reduction in the risk of hospitalization and death in the clinical trial—a reduction high enough to prompt the National Institutes of Health (NIH) to prioritize it over other COVID-19 treatments. The good news is that it's provided for free by the U.S. government while there is a public health emergency, and it appears to work against multiple variants, including the current omicron variant.

Even though Paxlovid was authorized for use in December, it has recently gained more interest as it is now widely available (early manufacturing constraints limited its use) and its successful track record at treating a COVID-19 infection when detected within five days of onset.

How does Paxlovid work?

Paxlovid is an antiviral therapy that consists of two medications packaged together. When you take the three-pill dose, two of those pills will be nirmatrelvir, the drug that inhibits the SARS-CoV-2 protein from replicating. The other is ritonavir. It boosts the effectiveness of nirmatrelvir by slowing the rate at which it is metabolized by the liver so that it doesn't move out of your body as quickly, which means it can work longer—giving it a boost to help fight the infection

When should I take Paxlovid?

Treatment with Paxlovid needs to begin within five days of your first COVID-19 symptoms, such as fever or chills, shortness of breath, fatigue or loss of taste or smell. If you test with a rapid, at-home test, remember that these tests may not return a positive result until several days after your first symptoms have appeared. If you suspect you were exposed to COVID-19 and are at high risk for developing severe illness but get a negative result on your first rapid test, keep testing at home or get a PCR test from your primary care physician or a COVID-19 testing site.

How often do I take Paxlovid?

The Paxlovid treatment consists of three pills taken twice daily for five days, and a complete course adds up to 30 pills. The pills come in a "dose card," a medication blister pack that allows you to punch out the pills as you take them.

Can anyone get a Paxlovid prescription?

To qualify for treatment with Paxlovid, an individual must be:

• 12 years of age or older,
• weigh at least 88 pounds,
• have tested positive for COVID-19,
• be symptomatic, and
• be at high risk for developing severe COVID-19 illness.

High-risk individuals include people who are 65 and older and individuals of any age with certain underlying conditions, including cancer, diabetes, or obesity.

To get a prescription for Paxlovid, contact your PeaceHealth primary care provider, visit a PeaceHealth clinic or visit a COVID-19 test-to-treat facility. Please do not come to your local hospital's Emergency Department unless you have a life-threatening condition, such as trouble breathing.

How well does Paxlovid work?

When given EUA, Pfizer presented data from a clinical trial conducted between mid-July and early December 2021 that showed participants (all of whom were unvaccinated) who were treated with Paxlovid were 89% less likely to develop severe illness and death than trial participants who received a placebo.

Despite being tested on unvaccinated individuals, the availability of Paxlovid is not a reason not to get vaccinated for COVID-19. Vaccination remains a crucial part of prevention, even as more treatments become available.

What are the side effects of Paxlovid?

Common side effects, which are usually mild, include:

• Altered or impaired sense of taste,
• Diarrhea,
• Increased blood pressure, and
• Muscle aches.

The FDA fact sheet on Paxlovid has a list of known side effects.

Paxlovid interacts with several other medications, including many widely used medications for chronic conditions. Discuss the medications you take with your doctor or pharmacist before taking Paxlovid. They may recommend a dosage adjustment to your current medications while taking Paxlovid.

What is the "rebound effect" of Paxlovid?

There are reports of a "rebound" of COVID-19 symptoms in some people who have completed the entire course of Paxlovid. In those cases, symptoms have recurred two to eight days after the treatment. Some individuals have also tested positive for COVID-19. Most rebound infections appear relatively mild and clear quickly without further treatment.

People who have taken Paxlovid and test positive again or have symptoms return after finishing their pills should restart their isolation period (five full days). Isolation can end if the person feels better and the fever has been gone for 24 hours without medication. The CDC also recommends that people wear a mask for ten days after their symptoms come back.

What can I take if I am not eligible for Paxlovid?

There are other therapies for COVID-19. Anyone who cannot take Paxlovid should talk to their primary care physician about the best approach for their situation.