Antiviral Pills for COVID-19

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Oral medication now available to shorten the course and severity of Covid-19.

Ritonavir-Boosted Nirmatrelvir (Paxlovid)

Clinical trials showed it cut the risk of hospitalization and death for people at high risk of severe COVID-19 by nearly 90%.

On December 22, 2021, the Food and Drug Administration issued an Emergency Use Authorization (EUA) for ritonavir-boosted nirmatrelvir for the treatment of patients with mild to moderate COVID-19 aged ≥12 years and weighing ≥40 kg (88 lbs)  who are within 5 days of symptom onset and at high risk of progressing to severe disease.

Recommendations

  •  The COVID-19 Treatment Guidelines Panel (the Panel) recommends using nirmatrelvir 300 mg with ritonavir 100 mg (Paxlovid) orally twice daily for 5 days in non-hospitalized patients with mild to moderate COVID-19 aged ≥12 years and weighing ≥40 kg who are at high risk of disease progression;3 treatment should be initiated as soon as possible and within 5 days of symptom onset (AIIa).
  • Ritonavir-boosted nirmatrelvir has significant and complex drug-drug interactions, primarily due to the ritonavir component of the combination.
  • Before prescribing ritonavir-boosted nirmatrelvir, clinicians should carefully review the patient’s concomitant medications, including over-the-counter medications, herbal supplements, and recreational drugs, to evaluate potential drug-drug interactions.

You would take 3 Paxlovid pills (2 nirmatrelvir pills and 1 ritonavir pill) by mouth twice a day for 5 days. You should start taking the pills within the first 5 days of feeling COVID-19 symptoms.

Can anyone get a Paxlovid prescription?

The FDA authorized Paxlovid for people ages 12 and older who weigh at least 88 pounds. But in order to qualify for a prescription, you must also have had a positive COVID-19 test result and be at high risk for developing severe COVID-19. If you have mild cold symptoms and have no underlying illnesses that put you in the high risk category, you should not take Paxlovid.

The high risk category means that you must either have certain underlying conditions (including cancer, diabetes, obesity, or others) or be 65 years of age or older (more than 81% of COVID-19 deaths occur in in this group). The more underlying medical conditions a person has, the higher their risk for developing a severe case of COVID-19, according to the CDC.

The hope is that the restrictions on who can take Paxlovid will be relaxed over time. The FDA granted the EUA in December, just as a staggering number of people were infected with Omicron and the need for care skyrocketed, leading to supply issues.

In studies, Paxlovid interacted with many common medications and therefore you must discuss all of the current medications that you are taking with a physician before starting on this anti-viral medication.

Paxlovid is the first-choice recommendation for patients with mild to moderate COVID-19 who are at high risk of hospitalization or death, according to the National Institutes of Health.

What should I tell my healthcare provider before I take PAXLOVID?

Tell your healthcare provider if you:

  • Have any allergies
  • Have liver or kidney disease
  • Are pregnant or plan to become pregnant
  • Are breastfeeding a child
  • Have any serious illnesses

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.   Some medicines may interact with PAXLOVID and may cause serious side effects. Keep a list of your medicines to show your healthcare provider and pharmacist when you get a new medicine.

Monitoring and Adverse Effects:

The most common adverse effects of ritonavir-boosted nirmatrelvir are dysgeusia (altered bad taste), diarrhea, hypertension, and myalgia (muscle aches).

Summary:

  • You must test positive for Covid-19 either with a take home rapid antigen test or with a PCR-RNA test.
  • You must be at least 12 year of age, 88 lbs or greater and have underlying medical conditions that place you at higher risk of progressing to severe disease or be 65 years of age or older.
  • You must start the medication within 5 days of symptom onset.