Paxlovid
Paxlovid (nirmatrelvir / ritonavir) is used to treat people with mild-to-moderate coronavirus SARS-CoV-2 (COVID-19) who are at high risk for severe illness. It's made up of two antiviral medications that you take by mouth. A full course of treatment only lasts 5 days. For the best results, you should start taking the medications as soon as possible, but within 5 days of having symptoms. The most common side effects from Paxlovid (nirmatrelvir / ritonavir) include changes in taste and diarrhea.
Update: As of May 2023, Paxlovid (nirmatrelvir / ritonavir) is fully FDA-approved to treat COVID-19 in adults. But it's still under emergency use authorization (EUA) for children ages 12-18 years old.
What is Paxlovid (nirmatrelvir / ritonavir)?
What is Paxlovid (nirmatrelvir / ritonavir) used for?
Mild-to-moderate COVID-19 in people 12 years and older (and weighing over 88 lbs) who are at high risk for severe illness
How Paxlovid (nirmatrelvir / ritonavir) works
Paxlovid (nirmatrelvir / ritonavir) is a combination of two different medications.
Nirmatrelvir is a protease inhibitor. It treats COVID-19 by blocking a certain protease, which is a protein the virus needs to make copies of itself and continue to infect.
Ritonavir is also a protease inhibitor. Low-dose ritonavir is included in Paxlovid to slow the breakdown of nirmatrelvir. This allows nirmatrelvir to stay in your body longer to fight COVID-19.
Drug Facts
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What are the side effects of Paxlovid (nirmatrelvir / ritonavir)?
Common Side Effects
- Changes in taste (6%)
- Diarrhea (3%)
Other Side Effects
- High blood pressure
- Muscle pain
- Headache
Serious Side Effects
- Severe allergic reaction: trouble breathing; rash; fever; swelling of the face, lips, or throat
- Liver problems: dark urine, feeling tired, upset stomach or stomach pain, yellowing of the skin or whites of the eyes
Source: DailyMed
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The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Redness, blistering, peeling, or loosening of the skin, including inside the mouth
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Change in taste
- Diarrhea
- General discomfort and fatigue
- Increase in blood pressure
- Muscle pain
- Nausea
- Stomach pain
Pros and cons of Paxlovid (nirmatrelvir / ritonavir)
Pros
Works very well to lower the chance of severe illness and death in people who are at high risk and have mild-to-moderate COVID-19 symptoms
Taken by mouth, which is good for people who are afraid of needles
Can take at home, instead of needing to receive treatment at a facility
Only need to take it for 5 days
Children 12 years and older can take it
Cons
Need to take it within 5 days of having symptoms from COVID-19
Can't use in people with severe COVID-19 illness, including those who are hospitalized
Currently not recommended for children under 12 years old, people who weigh less than 88 lbs, or people with serious liver or kidney problems
Has many medication interactions, some of which can be dangerous
Won't help your body fight against COVID-19 in the future, since it's not a vaccine
Pharmacist tips for Paxlovid (nirmatrelvir / ritonavir)
You can take Paxlovid (nirmatrelvir / ritonavir) with or without food. Swallow the tablets whole. Don't chew, crush, or break the medications because it might not work as well.
For each dose of the medication, you should be taking three tablets total at one time: two 150 mg nirmatrelvir tablets (pink, oval shaped) and one 100 mg ritonavir tablet (white, oval shaped).
Finish your full five-day course of Paxlovid (nirmatrelvir / ritonavir) even if you feel better before you're done. Stopping this medication too early can put you at risk for serious COVID-19 illness. Make sure to take steps to protect yourself and others while you're taking this medication in order to get well soon and to prevent others from getting sick with COVID-19.
Some people notice a bitter taste in their mouth while taking Paxlovid (nirmatrelvir / ritonavir). This side effect should go away once you finish your course of medication. But if it's bothersome to you during Paxlovid (nirmatrelvir / ritonavir) treatment, try sucking on cinnamon candies or chewing gum to lessen the bitter taste from the pills.
Paxlovid (nirmatrelvir / ritonavir) is prescribed for you only. Don't share it with others, even if they have similar symptoms as you. This medication might not be right for everyone.
Paxlovid (nirmatrelvir / ritonavir) can cause hormonal birth control medications to not work well. If you or your partner is currently taking hormonal birth control, use condoms or other birth control methods to prevent unintended pregnancies during the 5 days of treatment. It's recommended to continue using other forms of birth control until you've had one complete menstrual cycle after stopping Paxlovid (nirmatrelvir / ritonavir).
If your COVID-19 symptoms get worse, get medical help right away. This medication won't prevent all COVID-19 cases from getting worse. Call 911 if you experience symptoms such as worsening cough, trouble breathing, chest pain that doesn't go away, confusion, a hard time staying awake, and pale or blue-colored skin.
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What are the risks and warnings for Paxlovid (nirmatrelvir / ritonavir)?
Paxlovid (nirmatrelvir / ritonavir) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Serious interactions with other medications
Risk factors: Taking medications that are removed from your body or activated by a specific liver protein | Taking medications that affect a specific liver protein
Paxlovid (nirmatrelvir / ritonavir) interacts with many medications because it blocks a specific liver protein that works to either remove or activate (turn on) certain medications in your body. Paxlovid (nirmatrelvir / ritonavir) can prevent your body from removing certain medications, such as simvastatin (Zocor) or lurasidone (Latuda). This can lead to dangerously high levels of these medications that stay in your body and cause potentially life-threatening side effects. Other medications, such as carbamazepine (Tegretol) and rifampin (Rifadin), cause your body to get rid of Paxlovid (nirmatrelvir / ritonavir) faster than normal if taken together. This causes Paxlovid (nirmatrelvir / ritonavir) to not work as well, and it puts you at risk for severe COVID-19 illness. Make sure your provider is aware of all the medications you're currently taking before you start Paxlovid (nirmatrelvir / ritonavir). Ask your provider if you're not sure whether you can take Paxlovid (nirmatrelvir / ritonavir) with certain medications.
Severe allergic reaction
In some rare cases, life-threatening reactions are possible with Paxlovid (nirmatrelvir / ritonavir), such as anaphylaxis (closing of the throat). In addition, some people who have taken ritonavir (an ingredient in Paxlovid (nirmatrelvir / ritonavir)) have had severe skin reactions. If you experience a rash; fever; shortness of breath; or swelling in your face, lips, or tongue; get medical help as soon as possible.
Liver problems
Risk factors: History of liver problems | Taking other medications that affect your liver
Paxlovid (nirmatrelvir / ritonavir) can cause liver injury or damage. Your risk is higher if you already have liver problems or you're taking medications that can damage your liver. Signs of liver problems include dark urine, feeling tired, upset stomach or stomach pain, and yellowing of your skin or the whites of your eyes. If you notice any of these symptoms, call your provider immediately.
Risk of resistance to certain HIV medications
Risk factors: Undiagnosed HIV infection | HIV infection that's not under control
Paxlovid (nirmatrelvir / ritonavir) contains ritonavir, a medication that's commonly used to treat human immunodeficiency virus (HIV). If you have HIV that's undiagnosed or not under control, taking Paxlovid (nirmatrelvir / ritonavir) can cause resistance to HIV medications that contain ritonavir or other protease inhibitors. This means that certain HIV medications won't work as well to fight off the HIV infection. If you think you have HIV, get tested right away. Early signs include fever, chills, rash, night sweats, and muscle aches. Symptoms of HIV in its later stages include very rapid weight loss; extreme tiredness; sores in the mouth or genitals; and swelling in the lymph nodes in the armpits, groin, or neck. Before you start any medications for HIV, let your provider know if you've taken Paxlovid (nirmatrelvir / ritonavir) in the past so they can help decide the best HIV treatment for you.
Paxlovid (nirmatrelvir / ritonavir) dosage forms
Typical dosing for Paxlovid (nirmatrelvir / ritonavir)
Paxlovid (nirmatrelvir / ritonavir) comes as a pre-packaged course of medication. Each dose of this medication is made up of three tablets taken together: two 150 mg nirmatrelvir tablets and one 100 mg ritonavir tablet.
The typical dose is 300 mg of nirmatrelvir and 100 mg of ritonavir by mouth every 12 hours for 5 days.
Your dose might be different if you have kidney problems.
More on Paxlovid (nirmatrelvir / ritonavir) dosage forms
How much does Paxlovid (nirmatrelvir / ritonavir) cost?
Paxlovid (nirmatrelvir / ritonavir) contraindications
Taking other medications that are removed from your body or activated by a specific liver enzyme
What are alternatives to Paxlovid (nirmatrelvir / ritonavir)?
Mild-to-moderate COVID-19 in people 12 years and older (and weighing over 88 lbs) who are at high risk for severe illness
Mild-to-moderate COVID-19 in adults who are at high risk for severe illness and aren't able to receive other FDA-authorized treatments
What is the latest news about Paxlovid (nirmatrelvir / ritonavir)?
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References
Best studies we foundCenters for Disease Control and Prevention. (2022). COVID-19 Rebound After Paxlovid Treatment.
Centers for Disease Control and Prevention. (2022). Pregnant and Recently Pregnant People.
Centers for Disease Control and Prevention. (2022). Symptoms of COVID-19.
Centers for Disease Control and Prevention. (2023). People with Certain Medical Conditions.
Centers for Disease Control and Prevention. (2023). SARS-CoV-2 Variant Classifications and Definitions.
HIV.gov. (2022). Symptoms of HIV.
MedlinePlus. (2020). Stevens-Johnson syndrome/toxic epidermal necrolysis.
Pesko, B., et al. (2022). Safety and tolerability of Paxlovid (nirmatrelvir/ritonavir) in high-risk patients. Clinical Iinfectious Diseases.
Pfizer Inc. (2021). Pfizer Announces Additional Phase 2/3 Study Results Confirming Robust Efficacy of Novel COVID-19 Oral Antiviral Treatment Candidate in Reducing Risk of Hospitalization or Death.
Pfizer Laboratories Div Pfizer Inc. (2023). PAXLOVID- nirmatrelvir and ritonavir kit [package insert]. DailyMed.
U.S. Food and Drug Administration. (2023). FDA Approves First Oral Antiviral for Treatment of COVID-19 in Adults.
Xie, Y., et al. (2022). Nirmatrelvir and the Risk of Post-Acute Sequelae of COVID-19. MedRxiv.
Xie, Y., et al. (2023). Association of Treatment With Nirmatrelvir and the Risk of Post–COVID-19 Condition. JAMA Internal Medicine.
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