Information about COVID-19 and related treatment options changes rapidly. This article provides a snapshot of Paxlovid facts and guidelines as of February 2024. For the most up-to-date details on COVID-19, Paxlovid eligibility and availability, potential interactions and side effects, and other antiviral treatments, patients should consult the latest guidance from the Centers for Disease Control and Prevention (CDC).

With cold and flu season underway, oral antiviral medications like Paxlovid have become important tools for reducing hospitalizations and deaths among high-risk patients diagnosed with COVID-19. Paxlovid, produced by Pfizer, was granted emergency use authorization by the FDA in December 2021. Recent real-world data confirms it can significantly reduce the risk of hospitalization when given promptly after symptoms start. However, there are still common questions about who is eligible, how Paxlovid works, potential side effects and when to take it.

"We definitely saw a spike in cases not just for COVID-19 but also for RSV, Influenza and other viral upper respiratory illnesses as well as strep throat between November 2023 and January 2024. Fortunately, cases are starting to come down towards the end of February and I estimate that we see a few patients with respiratory illnesses, including COVID-19," said Luis Lorenzo, MD, family medicine doctor at CU Medicine Family Medicine – Louisville.

Dr. Lorenzo went on to say, "Paxlovid is an effective medicine for COVID-19. I offer it to patients who test positive for COVID-19 and are eligible for it, meaning their symptoms are mild to moderate and they are within 5 days of the onset of their symptoms which is when the medicine is most effective. Paxlovid is indicated for adults and children 12 years and older and also those at risk for severe COVID-19."

We break down key information about Paxlovid to help patients understand how it can be used as an early treatment option if diagnosed with COVID-19 during cold and flu season.

1. What exactly is Paxlovid and how does it work to treat COVID-19?

Paxlovid is an antiviral medication developed by Pfizer that was granted emergency use authorization by the FDA in December 2021 for the treatment of mild-to-moderate COVID-19 in high-risk patients. It consists of two antiviral drugs - nirmatrelvir and ritonavir - that work together to stop the replication of the SARS-CoV-2 virus that causes COVID-19.

When started within 5 days of the onset of COVID-19 symptoms, taking Paxlovid for 5 days as prescribed can reduce the risk of hospitalization and death. By preventing rapid viral replication early on, Paxlovid can help patients avoid severe symptoms that require hospital care.

2. Who is eligible for Paxlovid?

Paxlovid is intended for patients 12 years and older who weigh at least 40kg (88 pounds) and have mild to moderate COVID-19 illness. They also must be within 5 days of symptom onset to receive the medication, as starting it early is important to prevent severe illness.

To be prescribed Paxlovid, patients should be at high risk of developing severe COVID-19. This includes those aged 65 and older regardless of health status. Younger adults may also be eligible if they have certain medical conditions associated with increased COVID-19 severity.

Paxlovid requires a prescription after testing positive for COVID-19. Patients who test positive should contact their physician promptly to determine if Paxlovid is recommended for them based on timing of symptoms, risk factors, potential medication interactions and other considerations.

3. How effective is Paxlovid?

Clinical trial data that supported the FDA's emergency use authorization found Paxlovid reduced the risk of hospitalization and death from COVID-19 by around 89% compared to placebo. This study was done in unvaccinated high-risk adults when treatment was started within 5 days of symptom onset.

Observational data, including vaccinated patients from Israel, United States and Hong Kong is consistent with benefits in high-risk patients:

• 67% reduction in hospitalizations and 81% reduction in deaths compared to the untreated for patients over 65
• 45% reduction in hospitalization and greater reductions for obese or unvaccinated patients among adult patients
• 75% reduction in death compared to non-users

4. What is COVID-19 rebound?

Some patients who take Paxlovid as prescribed may experience a recurrence or worsening of COVID-19 symptoms after initially improving. This is known as a COVID-19 rebound. If symptoms like fever, cough or shortness of breath re-emerge or worsen after completing Paxlovid treatment, patients should contact their doctor right away.

In many cases, these rebound symptoms are mild and will subside in a few days without additional treatment. However, patients at high risk for progression to severe COVID-19 may require additional medical care if symptoms significantly worsen.

Close monitoring of symptoms and prompt communication with a healthcare provider is advised if a rebound occurs. Patients with worsening symptoms should follow up as instructed by their provider and seek medical care immediately for any concerning or severe symptoms.

5. What are possible Paxlovid side effects?

The most commonly reported side effects of Paxlovid are change in sense of taste and diarrhea. However, patients should contact their healthcare provider if they experience liver or allergic reactions. Other possible side effects are headache, vomiting, stomach-area (abdominal) pain, nausea, high blood pressure and generally feeling unwell.

6. What are the alternatives if a person cannot take Paxlovid?

For patients who test positive for COVID-19 but are unable to take Paxlovid due to supply, eligibility issues or medication interactions, there are some alternative antiviral treatments available:

Veklury (remdesivir) - An intravenous antiviral drug that is given once daily for 3 consecutive days. It is the other preferred treatment option besides Paxlovid for mild-moderate COVID-19 in high-risk patients.

Lagevrio (molnupiravir) - An oral antiviral that is taken twice daily for 5 days. It can be used when other treatment options are not available but is not preferred over Paxlovid.

Stay informed

While vaccination against COVID-19 is the best way to prevent severe illness and complications, drugs like Paxlovid provide hope for those who are at risk of developing serious complications. Learn the latest Centers for Disease Control guidelines for COVID-19 here.

If you test positive for COVID-19, act quickly to determine if you may be eligible for Paxlovid treatment. Contact your primary care provider or an urgent care clinic right away to speak with a doctor about your symptoms, risk factors and medication history. They can advise if Paxlovid is recommended for you and provide a prescription if appropriate.