What to Know About Paxlovid™

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In December 2021, the U.S. Food and Drug Administration (FDA) issued emergency use authorization for a new COVID-19 treatment. Known as Paxlovid™, it can help patients with mild to moderate COVID-19 avoid severe outcomes, including hospitalization or death.

If you have tested positive for COVID-19, you may be eligible to receive Paxlovid. You can receive it from a pharmacy if you have a prescription.

What Is Paxlovid?

Paxlovid is an oral COVID-19 treatment that Pfizer developed. It consists of two different types of tablets — nirmatrelvir and ritonavir — taken together.

The nirmatrelvir works to fight off SARS-CoV-2, the virus that causes COVID-19. The ritonavir blocks your body’s ability to metabolize the nirmatrelvir. This helps the nirmatrelvir stay in your body long enough to battle the virus.

“Nirmatrelvir is an effective antiviral, and the ritonavir makes sure that the nirmatrelvir stays in the blood long enough to kill the virus,” says Erin McCreary, PharmD, infectious diseases pharmacist, UPMC.

Patients with normal kidney function take three pills twice a day for five days. Patients with some renal dysfunction — an estimated glomerular filtration rate (eGFR) of between 30 and 60 — take two pills twice a day for five days. An eGFR measures your kidneys’ ability to filter out blood.

Paxlovid is not a substitute for the COVID-19 vaccine. It is not authorized to prevent COVID-19. It is available as a COVID-19 treatment within five days of symptoms appearing. The best way to prevent COVID-19 is by getting the COVID-19 vaccine.

Can I Get Paxlovid?

To qualify for Paxlovid, you must have tested positive for COVID-19, and treatment must begin within five days of the start of your symptoms. Other qualifications for Paxlovid include:

  • You must be 12 years old or older.
  • Weigh at least 88 pounds.
  • Have mild to moderate COVID-19.
  • Be at high risk for severe COVID-19.

Conditions that would put you at risk for severe COVID-19 include a body mass index (BMI) of over 25, asthma, heart disease, high blood pressure, liver disease, lung disease, a compromised immune system, and many more.

“These are all chronic conditions that put you at risk of developing severe COVID-19,” Dr. McCreary says. “The EUA allows Paxlovid for a pretty broad list of conditions.”

Some people are not eligible for Paxlovid, Dr. McCreary says.

Patients with severe kidney dysfunction — an eGFR below 30 — are not eligible for Paxlovid. If you have a kidney problem, talk to your doctor to see if you can get Paxlovid.

Also, if you take certain other medications, Paxlovid could cause complications. Talk to your doctor and/or a pharmacist to find out if you’re a candidate for Paxlovid or if you should receive another treatment like monoclonal antibodies.

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Does Paxlovid Work Against COVID-19?

In issuing emergency use authorization for Paxlovid, the FDA referenced the EPIC-HR study.

The study measured the efficacy of Paxlovid in adults with mild to moderate COVID-19 who were at risk of severe disease. Data showed Paxlovid reduced the risk of COVID-19 hospitalization or death by any cause by 88%.

“The first Paxlovid reports were comparable to the effect we saw with monoclonal antibodies,” Dr. McCreary says. “That’s good because we want to keep patients out of the hospital. We do need to study Paxlovid in vaccinated patients and with the new variants to see if it remains as effective at decreasing hospitalizations and deaths as when it was first studied.”

The EPIC-HR study took place before Omicron (B.1.1.529) became the dominant variant of COVID-19, and it enrolled only unvaccinated patients. It is not yet known how well Paxlovid works against Omicron or in vaccinated patients.

Paxlovid Side Effects

In general, Paxlovid is safe to take if you meet the criteria to receive it. You should not take Paxlovid if you have a severe kidney problem, if you take a medicine that interacts significantly with Paxlovid, or if you are allergic to any of Paxlovid’s ingredients.

Common side effects of Paxlovid include:

  • Change in taste or bad taste in the mouth.
  • Diarrhea or upset stomach.
  • High blood pressure.
  • Muscle aches.

Paxlovid Vs. Monoclonal Antibodies

Paxlovid and monoclonal antibodies are both COVID-19 treatments. They are similar in many ways, including who is eligible to receive them and how effective they are. But they do have some differences.

Differences between the treatments include:

  • Paxlovid is an oral medication, while monoclonal antibodies are an intravenous (IV) infusion.
  • You can get Paxlovid more easily because it’s available at pharmacies with a prescription. To get monoclonal antibodies, you need a prescription and an infusion appointment at an infusion center.
  • Paxlovid is a five-day treatment. Monoclonal antibodies are a one-time infusion.
  • You can take Paxlovid at home.
  • You can receive monoclonal antibodies up to seven days after you start feeling COVID-19 symptoms. For Paxlovid, it’s five days.
  • People with kidney problems cannot receive Paxlovid.
  • If you take other medications, you may not be able to receive Paxlovid. There are no drug interactions with monoclonal antibodies.

If you have mild to moderate COVID-19, talk to your doctor about whether you should receive Paxlovid or monoclonal antibodies. You should not get both treatments.

Can I Get Paxlovid at UPMC?

If you have mild to moderate symptoms of COVID-19, you should get tested. UPMC has testing locations throughout our communities. You need to test positive for COVID-19 before you can receive Paxlovid.

Paxlovid treatment has to begin within five days of your first COVID-19 symptoms. That makes it important to get tested as soon as possible if you have symptoms. Talk to your doctor about getting a Paxlovid prescription if:

  • You test positive for COVID-19.
  • It has been less than five days since your symptoms appeared.
  • If you meet the other criteria for Paxlovid.

“The key thing is, anything is a symptom,” Dr. McCreary says. “Any cough, sniffles, anything — get tested. If you’re positive, see if you’re eligible for treatment. And then seek out treatment.”

If you don’t meet the criteria for Paxlovid, you may be a candidate for monoclonal antibodies. Due to high patient volumes, it may be more difficult to schedule a monoclonal antibody appointment at UPMC at this time. We are currently limiting monoclonal antibody treatments to our most at-risk patients, older adults, and people who are not candidates for Paxlovid.

UPMC is committed to caring for our communities during the COVID-19 pandemic. For more information on our efforts against COVID-19, visit our website.

Sources

U.S. Food and Drug Administration, Coronavirus (COVID-19) Update: FDA Authorizes First Oral Antiviral for Treatment of COVID-19. Link

U.S. Food and Drug Administration, Fact Sheet for Patients, Parents, and Caregivers: Emergency Use Authorization (EUA) of Paxlovid for Coronavirus Disease 2019 (COVID-19). Link

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