PAXLOVID IS REMARKABLY EFFECTIVE at reducing COVID-related hospitalizations and death from the virus. Today we look at Paxlovid basics.
Haven’t you heard of Paxlovid? The oral anti-viral pill is the latest COVID-19 treatment tool that has been all over the news.
The anti-viral drug received an emergency use authorization from the United States Food and Drug Administration in December 2021 and is for those at high risk for severe complications from a COVID infection. One must be at least 12 and weigh a minimum of 88 pounds.
One of the most valuable features of Paxlovid is that one can take it home. The drug can help individuals at high risk of getting so sick that they need hospitalization. If you are eligible and take the pills, you lower your chances of needing to go to the hospital.
How effective is Paxlovid? Here is what I recently wrote about the anti-viral medication:
“The rate of COVID-19 hospitalization is 15 cases per 100,000 person-days among patients treated with Paxlovid, compared with 59 per 100,000 person-days among untreated patients. The hospitalization rate is 73 percent lower for those taking Paxlovid.
Moreover, the patients taking Paxlovid had a 79 percent lower chance of dying from COVID-19 infection. However, the risk of death did not appear to be lower for the younger patients, ages 40 to 64.
Let’s get to the top 10 things you need to know about Paxlovid, the first effective oral anti-viral drug for the COVID-19 virus.
1. Paxlovid basics: How does the drug work?
How does this game-changer medicine work? Paxlovid consists of two medicines: nirmatrelvir tablets and ritonavir tablets. The two medicines are taken together two times each day for five days.
The pills come in a medication blister pack that lets you punch out the pills as indicated.
The team at Yale Medicine (USA) explains how the two drugs combine to deliver their knockout blow:
- Nirmatrelvir blocks a key enzyme that the COVID virus needs to make functional virus particles. After nurmatrelvir treatment, the COVID virus released from cells can no longer enter uninfected cells in the body, stopping the infection.
- Ritonavir, the second drug in Paxlovid, boosts the levels of anti-viral medicines. From a practical perspective, ritonavir shuts down nirmatrelvir’s breakdown in the liver, allowing the nirmatrelvir to linger in our body longer to fight the COVID infection.
Paxlovid is not for everyone. For example, those taking many medications that Paxlovid may interact with may not be candidates. Drugs that organ transplant patients take may be troublesome, as can some common drugs used to treat heart arrhythmias.
Paxlovid decreases blood thinner metabolism and can drive the levels of these anticoagulant drugs to unsafe levels. While Paxlovid can interact with cholesterol-lowering medicines such as Lipitor, holding the Lipitor for five days is not problematic.
2. Paxlovid basics: When should I take it?
If you are an appropriate candidate for Paxlovid and want to use it, you must take the anti-viral drug within five days of developing symptoms; Paxlovid works best early in the course of the infection. After about a week, Paxlovid cannot undo the virus’ damage to the body.
3. Paxlovid basics: Can anyone get a prescription?
The US Food and Drug Administration authorized Paxlovid for individuals at least age 12 who weigh at least 88 pounds. To qualify for the drug, you also need a positive COVID-19 test result and should be at high risk for developing severe COVID-19.
What is high-risk? You should be 65 or older or have underlying health problems such as diabetes, obesity, cancer, etc. The more medical conditions an individual has, the higher their risk for experiencing severe complications of COVID-19 infection.
Pregnant or breastfeeding? Please review your situation with your health care provider; there is no good experience to guide the use of the anti-viral drug in this population.
While health care providers can prescribe Paxlovid, pharmacists may provide the drug in many situations. Bring your medical records, medicines, and blood test results from the last year.
4. Paxlovid basics: Are there side effects?
According to Scott Roberts, MD, a Yale Medicine infectious diseases expert, most people do well on the drug. Still, he reminds us to stop the drug and call a health care provider immediately if you experience any of the following allergic reaction signs:
- hives
- trouble breathing or swallowing
- swelling of the mouth, lips, or face
- throat tightness
- hoarseness
- skin rash
Other possible side effects include:
- altered or impaired taste
- diarrhea
- increased blood pressure
- muscle aches
- abdominal pain
- nausea
- feeling generally unwell
Those with mild-to-moderate kidney disease may need Paxlovid dose adjustments as the kidneys clear the drug. Paxlovid is not recommended for those with severe kidney disease or on dialysis, offers Jeffrey Topal, MD, another Yale Medicine infectious diseases specialist.
Tell your healthcare provider if you are taking a combined hormonal contraceptive. PAXLOVID may affect how your birth control pills work.
Let your health care provider know if you exhibit any signs of liver troubles. Such symptoms can include a loss of appetite, yellowing of the skin or whites of the eyes (jaundice), dark-colored urine, pale-colored stools, itchy skin, or stomach-area pain.
Talk to your healthcare provider if you do not feel better or feel worse after five days.
The FDA has a fact sheet on Paxlovid with a full list of known side effects.
5. What about rebound?
You may have heard about the rebound of COVID-19 symptoms in some individuals two to eight days after completing their five-day course of Paxlovid. Others test positive again but have no symptoms.
Researchers are still examining the rebound phenomenon. The US Centers for Disease Control offers that a rebound doesn’t mean a person was resistant to Paxlovid, nor does it mean they had a COVID-19 re-infection.
A CDC study discovered that rebound symptoms tended to be unlikely to lead to hospitalization, with patients generally experiencing symptoms milder than had during the primary infection.
For anyone who experiences a rebound, the CDC advises people “restart isolation” for five days, following its isolation guidance. Pfizer recommends reporting it to them on its portal for adverse events associated with Paxlovid.
In its guidance for clinicians in June 2022, the Centers for Disease Control explains that “a brief return of symptoms may be part of the natural history of SARS-CoV-2 infection in some people, independent of treatment with Paxlovid, adding that there is no evidence that additional treatment is [routinely] needed.”
Some hypothesize that because Paxlovid suppresses viral replication early in the disease course, the immune system didn’t fully see the extent of the virus.
If you are experiencing symptoms of COVID-19 and think you are eligible for treatment, you can visit the government Test-to-Treat Locater. You can use the site to search for the places near you where you can fill out a COVID-19 prescription or identify sites that provide testing, medical care, and COVID-19 medications.
Paxlovid for high-risk individuals — My take
Paxlovid is an imperfect medicine but can help many (but not all) high-risk patients avoid hospitalization or death. Because starting the drug early in the disease course is important to its success, don’t hesitate to get tested if you have any symptoms.
Vaccination, testing, and mitigation efforts such as masking remain key elements of COVID-19 risk reduction, even as more effective drugs become available.
Thank you for joining me in this look at COVID-19 infection and Paxlovid basics.
The information I provided in this blog is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you seek medical advice, diagnoses, or treatment. I am not liable for risks or issues associated with using or acting upon the information in this blog.
