Should I take Paxlovid for a COVID infection?
This antiviral drug can keep you from getting really sick if you test positive. Find out if it’s right for you.
Ready for a bit of good news about COVID-19? There is a super effective drug that can help zap the virus. It can keep you from getting really sick or going to the hospital. And it’s a pill you take at home.
Paxlovid was cleared for emergency use by the U.S. Food and Drug Administration last winter. It became more widely available this past summer. It’s the go-to for lots of people who come down with COVID-19. But it’s not for everybody. How do you know if it’s right for you?
First step: Talk to your doctor. “Reach out as soon as you test positive,” says Shivanjali Shankaran, MD. She’s an infectious disease specialist at Rush University Medical Center in Chicago, Illinois. “Paxlovid is a good drug, and it’s really safe, but time is of the essence.”
You must start Paxlovid within 5 days of the start of symptoms, says the Centers for Disease Control and Prevention (CDC).
What’s up with this wonder drug? You’ve got questions. We’ve got answers.
What exactly is Paxlovid?
It’s a combination of 2 different drugs, says Dr. Shankaran. For the first 5 to 7 days that the COVID-19 virus is in your body, it’s multiplying like crazy. So one of the ingredients (called nirmatrelvir) works by slowing that process down.
The other ingredient (called ritonavir) works in your liver to keep the drug in your system longer. This helps it kill more of the virus. Together, those 2 ingredients do the job.
In a clinical study of 2246 patients, those who took Paxlovid within 5 days of testing positive lowered their risk of severe illness and hospitalization by nearly 88%. That was compared to those who took a placebo.
And no one in the Paxlovid group died. That’s compared to 13 deaths among those in the placebo group.
From at-home tests to at-home care, Optum’s COVID-19 resource center is here for you.
How do I know if it’s right for me?
Are you over age 65? Do you have a chronic condition such as cancer, diabetes, heart disease, obesity or lung issues? Then Paxlovid may be a good choice for you, says the CDC. (It’s also approved for kids over 12 who weigh at least 88 pounds.)
“You and your doctor will weigh the risks and benefits of the medication,” says Rebecca Wang, MD. She’s an infectious disease specialist at Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire.
What should I tell my doctor before taking Paxlovid?
If you test positive for COVID and have mild to moderate symptoms, call your provider. Let the doctor know:
- If you have any allergies
- If you have liver or kidney disease
- If you’re pregnant, planning to become pregnant or are breastfeeding
- If you have any serious illnesses
- All medications you’re taking, including over-the-counter remedies, vitamins and herbal supplements
Can I take Paxlovid if I’m taking other medications?
That depends. There’s a big list of medications that can make Paxlovid off-limits for you. That’s because one of the ingredients slows down the metabolism of the drug, so it stays in your body longer. That’s a good thing. But there’s a flip side: It can also keep other drugs in your system longer.
“That can be a big problem with some medications, like those that treat heart disease or seizures, or the ones you take after transplants,” says Dr. Wang.
You may be able to temporarily pause some medications (such as those for high cholesterol or hypertension). But never take Paxlovid without reviewing all your medications with your doctor first.
Are there any side effects?
Paxlovid is safe when it’s used by people with their doctor’s OK. The main side effects are pretty minor. About 5 percent of people who take Paxlovid experience a bitter taste in their mouth. It goes away when you finish the medication, says Dr. Shankaran.
And some people may experience nausea or vomiting. If you do, try to take the pills with food. Chocolate milk, peanut butter or cinnamon gum can help.
What triggers a “COVID rebound”?
Just when you think you’ve got the all-clear — boom. You’ve tested positive for COVID again. The phenomenon has been dubbed COVID rebound. It can happen after taking a 5-day course of Paxlovid. The person tests negative, heads back to work and then gets sick again a few days later.
You may have heard about it in the news recently. But it’s not as common as you might think. In a recent study of almost 500 patients who’d been treated with Paxlovid, only 4 had a rebound.
Experts aren’t sure exactly why this happens. One theory: “There might be a small reservoir of the virus still in your body,” says Dr. Wang. “And when you stop the Paxlovid, the virus might start replicating again. But we’re still in the early stages of learning about this.”
If I get COVID rebound, what should I do?
First of all, don’t worry. Your symptoms will probably be mild. But with a positive test, you are contagious. So be sure to restart your isolation period. “That can be disruptive in your life,” Dr. Wang says. “But it’s worth the annoyance. Follow the CDC guidelines.”
Paxlovid study: New England Journal of Medicine (2022). “Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19”
Treatment recommendations: Centers for Disease Control and Prevention (2022). “Covid-19 Treatments and Medications”
Rebound study: Mayo Clinic (2022). “Study finds few COVID-19 patients get rebound symptoms after Paxlovid treatment”