"Today's authorization introduces the first treatment for COVID-19 that is in the form of a pill that is taken orally—a major step forward in the fight against this global pandemic," said Patrizia Cavazzoni, MD, the director of the FDA's Center for Drug Evaluation and Research, in a statement last year.
Still, this encouraging news might have left you with a lot of lingering questions: What is the purpose of Paxlovid? Who's authorized to take it? What are the limitations of the drug? Below, Lee Nguyen, PharmD, associate clinical professor of the Department of Clinical Pharmacy Practice at the UC Irvine College of Health Sciences, answers your COVID-19 antiviral pill questions.
What are COVID-19 antiviral pills?
Per the Mayo Clinic, antiviral medications are drugs that assist the body in fighting off dangerous viruses. Antiviral medications can also lessen symptoms and shorten the duration of a given virus. Currently, there are two such drugs authorized for the treatment of COVID-19.
Paxlovid is a combination of nirmatrelvir and ritonavir tablets co-packaged for oral use. "Paxlovid has three pills that are taken twice daily for five days. Two of the pills are nirmatrelvir and one is ritonavir," explains Dr. Nguyen. Nirmatrelvir inhibits a SARS-CoV-2 protein to stop the virus from replicating, while ritonavir slows down nirmatrelvir's breakdown so it stays in the body for longer.
"The second product made by Merck is called molnupiravir and does not have a brand name in the U.S.," says Dr. Nguyen. Molnupiravir works by creating errors in the SARS-CoV-2 virus' genetic code, which keeps the virus from replicating further. "Molnupiravir is administered as four 200 milligram capsules taken orally every 12 hours for five days, for a total of 40 capsules. Molnupiravir is not authorized for use for longer than five consecutive days," says the FDA, it's also not authorized for use on anyone under 18 years old.
While both medications are used to prevent the replication of the COVID-19 virus, they are not a substitute for the COVID-19 vaccine and booster shots, and they're not suitable for everyone.
Who are COVID-19 antiviral pills for?
"These medications will have the greatest benefits in patients at high risk for disease progression from mild-moderate to seriously ill. These patients can be described as older individuals or those with medical conditions such as diabetes, cancer, or other immunocompromising conditions," says Dr. Nguyen.
Both Paxloid and molnupiravir must be prescribed by your doctor, who will determine which drug you get based on your age and weight. "Getting a COVID-19 test as soon as possible is an important process in determining the need for Paxlovid or molnupiravir," says Dr. Nguyen. So consult with your doctor if you've contracted COVID-19 and feel you may be part of an at-risk group.
The potential pitfalls of COVID-19 antiviral pills
While antiviral pills can be beneficial in offering your body some much-needed backup while fighting COVID-19, these drugs are not without pitfalls—the first being timing. "I think one of the limitations of these antiviral pills is not the medication themselves, but process of starting [treatment]," explains Dr. Nguyen. "The window to start these medications is relatively short: five days from the onset of symptoms. Patients need to recognize that they might have COVID-19 in the first few days and get tested." Add up the time it takes to receive a positive COVID-19 test, get an appointment with your primary care provider, and hunt down a pharmacy that carries the medication, and you may well miss that window. So it's best to act fast if you're in an at-risk group and suspect you may have COVID-19.
Another major factor to consider is drug interactions. "If patients are taking other medications, there is a chance that ritonavir will boost those medications too. Patients taking blood thinners—anticoagulants—such as rivaroxaban or "Xarelto" are at increased risk of bleeding if taken with Paxlovid. The current recommendation is to avoid taking both medications at the same time," explains Dr. Nguyen. So make sure you're upfront with your doctor about all your medications.
Long story short: COVID-19 antiviral pills
As of right now, there are two antiviral pills authorized to combat the worst effects of COVID-19: Paclovid and molnupiravir. People at moderate to high risk of serious illness—like immunocompromised and older people—will benefit most from courses of COVID-19 antiviral pills. However, it's important to consult your doctor as soon as possible and be upfront about your other prescriptions.
Oh, and just to reiterate: The vaccine is crucial to combatting the worst effects of COVID-19. "One of the best ways to prevent severe complications associated with COVID-19 such as hospitalization is to get vaccinated if you are eligible and practice good hand hygiene," says Dr. Nguyen.
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