5 Things to Know About Paxlovid, an Oral Treatment for COVID-19

It was a big deal when Paxlovid became available to the public in December 2021. COVID-19 was still surging across the country, causing high numbers of hospitalizations and deaths. A pill that you could take at home to reduce the risk of serious illness was a game changer.

Paxlovid was authorized for adults and children over 88 pounds who were at high risk of severe illness. This included people older than 65 or who had other serious health problems, such as heart or lung conditions, a weakened immune system, obesity or diabetes.

With more than 40 percent of the U.S. population considered obese, many people are eligible for Paxlovid, says UNC Health infectious diseases specialist David Wohl, MD.

Now that Paxlovid is readily available, should you take it if you are eligible and get COVID-19? The answer is: It depends. We talked to Dr. Wohl to learn more.

1. Who should take Paxlovid?

When Paxlovid first came along, COVID-19 was surging throughout the country, and hospitalizations and deaths were high.

“Vaccines and whatever immunity results from prior infections had not achieved the protection from getting really sick that we now have, so the criteria that the government came up with to qualify for Paxlovid was extremely broad,” Dr. Wohl says. “At the time, that made sense because there really wasn’t anything else as readily available as oral Paxlovid to prevent people from getting hospitalized.”

Now, because there is more immunity built up against COVID-19, fewer people are being hospitalized or getting really sick.

“The number of people who need Paxlovid to prevent hospitalization is much smaller now,” Dr. Wohl says. However, there are still hundreds of people dying from COVID-19 in the United States each day and many more being hospitalized due to this infection.

“The vast majority of these severely ill cases of COVID-19 are people who can’t build up a good immune response following vaccination or prior infection,” he says.

Studies show that those who remain at greatest risk are people over age 65, people who have lung or heart troubles, and anyone who has a suppressed immune system.

“Older people and those with serious underlying conditions should be offered and consider taking Paxlovid as soon as possible after testing positive for COVID-19. If you’re 65, even though you run, you’re healthy and you play pickleball, your immune system is 65 years old,” Dr. Wohl says. “And a 65-year-old immune system doesn’t work like a 50-year-old or 40-year-old or 16-year-old immune system.”

The data also suggest a benefit from Paxlovid treatment for people who are pregnant. “Pregnancy increases the risk for severe COVID-19, and the infection can also threaten the pregnancy,” Dr. Wohl says.

The Society for Maternal-Fetal Medicine endorses the use of Paxlovid in pregnancy. Available data show that pregnant women who become infected with COVID-19 are more likely to die or experience serious complications compared with women who are not pregnant. COVID-19 increases the risk of preterm birth and, some studies suggest, stillbirth. Unvaccinated pregnant women are especially at risk.

“Pregnant people suffer consequences from COVID-19, including preterm labor and fetal demise, so they should take Paxlovid if they get sick,” Dr. Wohl says.

2. If you’re young and healthy, you probably don’t need to take Paxlovid.

Most people who get sick with COVID-19 are able to recover at home, especially if they’re younger, healthier, have been vaccinated and boosted, and have good access to healthcare. For these people, some of the things you do to feel better if you have the flu or a bad cold also help with COVID-19 symptoms. That includes getting enough rest, staying hydrated and taking over-the-counter medications such as Tylenol and Advil to relieve fever, aches and pains. The Centers for Disease Control and Prevention has guidance for at-home treatment of COVID-19.

“If you’re young and healthy, the value of Paxlovid is really reduced because your chance of getting hospitalized is low. And if you are up to date on your vaccination, it is extraordinarily low,” Dr. Wohl says.

Paxlovid’s ability to shave off time to recovery is also not strong, Dr. Wohl warns. “In clinical studies, while it prevented hospitalization, Paxlovid’s track record of making symptoms go away quicker was mixed. So, if you’re looking to get your symptoms gone quicker or get back to work quicker, data show Paxlovid doesn’t reliably do that.”

3. It’s important to ask your doctor whether your medications are safe to take with Paxlovid.

Paxlovid is a combination of two medications: one that works against the virus and another that helps boost the level of the first drug in the body. This boosting agent can also make the levels of some other medications higher, which can be dangerous. However, in most cases where there is an interaction between Paxlovid and another medication, it can be managed by temporarily holding or reducing the dose of the other medication.

“For some people, Paxlovid is not an option due to serious interactions with medications they need to take, but clinicians sometimes are withholding Paxlovid from people at high risk of progressing to severe COVID-19 because of a drug interaction that can be easily managed,” Dr. Wohl says. “For example, while Paxlovid can interact with statin medications used to control cholesterol, holding the statin for the five-day course of Paxlovid poses no risk to the patient and would allow the patient to reduce their risk of ending up in the hospital due to COVID-19.”

There are online drug interaction checkers specially developed to help clinicians see which medications Paxlovid interacts with, and these provide advice on management.

4. COVID-19 rebound can happen with or without Paxlovid.

For some people, COVID-19 symptoms may improve and then return a few days later. In some cases, people report that their home tests became negative as they were recovering, then turned positive when their symptoms started up again. This is called rebound and was initially reported in people taking Paxlovid. Studies now show that even people not taking Paxlovid or any COVID-19 medication can experience rebound; however, there is some evidence to suggest it may be more common in people treated with Paxlovid.

“That’s another factor to consider. If you don’t really need Paxlovid, that risk of a rebound means you’re starting back all over again,” Dr. Wohl says. “You’re out of work longer, you’re feeling miserable, and you have a prolonged period of feeling worse.”

5. Start Paxlovid within five days of developing symptoms.

If you have mild to moderate symptoms, test positive for COVID-19 and think you are eligible for Paxlovid, talk to your doctor promptly. A healthcare provider or pharmacist can determine whether you should take the medication.

Once you’re prescribed Paxlovid, you will take three pills twice a day for five days. It should be started within five days of symptom onset.

Paxlovid can cause interactions with widely used medications, including statins, blood thinners and some antidepressants, so ask your doctor if Paxlovid can be taken safely with your medications. The Food and Drug Administration does not recommend Paxlovid for people with severe kidney or liver disease.

Think you may have COVID-19? Talk to your doctor. Don’t have one? Find a doctor near you.