What are the directions for taking Paxlovid (nirmatrelvir/ritonavir)?

From the Guidelines

Paxlovid should be taken as prescribed by your healthcare provider, typically two nirmatrelvir tablets (150 mg each) and one ritonavir tablet (100 mg) taken together twice daily for five days. This recommendation is based on the most recent and highest quality study, which supports the use of nirmatrelvir-ritonavir combination therapy for the treatment of symptomatic patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 5 days of the onset of symptoms and at a high risk for progressing to severe disease 1.

Key Considerations

• Take the medication with or without food, but always swallow the tablets whole without crushing or chewing them.
• Start Paxlovid as soon as possible after COVID-19 diagnosis and within 5 days of symptom onset for best effectiveness.
• Complete the full 5-day treatment course even if symptoms improve.
• Inform your doctor about all medications you take, as ritonavir can interact with many drugs, potentially requiring dose adjustments or temporary discontinuation of certain medications.
• Paxlovid works by preventing viral replication - nirmatrelvir blocks a key enzyme the virus needs to multiply, while ritonavir slows the breakdown of nirmatrelvir, keeping it active in your body longer.

Missed Doses

• If you miss a dose, take it as soon as possible within 8 hours; if more than 8 hours have passed, skip that dose and take the next one at the regular time.

The American College of Physicians recommends considering nirmatrelvir-ritonavir combination therapy for outpatient treatment of adults with confirmed COVID-19 at a high risk for progressing to severe disease 1. This recommendation is based on the latest evidence, which shows a reduction in all-cause mortality, COVID-19 mortality, and COVID-19 hospital admission with the use of nirmatrelvir-ritonavir combination therapy.

From the FDA Drug Label

The recommended dosage for PAXLOVID is 300 mg nirmatrelvir (two 150 mg tablets) with 100 mg ritonavir (one 100 mg tablet) with all 3 tablets taken together orally twice daily for 5 days. In patients with moderate renal impairment (eGFR ≥30 to <60 mL/min), the dosage of PAXLOVID is 150 mg nirmatrelvir (one 150 mg tablet) and 100 mg ritonavir (one 100 mg tablet) with both tablets taken together twice daily for 5 days The 5-day treatment course of PAXLOVID should be initiated as soon as possible after a diagnosis of COVID-19 has been made, and within 5 days of symptom onset If the patient misses a dose of PAXLOVID within 8 hours of the time it is usually taken, the patient should take it as soon as possible and resume the normal dosing schedule PAXLOVID (both nirmatrelvir and ritonavir tablets) can be taken with or without food

The directions for Paxlovid are to take 300 mg of nirmatrelvir and 100 mg of ritonavir twice daily for 5 days.

• The treatment should be started as soon as possible after diagnosis and within 5 days of symptom onset.
• If a dose is missed within 8 hours, it should be taken as soon as possible and the normal schedule resumed.
• The tablets can be taken with or without food and should be swallowed whole.
• For patients with moderate renal impairment, the dosage is 150 mg of nirmatrelvir and 100 mg of ritonavir twice daily for 5 days 2

From the Research

Paxlovid Directions

Paxlovid is an oral antiviral treatment authorized for adults with mild-to-moderate COVID-19 who are at increased risk for progression to severe illness. The following are key points regarding Paxlovid directions:

• The standard treatment regimen for Paxlovid is 300 mg of nirmatrelvir and 100 mg of ritonavir orally, every 12 hours for 5 days 3.
• Paxlovid should be initiated as soon as possible after diagnosis of COVID-19 and within 5 days of symptom onset 3, 4.
• The treatment is intended for adults at high risk for progression to severe COVID-19, including older adults, immunosuppressed individuals, and those with underlying medical conditions such as neurological or cardiovascular disease 3, 4.

Efficacy and Safety

The efficacy and safety of Paxlovid have been evaluated in several studies:

• A phase 2-3 double-blind, randomized, controlled trial found that Paxlovid significantly reduced the risk of COVID-19-related hospitalization or death by 89% compared to placebo 3.
• A real-world study using population-based data found that Paxlovid was associated with a significant decrease in the rate of severe COVID-19 or mortality, with an adjusted hazard ratio of 0.54 (95% CI, 0.39-0.75) 4.
• Paxlovid has been found to be safe and well-tolerated, with common adverse events including dysgeusia and diarrhea 3, 5.

Special Considerations

The following special considerations should be taken into account when using Paxlovid:

• Paxlovid is not recommended for patients with severe renal impairment or end-stage renal disease 5.
• Paxlovid may interact with other medications, including those highly dependent on CYP3A4 for clearance and CYP3A4 inducers 3, 5.
• The effectiveness of Paxlovid in preventing SARS-CoV-2 infection (PrEP and PEP) has not been established 5.