How should I take the Paxlovid (nirmatrelvir/ritonavir) dose pack?

How to Take Paxlovid Dose Pack

Take Paxlovid as 300 mg nirmatrelvir (2 pink tablets) plus 100 mg ritonavir (1 white tablet) together twice daily (morning and bedtime) for 5 consecutive days, starting as soon as possible within 5 days of symptom onset 1.

Standard Dosing Regimen

Normal Kidney Function (eGFR ≥60 mL/min)

• Each dose consists of 3 tablets total:
  • 2 pink nirmatrelvir tablets (150 mg each = 300 mg total)
  • 1 white or off-white ritonavir tablet (100 mg)
• Frequency: Twice daily (every 12 hours)
• Duration: 5 days (10 total doses)
• Timing: Take in the morning and at bedtime 2

Reduced Dose for Moderate Kidney Impairment (eGFR 30-59 mL/min)

• Each dose consists of 2 tablets total:
  • 1 pink nirmatrelvir tablet (150 mg)
  • 1 white or off-white ritonavir tablet (100 mg)
• Frequency: Twice daily (every 12 hours)
• Duration: 5 days 2

Practical Administration Instructions

Taking the Medication

• Remove tablets from blister card only when ready to take your dose 1
• Swallow tablets whole—do not chew, break, or crush 1
• Can be taken with or without food 1
• Take all tablets from one blister card together as a single dose 1

Timing Your First Dose

• Start treatment as early as possible within 5 days of symptom onset 2
• Take your first dose either in the morning or at bedtime, depending on when you pick up your prescription 1

If You Miss a Dose

• Within 8 hours of scheduled time: Take it as soon as you remember
• More than 8 hours late: Skip the missed dose and take the next dose at your regular time
• Never take 2 doses at the same time 1

Critical Safety Considerations

Drug Interactions

Ritonavir is a potent CYP3A4 inhibitor that causes numerous serious drug-drug interactions 2. Before starting Paxlovid:

• Check the Liverpool COVID-19 drug interaction tool for comprehensive interaction information 2
• Tell your healthcare provider about all medications, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements 1
• Some medications may need to be temporarily stopped, dose-adjusted, or switched to alternatives during the 5-day treatment course 2

Special Populations Requiring Caution

Severe Kidney Impairment (eGFR <30 mL/min):

• Use with caution; dosing recommendations are evolving
• Recent evidence suggests 300/100 mg loading dose followed by 150/100 mg once daily may be appropriate for severe renal impairment including hemodialysis patients 3

Liver Impairment:

• Use with caution in patients with severe liver disease 2, 1

Pregnancy and Breastfeeding:

• Can be considered as an option, though uncertainty exists regarding potential adverse reactions
• Paxlovid passes into breast milk 2, 1

Hormonal Contraceptives:

• Paxlovid may reduce effectiveness of hormonal birth control
• Use additional barrier contraception or alternative methods during treatment 1

When to Seek Medical Attention

Stop Taking and Get Emergency Help If You Experience:

• Allergic reaction signs: skin rash, hives, blisters, peeling skin, mouth/throat sores, swelling of mouth/lips/tongue/face, trouble swallowing or breathing, throat tightness, hoarseness 1
• Liver problem signs: loss of appetite, yellowing of skin or eyes, dark urine, pale stools, itching, abdominal pain 1

Common Side Effects (Usually Mild)

• Altered sense of taste (dysgeusia) and diarrhea are most common 2, 1
• Other possible effects: headache, vomiting, abdominal pain, nausea, high blood pressure 1

Important Reminders

• Complete the full 5-day course even if you feel better—do not stop early without consulting your healthcare provider 1
• Contact your healthcare provider if you don't feel better or feel worse after 5 days 1
• Store at room temperature between 68°F to 77°F (20°C to 25°C) 1
• If you take too much, call your healthcare provider or go to the emergency room immediately 1