Adverse Side Effects of Paxlovid: Frequency and Management
Based on clinical trial data, approximately 5-6% of patients experience dysgeusia (altered taste) and 3% experience diarrhea as the most common adverse effects of Paxlovid, with most side effects being mild to moderate in severity. 1
Common Adverse Effects and Their Frequency
Gastrointestinal Effects
- Dysgeusia (altered taste): 5-6% of patients 1, 2
- Diarrhea: 3% of patients 1
- Nausea/vomiting: Reported during post-marketing surveillance 1
- Abdominal pain: Reported during post-marketing surveillance 1
Neurological Effects
- Headache: Common post-marketing adverse event 1, 3
- Anosmia: Reported in post-marketing surveillance 3
Other Effects
- Malaise: Reported during post-marketing surveillance 1
- Hypertension: Reported during post-marketing surveillance 1
Demographic Patterns in Adverse Effects
- Female patients are 1.7 times more likely to report dysgeusia compared to male patients 2
- Most adverse events occur within the first day after starting treatment, with a median onset time of 8 days 4
- Neurological adverse events are reported approximately 2.27 times more frequently with Paxlovid compared to other COVID-19 medications 3
Serious Adverse Effects (Rare)
- Hypersensitivity reactions: Including anaphylaxis, toxic epidermal necrolysis, and Stevens-Johnson syndrome 1
- Hepatotoxicity: Hepatic transaminase elevations, clinical hepatitis, and jaundice have occurred in patients receiving ritonavir (a component of Paxlovid) 1
Clinical Management Considerations
Monitoring Recommendations
- Monitor for signs of hypersensitivity reactions, particularly in the first few days of treatment
- Exercise caution in patients with pre-existing liver disease or abnormal liver enzymes 1
- Be aware that most adverse effects are self-limiting and resolve after completion of the 5-day treatment course
Risk Mitigation
- For dysgeusia: Reassure patients this is temporary and typically resolves after completing treatment
- For diarrhea: Recommend adequate hydration and monitor for signs of dehydration
- For serious hypersensitivity reactions: Immediately discontinue Paxlovid and initiate appropriate treatment 1
Special Populations
- Pregnant women: Limited data suggests Paxlovid is generally well-tolerated with dysgeusia and diarrhea being the most common adverse effects 5
- Patients with severe renal impairment: Safety profile appears consistent with that observed in the general population, though dosage adjustments are required 1
Clinical Perspective
Despite these adverse effects, the benefit of Paxlovid in reducing hospitalization and mortality in high-risk COVID-19 patients (54% reduction) generally outweighs the risks of these predominantly mild and transient side effects 6. The most common reason patients may consider discontinuing treatment is dysgeusia, which while unpleasant, is temporary and not medically serious.