From the Guidelines
Paxlovid (nirmatrelvir/ritonavir) should be considered for treatment in 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. This recommendation is based on the latest evidence from the American College of Physicians, as outlined in their living, rapid practice points for the outpatient treatment of confirmed COVID-19 1. The use of nirmatrelvir–ritonavir combination therapy is supported for patients who meet these criteria, with the goal of reducing the risk of progression to severe disease and improving outcomes.
Key considerations for the use of Paxlovid include:
- The patient must be within 5 days of symptom onset
- The patient must have confirmed mild to moderate COVID-19
- The patient must be at high risk for progressing to severe disease, which may include older adults, people with underlying medical conditions, immunocompromised states, and other high-risk groups
- The standard regimen is nirmatrelvir (300 mg) with ritonavir (100 mg) taken together twice daily for 5 days
It is essential to note that Paxlovid has significant drug interactions due to the ritonavir component, and patients should inform their healthcare provider about all medications they are taking to ensure safe and effective treatment 1. By considering these factors and using Paxlovid in accordance with the latest evidence-based guidelines, healthcare providers can help reduce the risk of hospitalization and death in high-risk patients with COVID-19.
From the FDA Drug Label
INDICATIONS AND USAGE PAXLOVID which includes nirmatrelvir, a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) main protease (Mpro: also referred to as 3CLpro or nsp5 protease) inhibitor, and ritonavir, an HIV-1 protease inhibitor and CYP3A inhibitor, is indicated for the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adults who are at high risk for progression to severe COVID-19, including hospitalization or death. DOSAGE AND ADMINISTRATION ... Initiate PAXLOVID treatment as soon as possible after diagnosis of COVID-19 and within 5 days of symptom onset.
Paxlovid (nirmatrelvir/ritonavir) Treatment Timing:
- Initiate treatment as soon as possible after diagnosis of COVID-19.
- Treatment should be started within 5 days of symptom onset 2. Key Points:
- Paxlovid is indicated for the treatment of mild-to-moderate COVID-19 in adults at high risk for progression to severe COVID-19.
- Treatment duration is 5 days 2.
From the Research
Eligibility for Paxlovid Treatment
Paxlovid (nirmatrelvir/ritonavir) is authorized for early treatment of mild to moderate COVID-19 in patients at increased risk for progression to severe illness 3, 4. The following groups are eligible for Paxlovid treatment:
- Adults with mild to moderate COVID-19 who are at risk for progression to severe disease 4
- Patients aged ≥12 years weighing ≥40 kg with mild to moderate COVID-19 who are at risk for progression to severe disease 5
- Patients with COVID-19 who are at high risk for progression to severe disease, including those with underlying medical conditions 3, 4
Timing of Paxlovid Treatment
Paxlovid treatment should be started within 5 days of symptom onset and given for 5 days' duration 5. Early treatment with Paxlovid is crucial to reduce the risk of hospitalization and death among patients with mild to moderate COVID-19 who are at risk for progression to severe disease 3, 4.
Benefits of Paxlovid Treatment
The benefits of Paxlovid treatment include:
- Reduced risk of hospitalization and death among patients with mild to moderate COVID-19 who are at risk for progression to severe disease 3, 4, 6
- Decreased hospitalization rate among adults with COVID-19 4
- Shorter hospital length of stay and polymerase chain reaction negative conversion time compared to the control group 6
- Effective therapeutic agent for treating patients with COVID-19 6
Special Considerations
Special considerations for Paxlovid treatment include: