From the Guidelines
Yes, Paxlovid is still recommended for treating COVID-19 in eligible patients. Paxlovid (nirmatrelvir/ritonavir) is prescribed as a 5-day course with a typical dosage of 300 mg nirmatrelvir (two 150 mg tablets) with 100 mg ritonavir (one tablet) taken together twice daily. It's most effective when started within 5 days of symptom onset and is primarily recommended for individuals at high risk for severe COVID-19, including older adults (particularly those over 65), unvaccinated individuals, and those with underlying medical conditions like heart disease, diabetes, obesity, or immunocompromising conditions. Before taking Paxlovid, patients should inform their healthcare provider about all medications they're taking, as ritonavir can interact with many common drugs. Some patients may need dosage adjustments if they have kidney problems. Paxlovid works by inhibiting a key enzyme that the coronavirus needs to replicate, thereby reducing viral load and helping prevent progression to severe disease. Clinical trials have shown it can reduce the risk of hospitalization and death by approximately 89% in high-risk patients when started early, as supported by recent guidelines from the American College of Physicians 1. The choice of Paxlovid over other treatments like molnupiravir or remdesivir is due to its superior efficacy and safety profile, provided that the patient is not using other drugs that interact with nirmatrelvir/ritonavir 1. Key points to consider include:
- Eligibility: High-risk patients for severe COVID-19
- Dosage: 300 mg nirmatrelvir with 100 mg ritonavir, twice daily for 5 days
- Timing: Most effective when started within 5 days of symptom onset
- Interactions: Patients should disclose all medications to their healthcare provider due to potential interactions with ritonavir
- Efficacy: Reduces risk of hospitalization and death by approximately 89% in high-risk patients when started early.
From the FDA Drug Label
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 even if baseline COVID-19 symptoms are mild
Paxlovid (nirmatrelvir/ritonavir) is still recommended for the treatment of COVID-19, as indicated by the FDA drug label. The recommended dosage is 300 mg nirmatrelvir with 100 mg ritonavir, taken together orally twice daily for 5 days. Initiation of treatment should be as soon as possible after diagnosis and within 5 days of symptom onset.
- Key considerations for use include renal impairment, hepatic impairment, and potential drug interactions.
- Contraindications include a history of clinically significant hypersensitivity reactions and use with certain medications that are primarily metabolized by CYP3A. 2
From the Research
Efficacy of Paxlovid
- Paxlovid (nirmatrelvir/ritonavir) has been shown 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, 5, 6.
- A large-scale observational cohort study found that Paxlovid treatment was associated with reduced risk of Long COVID, all-cause death, and hospitalization in the post-acute phase 3.
- A systematic review and meta-analysis found that Paxlovid significantly reduced the risk of hospitalization, all-cause mortality, hospitalization or death, intensive care unit admission, and emergency department visits compared to the control group 6.
COVID-19 Rebound
- COVID-19 rebound after Paxlovid treatment has been reported, but the incidence is rare 4, 7.
- A case report suggested that proxalutamide might be an effective remedial treatment option for patients experiencing a COVID-19 rebound after Paxlovid treatment 7.
- However, a systematic review and meta-analysis found no significant difference between the Paxlovid and control groups in terms of COVID-19 rebound 6.
Recommendations
- Paxlovid is recommended for the treatment of COVID-19 in patients with mild to moderate disease who are at risk for progression to severe disease 3, 4, 5, 6.
- The treatment should be started within 5 days of symptoms onset and given for 5 days' duration 5.
- Paxlovid can be considered an effective therapeutic agent for treating patients with COVID-19, with a significant reduction in hospitalization, all-cause mortality, and other adverse outcomes 6.