Paxlovid Treatment Course for COVID-19
Paxlovid is administered as 3 tablets taken together twice daily for 5 days, totaling 30 doses over the complete treatment course. 1
Standard Dosing Regimen
The complete 5-day course consists of:
- 300 mg nirmatrelvir (two 150 mg tablets) plus 100 mg ritonavir (one 100 mg tablet) 1
- Taken twice daily (morning and bedtime) 1
- Total of 10 treatment administrations (twice daily × 5 days) 1
- Total of 30 tablets (3 tablets per dose × 10 doses) 1
Critical Timing Requirements
Treatment must be initiated within 5 days of symptom onset to achieve optimal effectiveness in reducing hospitalization and death. 2, 1 The FDA label explicitly states that the 5-day treatment course should be started as soon as possible after COVID-19 diagnosis and within this 5-day window, even if baseline symptoms are mild. 1
Dose Modifications for Renal Impairment
The standard 5-day duration remains the same, but the number of doses changes based on kidney function:
Moderate Renal Impairment (eGFR 30-59 mL/min)
- 150 mg nirmatrelvir with 100 mg ritonavir twice daily for all 5 days 1
- This reduces to 20 total tablets over the course
Severe Renal Impairment (eGFR <30 mL/min, including hemodialysis)
- Day 1: 300 mg nirmatrelvir with 100 mg ritonavir once 1
- Days 2-5: 150 mg nirmatrelvir with 100 mg ritonavir once daily 1
- On hemodialysis days, administer after dialysis 1
- This reduces to 11 total tablets over the course
Administration Details
- Can be taken with or without food 1
- Tablets must be swallowed whole—do not chew, break, or crush 1
- Nirmatrelvir must be co-administered with ritonavir; failure to do so results in insufficient nirmatrelvir levels 1
Missed Dose Management
- If missed by ≤8 hours: Take as soon as possible and resume normal schedule 1
- If missed by >8 hours: Skip the missed dose and take the next dose at the regularly scheduled time 1
- Never double the dose to make up for a missed dose 1
Completion of Full Course
Complete the full 5-day treatment course regardless of symptom improvement to maximize viral clearance and minimize SARS-CoV-2 transmission. 1 Even if a patient requires hospitalization for severe COVID-19 after starting Paxlovid, the healthcare provider should consider completing the full 5-day course. 1
Clinical Effectiveness Context
The 5-day course has demonstrated significant clinical benefit, with an 89% relative risk reduction in progression to severe COVID-19 compared to placebo in clinical trials. 3 Real-world data confirms a 39% reduction in hospitalization risk and 61% reduction in death risk, with benefits observed even in vaccinated patients and particularly among those aged 65+ years. 4