What is the recommended treatment duration for Paxlovid (nirmatrelvir/ritonavir) in an adult patient with COVID-19?

Paxlovid Treatment Duration for COVID-19

Paxlovid (nirmatrelvir/ritonavir) should be administered for 5 days, with treatment initiated within 5 days of symptom onset. 1

Standard Treatment Course

• The FDA-approved regimen is 300 mg nirmatrelvir (two 150 mg tablets) with 100 mg ritonavir (one 100 mg tablet) taken together orally twice daily for 5 days. 1

• Treatment must be started as soon as possible after COVID-19 diagnosis and within 5 days of symptom onset, even if baseline symptoms are mild. 1

• All three tablets should be taken together twice daily (morning and bedtime) for the full 5-day course. 1

Importance of Completing the Full Course

• Completion of the full 5-day treatment course is critical to maximize viral clearance and minimize SARS-CoV-2 transmission. 1

• If a patient requires hospitalization for severe or critical COVID-19 after starting Paxlovid, they should still complete the full 5-day course per healthcare provider discretion. 1

• The 5-day duration has been consistently used across clinical trials and real-world studies, demonstrating significant reductions in hospitalization (39% relative risk reduction) and death (61% relative risk reduction). 2, 3

Missed Dose Instructions

• If a dose is missed within 8 hours of the usual time, take it as soon as possible and resume the normal schedule. 1

• If a dose is missed by more than 8 hours, skip the missed dose and take the next dose at the regularly scheduled time—do not double the dose. 1

Modified Duration for Renal Impairment

• Patients with severe renal impairment (eGFR <30 mL/min) including those on hemodialysis receive a modified regimen: 300 mg nirmatrelvir with 100 mg ritonavir once on Day 1, then 150 mg nirmatrelvir with 100 mg ritonavir once daily on Days 2-5. 1

• Patients with moderate renal impairment (eGFR 30-60 mL/min) receive 150 mg nirmatrelvir with 100 mg ritonavir twice daily for all 5 days. 1

• On hemodialysis days, Paxlovid should be administered after dialysis. 1

Key Distinction from Other Antivirals

This 5-day timeframe for Paxlovid differs from remdesivir, which uses variable durations (3-10 days depending on disease severity and hospitalization status). 4 Both oral antivirals (Paxlovid and molnupiravir) require the same 5-day treatment window from symptom onset and 5-day treatment duration. 5, 6