Paxlovid as a COVID-19 Treatment: What You Should Know

Prescriptions for Pfizer’s COVID-19 antiviral medication Paxlovid—the first such pill to be authorized by the U.S. Food and Drug Administration (FDA)—have increased tenfold in the past two months. Albert Bourla from Pfizer CEO said that between late February and April 22 the number of Paxlovid patients increased by tenfold. Now, Paxlovid is available in 33,000 places across the country, including outpatient clinics and pharmacies.

The White House declared that it will intensify its efforts to get more physicians to prescribe antiviral medication. Biden Administration also announced that Paxlovid will soon be made available to pharmacies. It expects that the total number of Paxlovid-dispensing sites in the United States will increase to around 40,000. “The bottom line is that we want to make this therapeutic available to all Americans,” Dr. Ashish Jha, the White House COVID-19 response coordinator, told CNN.

With COVID-19 cases increasing again in the U.S. and Paxlovid becoming more widely available, it’s useful to understand a bit more about the drug, its efficacy, and who can get it.

How does Paxlovid work?

Paxlovid consists of two medicines: nirmatrelvir which prevents the SARS-2 protein from reproducing, and ritonavir which can be used as an HIV/AIDS treatment. It is designed to slow down the rate at which antivirals like nirmatrelvir are broken down so that your body can continue fighting the infection. Paxlovid patients are prescribed three to five pills per day, which is equal to 30 pills.

What is the effectiveness of Paxlovid in treating COVID-19

Studies have shown that Paxlovid should not be given more than five days from the onset of symptoms. People most susceptible to severe COVID-19 effects have seen their risk of hospitalization and serious illness drop by 89% if they take the pill within that timeframe. These data are based upon a Pfizer clinical study that was conducted in the second half 2021 with unvaccinated adults. Now, the company is in the middle a clinical trial to assess the safety and effectiveness of Paxlovid among children and teens aged between 6 and 17.

Pfizer believes that Paxlovid works against this variant, even though the clinical trials were conducted before Omicron became popular. The March 2013 study in the journal published lab results. New England Journal of MedicineIt was also discovered that Paxlovid’s main ingredients were very effective in fighting the Omicron subvariant BA.

Paxlovid “remains highly effective and is mainly well tolerated,” with the different variants, Dr. Zenobia Brown, medical director and vice president of population health care management at Northwell Health, told TIME. “However, we may be facing a situation where a longer course is warranted for some patients, especially those who receive the drug very early in their disease course and/or are immunocompromised.”

Dr. Paul Sax, professor of medicine at Brigham and Women’s Hospital and Harvard Medical School, adds that “the most important new information is that some people will experience a relapse of COVID symptoms a few days after stopping treatment. People who have this relapse should consider themselves potentially contagious to others, especially if they test positive again on an antigen test.”

How do you obtain Paxlovid

Paxlovid can be used by people aged 12 to 88 who have tested positive for COVID-19. They are considered at risk for severe illnesses. These include people who are over 65, or have any other underlying medical conditions like cancer or diabetes.

However, some experts are insisting that doctors prescribe the medication even before those who become positive for COVID-19 experience symptoms. “Because initially we had a shortage of drug supply, people got the message we should be very reserved and only use it for the very higher source people when they get sick,” FDA Commissioner Robert M. Califf told SiriusXM’s Doctor Radio Reports host Dr. Marc Siegel on May 6. “But in fact, what we want to do is to use it before they get sick—and people who are significantly at risk, older age or multiple comorbidities, for sure we want to treat those people early.”

“A problem that we’re seeing is people come in or get diagnosed, they’re feeling okay, but they’re high risk,” he continued. “And if you wait until they get sick, it’s too late. You want to prevent them from getting sick.”

Meanwhile, preliminary data suggests that Paxlovid may also protect people who aren’t considered high-risk, potentially bolstering the argument for the drug to be given to the wider population. Analysis based on an ongoing Pfizer trial found participants with COVID-19 who were given Paxlovid were 70% less likely to be hospitalized than those who weren’t given the drug.

What side effects are there for Paxlovid®?

You should be aware of the following side effects. One is dysgeusia, which negatively affects your sense of taste; it’s a side effect also listed for other drugs like antibiotics, chemotherapeutics, and antihistamines. Over 5% of the participants in Pfizer’s clinical trial experienced this side effect.

While each person’s experience can vary, many people who get this describe it as having a bitter or metallic taste in their mouths. “It tastes terrible—but not terrible enough to make most people stop therapy,” says Sax.

Another common side effect is diarrhea. “These side effects are relatively minor, and the drug is well tolerated by most,” says Brown. “The larger issue with Paxlovid, and why many providers are reluctant to use it, is that the drug is metabolized by the same enzymes that metabolize many common medications. In some instances, those interactions can increase or decrease drug levels dangerously or reduce the amount of drug and efficacy of the Paxlovid.” For example, she points out that “patients who are on hormonal contraceptives are asked to use a backup method.”

Ritonavir may also cause liver damage. Patients with liver disease, pre-existing conditions, liver enzyme abnormalities or hepatitis should consult their physician before they start taking Ritonavir. Paxlovid should not be used by patients suffering from severe kidney damage. Patients who have moderate to severe renal problems may require an alternative dosage.

Both active ingredients in Paxlovid may also interact with other medications—such as immunosuppressants for organ transplant recipients and blood thinners—so the FDA advises people to first talk to their doctor about any medications they are taking.

Paxlovid – Can Paxlovid Help with Long COVID

There isn’t much data on this yet. So far, two patients with Long COVID—one of whom was a researcher who tested it on herself—saw their symptoms lessen or go away after taking Paxlovid. One patient reported their severe fatigue and acute symptoms disappearing after just 48 hours.

Anecdotally, “it would appear that some of the factors that impact Long COVID and Paxlovid are the timing of the delivery as well as the likelihood of developing Long COVID based on previous vaccination and booster,” Brown explains. “In some cases, taking Paxlovid too soon after symptoms onset might not be protective. There are a few cases of rebound that may become Long COVID. This is because the rebound patients have more inflammation than the original cases. On the other hand, some studies would suggest a Long COVID benefit.” Much more research is needed.

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