Can Anyone Take Paxlovid for Covid? Doctors Explain.

The antiviral drug can protect some groups from getting severely ill with Covid. Here’s what you should know about it.

WHEN YOU HAVE COVID and aren’t feeling well, you may worry about your symptoms getting worse and that you might end up in the hospital. One option that you have to potentially keep that from happening is taking the medication Paxlovid.

Paxlovid is an antiviral that can treat mild to moderate Covid cases for people who are at high risk for severe disease, including hospitalizations or death, according to the U.S. Food and Drug Administration. The FDA granted it full approval in May 2023.

While Paxlovid is important for treating Covid, doctors say it’s not used as much as it should be. A national poll by the Covid States Project published in August found that just 11 percent of people who reported a Covid infection between May and July were prescribed Paxlovid.

“There’s a fair amount of confusion” about who’s eligible for a Paxlovid prescription, says Louis Papa, M.D., a primary care physician and professor at the University of Rochester Medical Center. “There are clearly groups that benefit from it more.”

The FDA says anyone at a high risk for developing severe Covid qualifies for Paxlovid. That includes people over 50 or anyone over age 12 with an underlying health condition, such as cancer, obesity, diabetes, or people who might be immunocompromised.

“Those individuals tend to be at the highest risk, and they probably get the most bang out of that buck,” Dr. Papa says.

But some docs say the parameters are unnecessarily strict, and it’s causing confusion in the medical community about when to prescribe Paxlovid. Sometimes, patients who are denied the drug should seek a second opinion if they feel they need it, he added.

To clear up some of the confusion about Paxlovid, doctors explain who should and shouldn’t take the medication, when it’s most effective, and other things to know.

Who’s eligible for Paxlovid?

If you test positive for Covid, have had mild to moderate symptoms for five days or less, and are in a high-risk group for developing severe illness, you’re eligible to get Paxlovid, says Shivanjali Shankaran, M.D., an infectious disease specialist at RUSH in Chicago.

High-risk groups include people over 50 or individuals with a chronic condition affecting the heart, lungs, kidney, or liver, or who are immunocompromised, she says.

“If you meet the criteria, you should get it,” Dr. Shankaran says. But, she adds, some doctors are reluctant to prescribe the medication, mainly because it can interact with certain other drugs, including statins, blood thinners, immunosuppressants, and antidepressants. So, disclosing anything you take and your health conditions is crucial.

How effective is Paxlovid?

Original Paxlovid research was done on unvaccinated people, Dr. Papa says. Clinical trials showed that Paxlovid decreased the risk of hospitalization or death for the unvaccinated by 89 percent. Other studies have shown it is about as effective for people who are vaccinated.

There’s evidence that Paxlovid could also reduce your viral shedding “to some degree,” Dr. Papa said. But, it’s important to still isolate from others when you test positive for Covid.

“The most it will do is reduce your risk of hospitalization, and if you’re a healthy person, your risk is so low that the benefit may not be there,” he explained.

Paxlovid might also reduce your risk for long Covid, research suggests.

When should you take Paxlovid?

Paxlovid should be taken as soon as possible during your Covid infection, Dr. Shankaran says. “It must be taken within five days of the onset of symptoms because that’s when the virus is replicating.”

While “it’s ideal to start within five days,” Vin Gupta, M.D., a pulmonologist and chief medical officer at Amazon Pharmacy, says some doctors may prescribe the medication on the sixth or seventh day after symptoms start if the patient is medically at high risk.

How is Paxlovid prescribed?

A Paxlovid prescription involves two medications: nirmatrelvir and ritonavir.

Nirmatrelvir works by preventing an enzyme in the Covid virus from replicating in your body, Dr. Papa says. “The problem is that particular drug is broken down pretty quickly by the body.”

So it’s combined with ritonavir, a medication that helps slow the metabolism of nirmatrelvir so that it can work longer and help you fight the infection.

A Paxlovid dosage involves taking three pills (two nirmatrelvir and one ritonavir) twice a day for five days, Dr. Papa says.

“The sooner you can get started on it, the better,” he explains, but at least within five days of when symptoms start.

Paxlovid Side Effects

The most common side effect of Paxlovid is an altered sense of taste, according to the FDA. The medication also has an unpleasant, metallic taste, Dr. Gupta says.

“Some people find taking the pills with something with a strong taste, like cinnamon gum, can help,” Dr. Shankaran adds.

Other side effects can include diarrhea, vomiting, headache, high blood pressure, and just feeling unwell, according to the FDA.

“In every case I’ve seen, the side effects are never severe enough to prevent somebody taking the next dose,” Dr. Gupta says.

Some studies have shown that people can experience a Covid rebound after they finish taking Paxlovid. But the rebound rate is comparable between people who took Paxlovid and those who didn’t. Rebound symptoms are also seen with other illnesses, like the flu, and they’re typically milder than the original infection, Dr. Shankaran says.

Who shouldn’t take Paxlovid?

Paxlovid can interact with several other drugs, including blood thinners, immunosuppressants, antidepressants, statins, some heart medications, HIV drugs, and medications for organ transplant patients, according to the FDA.

So before taking Paxlovid, tell your doctor about all the medications you take, Dr. Shankaran says.

If you have kidney or liver problems or HIV, Paxlovid might not be recommended for you. But, you may be able to take other antiviral medications for Covid, Dr. Shankaran says.

How to Get Paxlovid

Talk to your doctor about taking Paxlovid whenever you test positive for Covid, have symptoms, and fall into a high-risk group for a severe illness, Dr. Papa says. Pharmacists can also provide Paxlovid in some cases.

Paxlovid should be started as soon as possible after symptoms start, so early testing for Covid is key, Dr. Shankaran says.

The risk of taking the medication is low for most patients, and it can keep you from severe illness and hospitalization, Dr. Papa says. “This drug is readily available out there if you do get Covid.”

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