While there is an ongoing need for people to get vaccinated — and boosted — against COVID-19, there are a few medications on the market available that can help keep high-risk patients from getting so sick that they need to be hospitalized.
The medication proven to be the most effective is Paxlovid, an antiviral developed by Pfizer. This was the first oral treatment authorized by the FDA in December 2021 for high risk COVID-19 patients ages 12 and older.
But who should take Paxlovid? How do you get a prescription? And what are the side effects? Here’s what you need to know.
Paxlovid has been shown to be 88% successful in reducing severe illness, reduce hospitalization and death from COVID-19 if taken early on in the course of an infection.
“If you meet criteria, it’s important that you start taking Paxlovid within five days of experiencing symptoms for it to be effective,” says Ghazala Sharieff, MD, MBA, Scripps Health chief medical officer, acute care and clinical excellence. “That means, if your doctor prescribes Paxlovid after a positive COVID-19 test, you should start your prescription as soon as possible. Paxlovid can give you a bad taste but it is important to continue the full course even if you feel better in a few days. This is important to avoid any incomplete effects. The sooner you start taking Paxlovid, the better.”
Paxlovid is prescribed as three pills taken twice a day for five days.
“Patients are still confused about who is eligible for antiviral medication and how these treatments work,” says Dr. Sharieff.
Not everyone who tests positive for COVID-19 will get a prescription for antiviral pills, according to Dr. Sharieff. To be eligible, you must test positive and have symptoms that started within five days or fewer. You must also be at increased risk of developing severe COVID-19.
And while federal guidelines prioritize treatment for those who are unvaccinated or who are not fully vaccinated and boosted, your vaccination status will not affect your eligibility.
Those who are asymptomatic, or who have symptoms but are not higher risk, are not eligible.
“If you’re vaccinated and boosted, young and healthy, you likely won’t need Paxlovid and the virus will clear itself on its own,” says Dr. Sharieff.
First, you must test positive with a PCR or rapid test. This can be done at home, at a regular health care provider’s office or at a testing site.
If you test positive at “Test to Treat” location, you may be eligible to receive antiviral medication on the spot. If you test positive at a different testing site or through an at-home testing kit, you can schedule an online visit with your provider to possibly get a prescription as well.
The most common side effects of Paxlovid are diarrhea, nausea, vomiting and an altered sense of taste. “Ironically, these can also be symptoms of COVID-19. The side effects of Paxlovid can sometimes outweigh the benefits of taking the medication, which is another reason why this medication is prescribed only to those at high risk,” says Dr. Sharieff.
Certain medications or supplements, including painkillers and even St. John’s Wort, may have adverse interactions with Paxlovid. So, you may be advised to hold off on taking them for a week while being treated.
“There are certain medications, such as statins and other cholesterol-lowering drugs, where you need to consult with your physician regarding possible interactions,” says Dr. Sharieff. “But for some medications, like drugs that regulate heart rhythm, Paxlovid is not indicated. In those cases, your doctor may recommend another antiviral medication, such as molnupiravir or monoclonal antibody treatment, for COVID-19 instead.”
There have been reports that COVID-19 patients have improved or even tested negative after taking Paxlovid, only to have symptoms flare up again a few days later. The rebound may occur just four or five days after treatment, although symptoms appear to be milder the second time around.
“There isn’t enough data yet to understand why viral rebound after Paxlovid treatment happens. But I caution patients about discontinuing their medication before completing the entire course of treatment,” says Dr. Sharieff. “It’s important take Paxlovid as prescribed — at the right time, in the right way and the right frequency — in order to get the best results.”
“Prevention is always preferable to treatment, and antiviral medication is not meant to be a substitute for vaccination,” says Dr. Sharieff.
“Even though more breakthrough cases are occurring, this should not dissuade anyone from getting vaccinated or boosted if they haven’t already. Vaccines are still highly effective, and for people who have been infected already, vaccines are proven to give extra protection.”