Should I take Paxlovid?

This is a common question that has come up with the recent rise in COVID-19 cases.  

Paxlovid, also known as nirmatrelvir and ritonavir, is an antiviral medication used to treat COVID-19. It is typically prescribed for individuals with mild to moderate COVID-19 symptoms who are at high risk of progressing to severe illness. However, the reality is that it is being prescribed for anyone who has COVID-19 and wants to decrease the number of days they are sick.

Paxlovid works by inhibiting the replication of the SARS-CoV-2 virus. It does not get rid of the virus already in your system but does prevent more from being made. It needs to be started within 5 days of the start of symptoms.  The longer you wait to get the medication the less effect it will have on the number of sick days (which is variable with COVID anyway).  If you have had symptoms for 2-3 days and are starting to improve, you may not need the medication.

I believe that it really is best used with individuals who are at a high risk of severe illness.  It helps to decrease the risk by decreasing the amount of virus in their system.

So what is the negative for taking this medication?

The Characteristics Study, which is an ongoing study of individuals with acute COVID-19 infections, looked at patients who took Paxlovid vs those who did not.  They closely tracked viral loads and symptoms, cultured viral samples, and performed whole genome sequencing. In this study, investigators discovered that 20.8% of participants who took Paxlovid experienced virologic rebound, while only 1.8% of those who didn’t take Paxlovid had a similar rebound effect. Those with rebound also had prolonged viral shedding—for an average of 14 days compared to less than 5 days in those who did not experience rebound—indicating they were potentially still contagious for much longer. Importantly, the investigators found no evidence of drug resistance among these patients.

With any medication there are always positives and negatives.  The risk of a viral rebound at 20% is significant.  If your symptoms are mild, perhaps the risk outweighs the benefits.  If you are at risk of severe infection then the benefits may outweigh the risks.

So – if you are considering asking for Paxlovid, talk with your health care provider.  They can assess your specific situation, taking into account factors such as your health status, risk factors, and potential interactions with other medications.

If you have been prescribed Paxlovid it's crucial to follow your healthcare provider's instructions, including the recommended dosage and duration of the treatment. Additionally, discuss any potential side effects or concerns with your healthcare provider.

Keep in mind that information may evolve, and it's advisable to consult healthcare professionals or official health sources for the latest and most accurate information on COVID-19 treatments.