What to know about the COVID-19 antiviral drug Paxlovid

With a 23.37% COVID-19 positivity rate in Jefferson County and infections with the omicron BA.5 subvariant on the rise across the country, some are turning to the antiviral drug Paxlovid.

According to the White House, President Joe Biden, 79, is currently taking Paxlovid after testing positive for COVID-19 on Thursday.

Here’s what you need to know about antiviral drugs:

When was Paxlovid first approved?

The U.S. Food and Drug Administration first authorized the Pfizer-backed prescription drug Paxlovid in December 2021 for emergency use.

Who can take Paxlovid?

U of L Health chief medical officer Dr. Jason Smith said physicians in the system have been prescribing Paxlovid on an outpatient basis since its approval, particularly in patients with mild to moderate symptoms of COVID-19. He said most commercial pharmacies have Paxlovid available.

“He’s still effective,” Smith said. “How effective is it? We haven’t been able to guess some of the newer variants. But it seems to be effective in limiting the progression of the disease and the symptoms you may have.”

A Pfizer study indicated that it reduced hospitalizations and deaths of high-risk patients by almost 90%.

The FDA says people can take Paxlovid if:

  • They have a confirmed case of COVID-19 with mild to moderate symptoms and have one or more risk factors that may indicate the possibility of more severe illness.
  • Be 12 years of age or older and weigh at least 88 pounds.
  • Have no known or suspected severe liver or kidney impairment.
  • Have no history of clinically significant hypersensitivity reaction.

What are the side effects of Paxlovid?

Smith said the treatment is “relatively well tolerated”, with the main side effects being headaches and upset stomach.

“That’s probably true for most medications you’re going to take for COVID,” Smith added.

In rare cases, people will experience “Paxlovid mouth”, a symptom of the drug causing a bitter or metallic aftertaste. In an interview with Healtha Pfizer representative said it was a “mild” and “non-serious” symptom that only lasted as long as people took the drug, which is five days.

Yale Medicine says people should see a doctor if they experience these Paxlovid side effects because they indicate an allergic reaction:

  • Urticaria
  • Difficulty swallowing or breathing
  • Swelling of the mouth, lips or face
  • Throat tightening
  • Hoarseness
  • itchy skin

How does Paxlovid work?

Paxlovid is an antiviral medication made up of two different oral antivirals: nirmatrelvir and ritonavir.

Maryann Amirshahi, a medical toxicologist, wrote for the National Capital Poison Center that nirmatrelvir works to prevent viral replication of COVID-19 while ritonavir temporarily slows the metabolism of the person taking Paxlovid. This is to maintain the right levels of nirmatrelvir in the body. Together they work to reduce the viral load of COVID-19 in the body.

Is it safe to take Paxlovid with my other medications?

It is important to tell the doctor about all medications and supplements you are taking, whether prescribed or over-the-counter. Amirshahi said some can interact negatively with Paxlovid, and your doctor can change your prescriptions to allow you to take the drug. This could mean not taking your usual prescription for a few days or taking a lower dose while taking Paxlovid.

Amirshahi also added that it may cause interactions with “abnormal heart rhythm drugs, psychiatric drugs, blood thinners, gout drugs, chemotherapy drugs, high blood pressure drugs, HIV, cholesterol medications and certain herbal supplements”. Antivirals have also been shown to affect hormonal birth control, so other forms of birth control may be needed while taking the drug.

In some cases, doctors may choose to administer alternative treatments, such as a monoclonal antibody infusion, according to the US Department of Health and Human Services.

How do I get a Paxlovid prescription?

Previously, only physicians, nurse practitioners and physician assistants could prescribe Paxlovid. On July 6, the Food and Drug Administration expanded the authorization to allow state-licensed pharmacists to prescribe it to eligible patients.

In a press release, Patrizia Cavazzoni, director of the FDA’s Center for Drug Evaluation and Research, said, “Because Paxlovid must be taken within five days of the onset of symptoms, allow state-licensed pharmacists prescribing Paxlovid could expand access to prompt treatment for some patients…”

The FDA said that when requesting Paxlovid from a pharmacist, people should bring:

  • Electronic or printed health records that are less than 12 months old, including the most recent lab blood test reports that the state-licensed pharmacist needs to review for kidney or liver problems. State-licensed pharmacists could also receive this information through consultation with the patient’s healthcare provider.
  • A list of all medications they take, including over-the-counter medications, so the state-licensed pharmacist can screen for medications with potentially serious interactions with Paxlovid.

Contact journalist Eleanor McCrary at [email protected] and follow her on Twitter @ellie_mccrary.

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