Who is it recommended for?
If you test positive for COVID-19 and have symptoms, are over the age of 12, and — most importantly — you are at high risk for severe illness, Paxlovid will significantly reduce the chances of hospitalization or death. The CDC has a broad list of underlying health conditions that would make you eligible, including cancer, diabetes, heart conditions, chronic diseases, and obesity. But it is not yet approved for everyone.
How can you get a prescription?
The best way to get Paxlovid is to ask your healthcare provider. It is available by prescription only and, for now, is free of charge through government programs. It’s best to start taking it as soon as possible after testing positive for COVID-19 and within five days of having symptoms. Paxlovid does have interactions with other medications, so a healthcare provider should review your medical history before prescribing it.
Are there medications that should not be taken with Paxlovid?
Unfortunately, drug interaction is a real problem because Paxlovid impacts liver function. The list of drugs spans almost every category — from cardiac medications to HIV antivirals to statins and blood thinners. It is therefore important to get a prescription under the guidance of a healthcare provider and weigh the risks versus the benefits.
What is “Paxlovid rebound,” and are there other side effects?
Some patients report having a metallic taste in the mouth. This also happens with other medications, and it stops shortly after stopping the Paxlovid.
More notable is the Paxlovid “rebound” that has been widely reported on but is rare. The rebound phenomenon is when there is a recurrence of COVID-19 after taking Paxlovid and recovering from the illness. We are still learning how many COVID-19 cases are a result of a Paxlovid rebound, but the good news is, there are no reports of rebound infections causing severe disease. A new study also found that COVID “rebound” was only seen in 1% of patients who took oral antivirals and was not associated with an increased risk of mortality. So the rebound phenomenon is not a reason to avoid taking Paxlovid, especially if you have risk factors for severe illness.
Can you take Paxlovid more than once?
Yes, if you are eligible and high risk, I recommend Paxlovid if you have a reinfection from a new variant.
Does Paxlovid prevent long COVID?
A lot of patients in my long COVID clinic are asking about Paxlovid. A new, large study, published as a preprint before peer review, followed 56,340 patients and showed encouraging results: The 9,217 patients who took oral antivirals within five days of testing positive were 26% less likely to report post-COVID symptoms 90 days after infection, compared with 47,123 patients who did not take it.
In my clinic, I have also treated many long COVID patients with Paxlovid who had a reinfection, and none of these patients had a relapse of long COVID or worsening of their symptoms.
But we are just beginning to understand what causes long COVID and how Paxlovid may help. One hypothesis for long COVID is that small amounts of the virus may be lingering in the body. Another is that the virus causes an overactivation of the immune system, resulting in inflammation that the body is unable to reverse or stabilize. In both of these cases, you could imagine it would be beneficial to decrease the virus in the body early on — which is what Paxlovid does. I am looking forward to more studies on this treatment in the near future.