Nirmatrelvir/Ritonavir (Paxlovid)

Paxlovid is an antiviral pill for the treatment of COVID-19. 

It has been found to reduce the risk of hospitalization and death by 89% and is effective against the omicron variant.

Paxlovid is a three-dose antiviral treatment composed of two medications.

Dosed twice daily for five days.

It has been recommended for treating mild to moderate Covid-19 inpatients at higher risk for progression to severe COVID-19 and who are within five days of symptomatic onset.

Nirmatrelviris an oral inhibitor of Covid-19 chymotrypsin like cysteine protease enzyme.

Nirmatrelvir, is a drug that stops the virus from reproducing. 

Nirmatrelvir alone significantly lowered the rates of hospitalization and death due to Covid-19 among patients 65 years of age or older but had no benefit in younger adults.

Ritonavir, a medication boosts the levels of antiviral drugs.

Patients must take 30 pills over a five-day period. 

Paxlovid must be started within five days of symptoms.

Paxlovid is for individuals aged 12 years and older, and must also have a positive COVID-19 test and proof they are in a high-risk category: 65 or older, or have underlying medical conditions, such as cancer or diabetes. 

Pregnancy category-Not recommended.

Not recommended for patients with severe kidney disease.

Breastfeeding should be interrupted during treatment.

Routes of administration-oral

It is not authorized for the pre-exposure or post-exposure prevention of COVID-19 or for initiation of treatment in those requiring hospitalization due to severe or critical COVID-19.

If administered within five days of symptom onset, the efficacy of the co-packaged medication against hospitalization or death in unvaccinated adults is about 88%.

A clinical trial found that about 2% of patients experience a rebound after treatment ends. 

The drug does not prevent infection in people who live with an infected person.

Side effects: 

Co-administration with certain drugs may have serious effects and may sometimes be fatal.

Contraindicated in those with hypersensitivity to the two main components, with severely reduced kidney or liver function, co-administered with certain drugs, such as those dependent on CYP3A for removal for which a raised concentration results in serious reactions, or those with potent CYP3A inducers for which reduced blood concentration of the two main components may result in loss of effect against the virus and possible resistance, among others. 

Adverse events: dysgeusia (4.8%–6%), diarrhea (3%–3.9%), vomiting (1.3%), hypertension (1%), and myalgia (1%).

Authorization for nirmatrelvir/ritonavir are from EPIC-HR, a randomized, double-blind, placebo-controlled clinical trial studying nirmatrelvir/ritonavir for the treatment of non-hospitalized symptomatic adults with a laboratory confirmed diagnosis of SARS-CoV-2 infection.

Nirmatrelvir/ritonavir significantly reduced the proportion of people with COVID-19 related hospitalization or death from any cause by 88% compared to placebo among participants treated within five days of symptom onset and who did not receive COVID-19 therapeutic monoclonal antibody treatment.

Among these participants, 0.8% who received nirmatrelvir/ritonavir were hospitalized or died during 28 days of follow-up compared to 6% of the participants who received placebo.

The efficacy of the co-packaged medication against hospitalization or death in adults when administered within five days of symptom onset is about 88%.

Participants given Paxlovid were 89% less likely to develop severe illness or die compared to participants who received the placebo.

The drug works against the highly contagious variant omicron.

Common side effects: impaired sense of taste, diarrhea, increased blood pressure and muscle aches, which are typically mild.

Paxlovid can decrease the metabolism of blood thinners.

Among 1288 patients who received at least one dose of Nirmatrelvir/Ritonavir (Paxlovid)  or placebo, time to sustained alleviation of all signs and symptoms of Covid – 19, did not differ significantly between participants who receivedNirmatrelvir/Ritonavir (Paxlovid) and those who receive placebo (Hammond JF).


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