Should You Take Paxlovid for COVID-19?
The much-touted antiviral can help reduce symptoms significantly. But it has limitations.
For people at high risk of severe COVID-19, including seniors and those with chronic health issues, Pfizer’s Paxlovid—a prescription antiviral authorized for emergency use in December 2021—has been a game-changer.
A study by Pfizer showed that Paxlovid cut the risk for hospitalization or death in high-risk unvaccinated people by 88 percent when given within five days of the first symptoms. The effect may be less dramatic among people who are not as high-risk, who are vaccinated, or both, but Paxlovid may still help. One study from Israel that included both vaccinated and unvaccinated high-risk people showed that those who received Paxlovid had an overall 46 percent lower risk of severe COVID-19 or death.
How Paxlovid Works
Paxlovid is actually two drugs: nirmatrelvir and ritonavir. Patients take both drugs in the morning and at night for five days.
Who Should Take It
Paxlovid is authorized for use in people 12 and older who are at high risk of severe COVID-19, including people who are older, are pregnant, or have chronic health issues such as obesity, hypertension, or diabetes. Experts we asked said anyone unvaccinated or not boosted who has a health issue that puts them at risk for severe disease or who is 50 or older is likely to benefit from Paxlovid.
But not everyone who qualifies necessarily needs it, Gallagher says. Early results from a Pfizer trial of 1,153 people didn’t show a significant benefit for unvaccinated people not at high risk or for fully vaccinated people with one risk factor for severe disease. Still, while there’s not yet data showing that boosted people need or benefit from Paxlovid, boosted older adults may be helped by it, according to experts we spoke with.
Ultimately, everyone should discuss the benefits and risks of the treatment with their provider, says Kelly Gebo, MD, a professor at the Johns Hopkins University School of Medicine and co-author of a set of guidelines on treating COVID-19.
Common side effects of Paxlovid include diarrhea, nausea, and an altered sense of taste. Liver problems, such as yellowing of skin and the whites of eyes, and allergic reactions are more rare.
The Paxlovid Rebound Effect
Some people who take Paxlovid report the return of symptoms (or a positive test) after treatment. If this happens to you, isolate and assume you are still contagious. Right now, no one knows exactly why this “rebound effect” is happening or how common it is. But this shouldn’t discourage anyone from using Paxlovid, experts say, because these relapses don’t appear to be leading to hospitalizations. “The drug is designed to keep you from being hospitalized,” Gallagher says. Paxlovid “did its job if you are not admitted.”
Editor’s Note: This article also appeared in the October 2022 issue of Consumer Reports On Health.
