Paxlovid Treatment for COVID-19 Infections

Over the past several weeks Los Angeles County has reported an increase in COVID-19 infection rates, likely as the result of the new highly transmissible variants, BA.4 and BA.5. While infection rates are on the rise, there are now treatment options available. The newest treatment is Paxlovid, an oral medication considered a game-changer because of its effectiveness in lowering the risk of severe COVID-19.

At this time, only people with certain medical conditions or who are at high risk for developing serious disease can be prescribed the drug. People who test positive for COVID-19 and are eligible for Paxlovid should contact their doctor.

Torrance Memorial Physician Network medical director, Dr. Robert Glazer, provides answers to common questions about Paxlovid.

What is Paxlovid?

Paxlovid is a combination of two anti-viral medications, taken over a five-day period. The combination of the two medications interferes with the genetic material within the virus, preventing viral replication and spread through the body. There are different treatments options available for patients with COVID-19, depending on whether the patient is in the hospital or being treated at home.

Is Paxlovid FDA approved?

No, in December 2021 the FDA issued Emergency Use Authorization (EUA) for Paxlovid for eligible patients, meaning the FDA reviewed the studies with this drug and determined that it may be effective, and the benefit outweighs the risks for use in a public health crises/pandemic.

Why did the FDA give Paxlovid an EUA?

Paxlovid was shown to dramatically reduce the risk, by nearly 90%, of hospitalizations and death with a COVID-19 infection. The initial studies that lead to the FDA EAU, were done before effective vaccines were widely available.

What about vaccines? Aren’t these helping to reduce hospitalizations?

Without question, vaccination, with boosters, reduces the risk of hospitalization and death and are a key part in prevention. With the emergence of new variants and higher numbers getting infected despite vaccination, we are not seeing hospitalizations spike like in previous waves. Vaccination remains an important step in mitigating serious illness and Paxlovid is considered the first-line treatment even if someone has been vaccinated or had a previous COVID-19 infection.

Who should take Paxlovid?

The FDA authorized Paxlovid for people ages 12 and older who weigh at least 88 pounds. But in order to qualify for a prescription, you must also have had a positive COVID-19 test result and be at high risk for developing severe COVID-19, hospitalization and death. Here is an excellent link to review the medical conditions that put patients at higher risk: People with Certain Medical Conditions | CDC.

Additionally, the vast majority of Americans have some level of protection, including partial vaccination, full vaccination, full vaccination and one or two boosters, and/or at least one previous exposure to COVID-19. If someone gets COVID-19 without being fully updated on their vaccinations he or she may be at higher risk of progression.

Does Paxlovid interfere with other medications?

There are many common prescriptions that do not have reactions with Paxlovid, but some have potentially significant interactions that may cause serious complications. For medications that should not be stopped, another COVID-19 treatment may be recommended. If you and your doctor are considering Paxlovid, all your current medications will be reviewed.

Are there any side effects from Paxlovid?

Most people who are prescribed Paxlovid will not experience any serious side effects. However, people should stop taking Paxlovid and call their physician if they are experiencing any of the following signs of allergic reaction:

• Hives
• Trouble swallowing or breathing
• Swelling of the mouth, lips or face
• Throat tightness
• Hoarseness
• Skin Rash

Other side effects may include:

• Diarrhea
• Increased in blood pressure
• Muscle aches
• Abdominal pain
• Nausea

Click here to see the FDA’s list of possible side effects

What is the Paxlovid rebound effect?

A small number of patients take Paxlovid, feel better and soon thereafter test negative for COVID-19. Then a few days later they begin to have upper respiratory symptoms, and again test positive. If you take Paxlovid and subsequently have rebound COVID-19, contact your doctor for further advice. Some physicians may recommend an additional Paxlovid treatment course. One thing to note, during the initial clinical studies a small number of patients who took a placebo (sugar pill) reported rebound COVID-19 after testing negative.

So, what should I do if I develop cold or flu-like symptoms or test positive for COVID-19?

If you develop symptoms, get tested immediately. Either perform a home antigen self-test or call your physician or health plan for direction.  

If the COVID-19 test is positive, please contact your physician to schedule a virtual telehealth visit. Your physician will assess your condition and decide the best course of action for you. If at any time you have problems breathing, do not delay getting to the nearest emergency department.