The Use of Paxlovid in COVID-19 Patients

The COVID-19 pandemic has been one of the greatest public health threats over the past 2 years. As of February 2022, there have been over 400 million cases and over 5.9 million deaths worldwide. In attempts to reduce the morbidity and mortality of the pandemic, there have been several antivirals, monoclonal antibody therapies and immunotherapies introduced. However, many of these options do not effectively reduce disease progression or are too expensive.

Pfizer has introduced a new oral, antiviral drug known as Paxlovid to use in COVID-19 patients. The medication is composed of Niramtrelvir and Ritonavir. Nirmatrelvir is a COVID-19 protease inhibitor, essentially meaning that it affects proteins within the virus. The dose regimen is to be continued for 5 successive days in patients with mild to moderate symptoms. Symptoms of COVID may include fever or chills, cough, shortness of breath, fatigue, headache, loss of taste, loss of smell, sore throat, diarrhea or nausea and vomiting. These symptoms may appear between 2-14 days after exposure to the virus. Several studies have been conducted on the efficacy of Paxlovid. Studies performed showed that Paxlovid lowered the risk of severe symptoms and mortality of elderly COVID-19 patients. However, this drug is now being used in younger populations and has a 95% efficacy rate (Debbiny, 2022). A recent study conducted showed that Paxlovid appeared to be more effective in patients who were immunocompromised, elderly and in those that had either cardiovascular or neurological diseases (Debbiny, 2022). Paxlovid has now been approved to be used in pediatric patients over 12 years of age pending risk factor analysis by their respective physicians.

A few recent studies have shown that some patients are having a symptom relapse after completing the 5 day treatment. However, the antiviral reduced the risk of COVID-19 hospitalization by almost 90% in patients who were at risk of severe illness. Therefore, it is imperative for those with COVID-19 to speak with their primary care physicians to determine if Paxlovid is an option for them through risk assessment. A prescription is required to receive this medication and both, patients that are vaccinated and unvaccinated, may receive it.

The CDC recommends vaccinated patients who were exposed to COVID-19 and are not experiencing symptoms to watch for symptoms for at least 10 days after exposure. Individuals should also wear a well fitting mask in public. In patients that have tested positive for COVID-19 and are experiencing symptoms regardless of vaccination, the CDC recommends staying home for at least 5 full days in isolation. After these 5 days are over, patients should still take precautions until day 10 and wear a well fitting mask. Additional CDC resources can be found at: https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html.

References:

Centers for Disease Control and Prevention. (n.d.). Covid-19 quarantine and isolation. Centers for Disease Control and Prevention. Retrieved June 6, 2022, from https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html

Najjar-Debbiny R, Gronich N, Weber G, Khoury J, Amar M, Stein N, Goldstein LH, Saliba W. Effectiveness of Paxlovid in Reducing Severe COVID-19 and Mortality in High Risk Patients. Clin Infect Dis. 2022 Jun 2:ciac443. doi: 10.1093/cid/ciac443. Epub ahead of print. PMID: 35653428.

Radcliffe, S. (2022, May 27). Can covid-19 symptoms come back after using PAXLOVID? what we know. Healthline. Retrieved June 6, 2022, from https://www.healthline.com/health-news/can-covid-19-symptoms-come-back-after-using-paxlovid-what-we-know#Who-is-eligible-for-Paxlovid?