Paxlovid and Other COVID-19 Treatments
We’ve come a long way since the outbreak of COVID-19 began in early 2020. Not only were vaccines quickly developed, but now we have several treatments for it as well.
COVID-19 treatments for adults
Treatment options for COVID-19 are now readily available for adults. Treatments vary depending on age, severity, and other medical conditions that may increase risk for severe disease. Treatment also differs if the patient is hospitalized or recovering at home.
COVID-19 outpatient treatment and antiviral medications
For individuals with mild cases of COVID-19, be sure to rest and drink plenty of fluids as you would with a cold or flu. For individuals who have more severe symptoms or who are at risk for severe COVID-19, we now have two oral, antiviral medications to treat COVID-19: Paxlovid (nirmatrelvir/ritonavir), which is available for individuals age 12 years and older, and Molnupiravir for individuals age 18 years and older.
A monoclonal antibody treatment is also available for individuals age 12 years and over at risk for developing severe COVID-19. The treatment can be administered either by intravenous route (through an IV) or by intramuscular injection.
You may be at increased risk for severe COVID-19 if you:
- are over age 65
- have other illnesses such as active cancer
- are receiving immunosuppressive treatments or have advanced or untreated HIV infection
Inpatient hospital treatment
Individuals who are hospitalized with more severe cases of COVID-19, may be given an antiviral medication called Remdesivir. It is administered intravenously for five days. In some patients it may be combined with a steroid medication known as Dexamethasone.
Also, individuals who are quite sick with COVID-19 and who may need high amounts of oxygen may be eligible for treatment with powerful anti-inflammatory medications such as Tocilizumab or Baricitinib, which help to improve your lung function.
COVID-19 treatment guidelines are always being updated and adapted for local use at Lifespan hospitals, and prescribers consult with the hospital pharmacists for most appropriate medications and dosing.
COVID-19 treatments for children
Children with any risk factor for developing severe COVID-19 (such as asthma, obesity, immune compromised, cancer, etc.) have several options for COVID-19 treatment.
Children age 12 years and older can receive oral Paxlovid (nirmatrelvir/ritonavir) as an outpatient. Children who are too young for Paxlovid can get Remdesivir as an outpatient, which is given intravenously over three consecutive days. Remdesivir is also available for children hospitalized with COVID-19. Finally, a monoclonal antibody treatment is also available for children age 12 years and older; it is administered intravenously or by intramuscular injection.
When should treatment begin for COVID-19?
COVID-19 treatments are given only in the early phase of COVID-19 illness. The goal of these medications is to reduce the severity of the disease and help individuals avoid hospitalization.
That’s why it’s important to take a COVID-19 test as you soon as you experience symptoms. Paxlovid and Molnupiravir are recommended to be given within the first five days of symptoms and are taken for five days; the monoclonal antibody is recommended to be given within the first week of symptoms.
Side effects of medications to treat COVID-19
Serious side effects must be reported to the FDA and the manufacturer within seven days. Currently there are some documented side effects from COVID-19 medications.
Paxlovid possible side effects include:
- altered sense of taste
- muscle aches
- COVID-19 rebound – a condition that occurs in some individuals a few days after finishing a course of Paxlovid, marked by a recurrence of COVID-19 symptoms with a positive PCR test, with symptoms lasting a few days and less severe than the earlier illness. Serious side effects (and the COVID-19 rebound illness) from the medication must be reported to the FDA and the manufacturer within seven days.
Molnupiravir possible side effects include:
Who should not take these COVID-19 medications?
These medications may not be appropriate for all individuals. You should avoid taking these medications if you:
- have severe kidney or liver disease, it may not be safe for you to take Paxlovid
- have moderately compromised kidneys, you may be prescribed a lower dose of Paxlovid
- are pregnant or breastfeeding, then you should not take Molnupiravir
How do you get the medications for COVID-19?
A prescription is required for medications to treat COVID-19. Contact your doctor if you have tested positive and are experiencing moderate to severe symptoms of COVID-19. Also, a pharmacist can prescribe the medication, if they have all the information they need about you, including other medications you may be taking and if you have known kidney or liver disease.
Get a COVID-19 vaccine and booster
Being vaccinated and getting booster shots will provide you with a lot of protection from COVID-19. Unfortunately, with the new variants spreading some people are still coming down with COVID-19. The likelihood of becoming extremely sick is very low, but you may still want to consider taking the oral medication or the monoclonal antibody.
Learn more on the RI Department of Health website.
About the Author:
Karen Tashima, MD, and Tanya Rogo, MD
Dr. Karen Tashima is an infectious diseases specialist and the director of clinical trials at the Immunology Center at The Miriam Hospital.
Dr. Tanya Rogo is a pediatrician and a pediatric infectious diseases specialist at Hasbro Children's Hospital.
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