Paxlovid vs. Tamiflu for COVID-19 and Flu: Important Differences and Potential Risks.

Key takeaways

Paxlovid (nirmatrelvir/ritonavir) and Tamiflu (oseltamivir) are both antiviral medications used to treat viral infections, but they target different viruses. Paxlovid is used to treat mild-to-moderate COVID-19 in people at high risk for severe illness, while Tamiflu is used to treat and prevent the flu (types A and B). Paxlovid is a combination of two protease inhibitors, nirmatrelvir and ritonavir, and is taken as three tablets every 12 hours for 5 days. Tamiflu is a neuraminidase inhibitor and is typically taken as one capsule twice daily for 5 days for treatment or once daily for prevention. Paxlovid is FDA-approved for adults and under emergency use authorization for children 12-18 years old, whereas Tamiflu can be used in children as young as 2 weeks old. Common side effects of Paxlovid include changes in taste and diarrhea, while Tamiflu may cause nausea and vomiting. Paxlovid has many drug interactions due to its effect on liver enzymes, whereas Tamiflu has fewer interactions but can affect the nasal spray flu vaccine. Both medications require a prescription, but Tamiflu is available in a lower-cost generic form.

Paxlovid

(nirmatrelvir / ritonavir)

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Tamiflu

(oseltamivir)

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Summary for Paxlovid

Prescription only

Paxlovid (nirmatrelvir / ritonavir) is an antiviral used to treat mild-to-moderate coronavirus SARS-CoV-2 (COVID-19) in people who are at high risk for severe illness. It's taken by mouth twice daily for 5 days. Some common side effects include changes in taste and diarrhea. Paxlovid (nirmatrelvir / ritonavir) can interact with other medications, like blood thinners or certain blood pressure medications, so your healthcare team will review your medication list before you start treatment. This medication is likely safe to take during pregnancy, but more research is needed in this area.

Note: Paxlovid (nirmatrelvir / ritonavir) Paxlovid (nirmatrelvir / ritonavir) is fully FDA-approved to treat COVID-19 in adults. But it's still under emergency use authorization (EUA) for children ages 12-18 years old.

Indications for Paxlovid

Mild-to-moderate COVID-19 in people ages 12 years and older (and weighing over 88 lbs) who are at high risk for severe illness

Pros and Cons for Paxlovid

Pros

Taken by mouth, good for people who are afraid of needles
Can take at home, instead of needing to receive treatment at a facility
Only need to take it for 5 days
Option for children ages 12 years and older

Cons

Need to take it within 5 days of having symptoms from COVID-19
Can't use in people with severe COVID-19 illness, including those who are hospitalized
Has many medication interactions
Won't help your body fight against COVID-19 in the future, since it's not a vaccine

Common Side Effects for Paxlovid

Changes in taste (6%)
Diarrhea (3%)

Warnings for Paxlovid

Serious interactions with other medications
Severe allergic reaction
Liver problems
Risk of resistance to certain HIV medications

Summary for Tamiflu

Prescription only

Tamiflu (oseltamivir) works well to treat the flu, but you have to take your first dose within 48 hours of the start of your flu symptoms. It can also help prevent the flu if you've recently been in close contact with someone who has the flu. Kids as young as 2 weeks old can take Tamiflu (oseltamivir), but keep in mind that the pediatric dosing is different than adult dosing. It's only available with a prescription (not available over the counter), so don't wait to see your provider if you start feeling sick. This medication comes as a brand or generic capsule or fruit-flavored liquid. Tamiflu (oseltamivir) can cause side effects like nausea and vomiting.

Indications for Tamiflu

Flu treatment (flu types A and B) in people 2 weeks of age and older
Flu prevention (flu types A and B) in people 1 year of age and older

Pros and Cons for Tamiflu

Pros

Helps you feel better from the flu about 1 to 2 days sooner than if you didn't take anything
Can also help prevent you from getting the flu
Can be used in children as young as 2 weeks of age and pregnant women
Lower-cost generic version available

Cons

Not a replacement for the annual flu shot
Requires a prescription from your healthcare provider
Only works if you take it within 2 days (48 hours) from when you first felt flu symptoms to treat (or when you were first in contact with someone who has the flu to prevent)