Can You Take Paxlovid During Pregnancy?
Key takeaways:
Paxlovid (nirmatrelvir / ritonavir) is an FDA-approved medication for mild-to-moderate COVID-19 in people with a high risk for developing severe illness. Pregnancy is one example of when your risk for severe COVID is higher.
Research suggests Paxlovid is likely safe to take if you’re pregnant. But more studies are needed to confirm this. Experts currently recommend Paxlovid as the preferred treatment for mild-to-moderate COVID during pregnancy.
Your prenatal care team can help you weigh the pros and cons of taking Paxlovid during pregnancy. In many cases, the benefits of taking Paxlovid greatly outweigh the risks.
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There are many circumstances that raise your risk of developing severe COVID-19. Pregnancy is one of these risk factors. It’s highly recommended to take steps to prevent infection, such as staying up to date with your COVID vaccines. But what happens if you get sick with COVID despite your best efforts to avoid it?
Paxlovid (nirmatrelvir / ritonavir) might be an option your healthcare team suggests. A 5-day course of this oral COVID treatment can lower the risk of hospitalization and death for people with one or more risk factors for severe illness. But during pregnancy, it’s common to have extra questions about the safety of your medications.
Research suggests it’s likely safe to take Paxlovid during pregnancy. But everyone’s risks are different. It’s a good idea to follow your prenatal care team’s recommendations.
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What is Paxlovid?
Paxlovid is a first-choice medication for people with mild-to-moderate COVID who have a higher risk for severe illness. It’s a combination product containing the antivirals nirmatrelvir and ritonavir. Paxlovid works best if you start it within 5 days of your first symptoms.
Paxlovid is a prescription-only medication. Some people may be able to get Paxlovid prescribed by a pharmacist at their local pharmacy. But if you’re pregnant, it’s best to contact your prenatal care team to discuss treatment options.
How does Paxlovid work?
The two antivirals in Paxlovid do different things. Nirmatrelvir is a protease inhibitor that works against COVID. It temporarily blocks an enzyme (protein) in your body that the virus uses to make copies of itself. Ritonavir is added to “boost” nirmatrelvir’s antiviral activity. It prevents your liver from breaking down nirmatrelvir too quickly, so it stays in the body longer.
Is it safe to take Paxlovid while pregnant?
Research suggests that it’s likely safe to take Paxlovid during pregnancy. But we need more studies to confirm this.
Pregnant and nursing women were excluded from initial Paxlovid clinical studies. But we have other sources to look at regarding its safety. For example, animal studies of nirmatrelvir found no harmful effects during pregnancy. And available research in humans hasn’t found a link between ritonavir and birth defects.
There have also been real-world studies focusing on Paxlovid’s safety during pregnancy:
A study of nearly 50 women who took Paxlovid during pregnancy found no increased risks of complications during pregnancy or delivery. Participants had higher rates of cesarean deliveries (C-sections) than expected. But researchers couldn’t determine if this was linked to the medication or happened by coincidence. All C-sections were successful.
A study of 30 women who took Paxlovid while pregnant found no elevated risk of complications during pregnancy or delivery. Similar to the above study, participants taking the medication had a higher rate of C-section deliveries. All C-sections were successful.
A study of over 200 women who took Paxlovid during pregnancy found a lower risk for complications during pregnancy and delivery compared with women who didn’t take the medication. This study found a lower rate of C-sections in those who took Paxlovid.
Keep in mind that these studies are small and not randomized controlled trials (the best type of study for determining cause and effect). Ideally, we need larger and more strongly designed studies to confirm Paxlovid’s safety in pregnancy.
What do experts say?
Experts recommend Paxlovid as the preferred treatment for mild-to-moderate COVID during pregnancy. The CDC and American College of Obstetricians and Gynecologists (ACOG) don’t recommend prescribers withhold Paxlovid treatment just because someone is pregnant. They believe the benefits of the medication outweigh the risks in most cases.
What are the risks of taking Paxlovid while pregnant?
To date, researchers haven’t found significant safety concerns. But research is ongoing. There may be risks that aren’t known yet.
Medications to avoid: Several medications are unsafe while you’re pregnant. Here are the top ones to steer clear of.
What it feels like to take Paxlovid: Three people share their experiences with Paxlovid, which can be beneficial for many people at high risk from COVID-19.
Possible side effects: Learn about notable Paxlovid side effects — from headaches to diarrhea — and how to manage them.
Like all medications, Paxlovid can cause side effects. These are generally mild. Possible Paxlovid side effects include:
Diarrhea
Headache
Temporary increase in blood pressure
A change in taste, sometimes called “Paxlovid mouth”
Side effects generally go away after finishing your 5-day treatment. Your prenatal care team might want to keep a closer eye on your blood pressure if it’s been high in the past. And if you have liver or kidney problems, your care team might not want you to take Paxlovid or may give you a lower dose.
You should tell your care team (including a pharmacist) about any medications or supplements you’re taking. They can check for interactions to make sure it’s OK for you to take them together. Many medications aren’t safe to combine with Paxlovid.
What can you take instead of Paxlovid while you’re pregnant?
Paxlovid is the only oral outpatient COVID treatment that’s recommended during pregnancy. Another COVID-19 pill called Lagevrio (molnupiravir) is not safe during pregnancy; it could harm the fetus.
Veklury (remdesivir) is another option for mild-to-moderate COVID during pregnancy. But it’s an IV infusion, so you’d need to go to a healthcare facility to receive it. But Veklury could be an alternative option if you can’t take Paxlovid. There are other safe treatment options if you’re in the hospital for severe COVID.
Over-the-counter (OTC) medications can help relieve bothersome COVID symptoms. But they won’t treat the infection. Certain OTC cold medications are generally safe during pregnancy, but make sure to talk with your care team or pharmacist first:
Some OTC steroid nasal sprays, like Rhinocort (budesonide), are generally considered safe during pregnancy and may help with sinus pressure and stuffy nose.
Most antihistamines, such as Benadryl (diphenhydramine) and Zyrtec (cetirizine), are considered safe during pregnancy. They can help relieve a runny nose and sneezing.
Tylenol (acetaminophen) is ACOG’s preferred medication for pain or fever during pregnancy.
Good to know: Some OTC medications are not recommended during pregnancy. Ibuprofen (Advil, Motrin) and Sudafed (pseudoephedrine) are two examples. Many cold and flu products contain multiple medications. To be safe, always check with your prenatal care team before taking any medication while pregnant.
What are other things you can do to relieve COVID symptoms while you’re pregnant?
Resting and staying well hydrated are always important when you’re sick. Following common cold self-care advice may also help.
Humidify your air. Adding a humidifier in your sleeping space can help keep your nose and throat more comfortable while you’re sick.
Try some tea with honey. Honey may soothe a cough, and warm tea can feel comforting. But choosing a decaffeinated tea is a good idea during pregnancy.
Gargle with salt water. This can help relieve a sore throat. To prepare, mix ½ tsp of table salt in a full glass of warm water.
What are the risks of not treating COVID while pregnant?
Untreated COVID during pregnancy can become severe, potentially leading to hospitalization or death. During pregnancy, your risk for hospitalization and death from COVID is higher than if you weren’t pregnant.
COVID also increases the risk of pregnancy-related complications, including:
Blood clots
Preterm birth (birth before 37 weeks of pregnancy)
Need for intensive care for you and your baby
Low birth weight
Keep in mind that these complications were more commonly seen in those who were very sick with COVID. People with moderate, mild, or no symptoms had a lower risk.
Your prenatal care team can help you understand your COVID risks and whether they recommend treatment with Paxlovid.
Frequently asked questions
Many people start to notice some COVID symptom improvement 1 to 2 days after starting Paxlovid. But it’ll likely take until you finish your 5-day course of medication to feel better. And it’s possible for people to experience lingering symptoms, such as fatigue, for several weeks afterwards.
There are currently no human studies that show whether Paxlovid can affect male or female fertility. But animal studies haven’t found ritonavir (one of Paxlovid’s active ingredients) to negatively affect male fertility. More studies are needed to say whether there’s a connection between the medication and future fertility.
Yes, you can take Benadryl (diphenhydramine) with Paxlovid. There is no known interaction between the two. But keep in mind that COVID often causes fatigue. Benadryl, which commonly causes drowsiness, may make this symptom worse.
The bottom line
Paxlovid (nirmatrelvir / ritonavir) is a first-choice medication for mild-to-moderate COVID-19. Research suggests it’s likely safe to take Paxlovid during pregnancy. But more studies are needed to confirm this.
Experts currently recommend Paxlovid as the preferred treatment for mild-to-moderate COVID during pregnancy. But the medication can cause side effects and has interactions to consider. Your prenatal care team can help you decide if Paxlovid is a good option for you.
COVID itself carries extra risks to know about if you’re pregnant. This includes a greater risk of hospitalization or death. It’s a good idea to ask your care team how to protect yourself and your baby.
Why trust our experts?
References
American College of Obstetricians and Gynecologists. (n.d.). COVID-19 FAQs for obstetrician-gynecologists, obstetrics.
American College of Obstetricians and Gynecologists. (2022). I’m pregnant and have COVID-19. Now what?
Bhimraj, A., et al. (2024). IDSA guidelines on the treatment and management of patients with COVID-19. Infectious Diseases Society of America.
Catlin, N. R., et al. (2022). Reproductive and developmental safety of nirmatrelvir (PF-07321332), an oral SARS-CoV-2 Mpro inhibitor in animal models. Reproductive Toxicology.
Centers for Disease Control and Prevention. (2024). Clinical considerations for special populations.
Centers for Disease Control and Prevention. (2024). How to protect yourself and others.
Centers for Disease Control and Prevention. (2024). Underlying conditions and the higher risk for severe COVID-19.
Chourasia, P., et al. (2023). Paxlovid (nirmatrelvir and ritonavir) use in pregnant and lactating woman: Current evidence and practice guidelines—a scoping review. Vaccines.
ClinicalTrials.gov. (n.d.). Search results for: COVID-19, covid | Other terms: Pregnancy | Paxlovid, nirmatrelvir.
Garneau, W. M., et al. (2022). Analysis of clinical outcomes of pregnant patients treated with nirmatrelvir and ritonavir for acute SARS-CoV-2 infection. JAMA Network Open.
Joyce, R. P., et al. (2022). The history, mechanism, and perspectives of nirmatrelvir (PF-07321332): An orally bioavailable main protease inhibitor used in combination with ritonavir to reduce COVID-19-related hospitalizations. Medicinal Chemistry Research.
Lin, C., et al. (2023). Clinical outcomes of nirmatrelvir-ritonavir use in pregnant women during the Omicron wave of the coronavirus disease 2019 pandemic. Journal of Infection and Public Health.
MotherToBaby. (2024). Nirmatrelvir/Ritonavir (Paxlovid®).
Panel on Treatment of HIV During Pregnancy and Prevention of Perinatal Transmission. (2024). Recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV transmission in the United States: Pharmacoenhancers. ClinicalInfoHIV.gov.
Pfizer Laboratories Div Pfizer Inc. (2024). Paxlovid [package insert].
Smith, E. R., et al. (2023). Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: An individual participant data meta-analysis. BMJ Global Health.
Wong, C. K. H., et al. (2023). Nirmatrelvir / ritonavir use in pregnant women with SARS-CoV-2 omicron infection: A target trial emulation. Nature Medicine.
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