Paxlovid vs. Tamiflu: 8 Differences Between These Antiviral Medications
Key takeaways:
Paxlovid (nirmatrelvir / ritonavir) and Tamiflu (oseltamivir) are both antivirals. Paxlovid treats mild-to-moderate COVID-19 in people age 12 and older. Tamiflu treats the flu (influenza) in adults and children as young as 14 days old (2 weeks).
Tamiflu can also help prevent the flu in people 1 year or older if they’re exposed to someone with the flu. But Paxlovid can’t prevent you from getting sick with COVID after an exposure.
Paxlovid interacts with many other medications, while Tamiflu doesn’t have many drug interactions. The two medications can be safely taken together if needed.
Access savings on related medications
Table of contents
Winter brings blankets, cozy sweaters — and an uptick in illness. Two illnesses that get a lot of attention in the winter are COVID-19 and the flu (influenza). Thankfully, there are treatments available to help tackle these bugs.
If you’ve been sick with either (or both) of these, the medication names Paxlovid (nirmatrelvir / ritonavir) and Tamiflu (oseltamivir) probably ring a bell. That’s because they’re both first-choice medications for the illnesses they treat.
Though they’re sometimes confused with one another, Paxlovid and Tamiflu are not the same thing. Below, we cover eight notable differences between the two.
Search and compare options
Paxlovid vs. Tamiflu at a glance
When comparing medications, having all the details side by side can be helpful. Below is some helpful information to keep in mind when comparing Paxlovid versus Tamiflu.
1. Paxlovid and Tamiflu treat different illnesses
One of the main differences when comparing Paxlovid versus Tamiflu is which illnesses they treat. Paxlovid treats mild-to-moderate COVID. Tamiflu treats seasonal influenza.
The medications can’t treat any other illnesses. So, Paxlovid won’t help if you have the flu. And Tamiflu doesn’t help if you’re sick with COVID.
What’s more, not everyone needs to take Paxlovid when they’re sick. It’s recommended for people who have a higher risk of developing severe illness from COVID. This includes older adults, people with weakened immune systems, and people who have certain chronic health conditions.
In clinical trials, Paxlovid didn’t provide significant benefits for people without these risk factors. And Paxlovid isn’t recommended if you’re currently in the hospital with severe COVID.
On the flip side, Tamiflu can help people with or without risk factors for severe illness. But it’s most beneficial for people who are more likely to get very sick with the flu. And unlike Paxlovid, Tamiflu is recommended if you’re hospitalized with severe flu symptoms.
2. Tamiflu can also be taken for prevention
Another difference between Paxlovid and Tamiflu is whether they can help prevent illness.
Tamiflu can help prevent you from getting sick with the flu after you’ve been exposed to it. For example, if someone you live with has the flu, your healthcare team may prescribe you Tamiflu. But Tamiflu is only recommended for prevention if you have a greater risk for developing severe illness. Getting your annual flu vaccine is the best way to help prevent the flu and its complications.
Paxlovid doesn’t prevent COVID. Clinical trials found that it wasn’t helpful for this use. Currently, there are no medications that can help prevent you from getting sick with COVID after you’ve been exposed to it. But staying up-to-date with your COVID vaccine can help prevent illness and reduce the severity of symptoms if you do get sick.
3. Paxlovid and Tamiflu work differently
Paxlovid and Tamiflu are both antivirals, but they work differently.
COVID-19 vs. the flu: Physicians weigh in on how to tell the difference between these viral respiratory infections.
How taking Paxlovid might feel: Three people share their experiences with Paxlovid, which can be beneficial for many people at high risk from COVID.
What is it like to take Tamiflu? Read three people’s experiences with this flu medication.
Paxlovid is a combination of two antiviral medications: nirmatrelvir and ritonavir. These are both types of protease inhibitors. Nirmatrelvir temporarily blocks a protein in your body that the virus that causes COVID uses to make copies of itself. Ritonavir stops your body from breaking down nirmatrelvir too quickly. This allows nirmatrelvir to keep fighting the virus for longer.
Tamiflu is a type of antiviral called a neuraminidase inhibitor. Unlike Paxlovid, it only contains one medication: oseltamivir. Tamiflu blocks a protein inside the flu virus that stops it from spreading to other cells in your body.
4. Paxlovid and Tamiflu are approved for different age ranges
Paxlovid and Tamiflu have been studied and approved for different age ranges.
Paxlovid is FDA approved for adults with mild-to-moderate COVID symptoms who have a high risk for developing severe symptoms. It’s also FDA authorized for high-risk adolescents age 12 and older who weigh at least 88 lbs (40 kg).
Tamiflu is FDA approved to treat the flu in adults and children who are at least 14 days (2 weeks) old. It’s also approved for flu prevention in adults and children who are 1 year or older.
Good to know: Tamiflu is the flu treatment of choice if you’re pregnant. It’s been extensively studied and shown to be safe during pregnancy. Paxlovid hasn’t been as well studied, but current studies suggest it’s likely safe during pregnancy. Experts recommend healthcare professionals offer Paxlovid to those who are pregnant if they otherwise qualify for the medication.
5. Paxlovid should be started within 5 days, but Tamiflu should be started within 2 days
Starting Paxlovid or Tamiflu as soon as possible is key when it comes to a quick recovery. But the recommended time frames for starting them are different.
You should start taking Paxlovid within 5 days of first feeling symptoms or getting a positive COVID test result. But you should start Tamiflu within 2 days of developing flu symptoms or exposure to the flu.
These are the time frames recommended by the manufacturers. But your healthcare team may still decide to prescribe these medications for you if it’s been longer than recommended. So if you think you may have COVID or the flu, contact your healthcare team, even if it’s past the suggested time frames.
6. Pharmacists can prescribe Paxlovid
You’re likely used to receiving your prescriptions for medications from a physician, nurse practitioner, or physician’s associate. But in some cases, a pharmacist can prescribe Paxlovid.
However, there are some requirements in order for a pharmacist to prescribe Paxlovid:
They must have access to your full medication history, including over-the-counter (OTC) medications and supplements.
They must have a copy of your health records, which must be less than a year old (paper and electronic copies are both acceptable).
They must have a copy of your current liver and kidney function test results, which must be less than a year old.
If you have this information available, getting pharmacist-prescribed Paxlovid may help you get started with treatment quicker. But if you don't have access to it, or your information is outdated, it may be better to contact your primary care provider’s office.
In most states, only a licensed prescriber can write Tamiflu prescriptions. These prescribers include physicians, nurse practitioners, or physician associates. But some pharmacies have these types of healthcare professionals in the same building, such as with CVS MinuteClinics. These retail health clinics can help you get a prescription for Tamiflu faster.
7. Paxlovid and Tamiflu have different side effects
Paxlovid and Tamiflu are generally well tolerated. But they can both cause side effects. These are typically mild and should wear off after you finish taking the medication.
Common Paxlovid side effects include:
A bad or metallic taste (“Paxlovid mouth”)
Diarrhea
Mild increase in blood pressure
Headache
Common Tamiflu side effects include:
Nausea
Vomiting (more common in children)
Diarrhea (more common in infants)
Headache
Serious side effects are very rare with both Paxlovid and Tamiflu. There’s a potential risk of liver damage with Paxlovid. And Tamiflu is linked to serious skin reactions. Discuss your personal risks for these serious side effects with your healthcare team.
8. Paxlovid and Tamiflu have different interactions
Paxlovid and Tamiflu also have different medication interactions.
Paxlovid interacts with many other medications. In some cases, you may need to stop taking one of your regular medications for a few days while you’re taking Paxlovid. In other cases, you may need to avoid Paxlovid completely.
Examples of severe Paxlovid interactions include:
Statin cholesterol medications, such as simvastatin (Zocor)
Carbamazepine (Tegretol, Equetro)
Phenytoin (Dialtanin, Phenytek)
Amiodarone (Pacerone)
Clopidogrel (Plavix)
Lurasidone (Latuda)
St. John’s wort
This isn’t a complete list of all Paxlovid interactions. Make sure your pharmacist and other healthcare professionals have a complete list of the medications you take. Include all OTC medications, vitamins, and supplements. This will help them determine if you can safely take Paxlovid with your other medications.
Tamiflu only has one known interaction. If you recently received the nasal flu vaccine (FluMist), you may need to repeat the vaccine after finishing Tamiflu. Other than that, Tamiflu can be safely combined with other prescription and OTC medications.
Can you take Tamiflu and Paxlovid together?
Yes, you can take Tamiflu and Paxlovid together. Despite the large number of possible Paxlovid interactions, Tamiflu isn’t one of them. So if you’re sick with COVID and the flu at the same time, you may be prescribed both medications.
The bottom line
Paxlovid (nirmatrelvir / ritonavir) and Tamiflu (oseltamivir) are both antivirals. But they’re not the same.
Paxlovid treats mild-to-moderate COVID-19. It’s approved for adults and authorized for adolescents age 12 and older who have a high risk of developing severe symptoms. Tamiflu treats the flu (influenza) in adults and children as young as 14 days (2 weeks) old. Adults and children at least 1 year old can also take Tamiflu to prevent the flu after exposure. Paxlovid isn’t approved to prevent COVID infection.
You should start taking Paxlovid within 5 days of developing COVID symptoms, and your pharmacist may be able to prescribe it for you. You should start taking Tamiflu within 2 days of feeling flu symptoms, but you may need to see a physician (or other similar healthcare professional) to get a prescription for it.
Tamiflu doesn’t have many drug interactions. Paxlovid interacts with a number of other medications. But you can take Paxlovid and Tamiflu at the same time if needed.
Why trust our experts?
References
American College of Obstetricians and Gynecologists. (2024). Influenza in pregnancy: Prevention and treatment.
Bhimraj, A., et al. (2024). IDSA guidelines on the treatment and management of patients with COVID-19. Infectious Diseases Society of America.
Centers for Disease Control and Prevention. (2023). Influenza antiviral medications: Summary for clinicians.
Centers for Disease Control and Prevention. (2024). Treating flu with antiviral drugs.
Centers for Disease Control and Prevention. (2024). Underlying conditions and the higher risk for severe COVID-19.
Epic Pharma. (2024). Oseltamivir phosphate capsule [package insert]. DailyMed.
National Alliance of State Pharmacy Associations. (2022). Pharmacist prescribing: ‘Test and treat.’
Pfizer. (2022). Pfizer reports additional data on Paxlovid supporting upcoming new drug application submission to U.S. FDA.
Pfizer. (2022). Pfizer shares top-line results from phase 2/3 EPIC-PEP study of Paxlovid for post-exposure prophylactic use.
Pfizer. (2024). Fact sheet for healthcare providers: Emergency use authorization for Paxlovid. U.S. Food and Drug Administration.
Pfizer Laboratories, division of Pfizer. (2023). Paxlovid- nirmatrelvir and ritonavir [package insert].
Sur, M., et al. (2024). Oseltamivir. StatPearls.
Was this page helpful?
Related Articles
Browse medications
View AllResearch prescriptions and over-the-counter medications from A to Z, compare drug prices, and start saving.