Key takeaways:
Paxlovid (nirmatrelvir / ritonavir) is an antiviral medication that’s FDA approved to treat mild to moderate COVID-19 in certain people. A bad taste in the mouth is Paxlovid’s most commonly reported side effect.
Paxlovid’s bad aftertaste has been informally called “Paxlovid mouth.” It’s a harmless side effect that should go away after you finish the medication.
Some people find that chewing gum or sucking on ice helps to manage Paxlovid mouth. If this side effect causes you to throw up shortly after a dose, contact a healthcare professional for next steps.
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All medications have possible side effects. Drowsiness, diarrhea, and vomiting are a few side effects you might come across on drug labels frequently. But some medications can lead to more unique side effects. One that stands out is dysgeusia — a bad or altered sense of taste.
There’s actually a lot of medications that list taste changes as a possible side effect. And Paxlovid (nirmatrelvir / ritonavir) is one of them. With Paxlovid, a bad taste in the mouth is the most commonly reported side effect. It’s so common that people call it “Paxlovid mouth.”
But why does Paxlovid cause a bad aftertaste? And how do you get rid of it?
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What is Paxlovid?
Paxlovid is a combination of two antiviral medications: nirmatrelvir and ritonavir. It’s FDA approved to treat mild to moderate COVID-19 in adults at high risk of developing severe illness. It’s also authorized for children ages 12 and older who weigh at least 88 lbs (40 kg).
The typical dosage of Paxlovid is 300 mg (2 tablets) of nirmatrelvir and 100 mg (1 tablet) of ritonavir by mouth every 12 hours for 5 days. For it to be most effective, you should start the medication within 5 days of first experiencing COVID symptoms.
What causes Paxlovid’s bad taste?
The bad taste that Paxlovid leaves in your mouth is likely caused by the ritonavir in the medication. Taste changes are a common side effect of ritonavir. About 16% of people taking this medication in clinical trials reported it. So, it’s likely what’s driving the bad taste that Paxlovid can cause.
Why does Paxlovid leave a bad taste in the mouth?
Experts aren’t fully sure why some medications, including Paxlovid, can leave a bad taste in the mouth. But they have some possible explanations.
Researchers have known for over 20 years that ritonavir causes a bitter or metallic taste. This side effect seems more common in people who have higher amounts of this medication in their saliva. In other words, the more medication present in your saliva, the more likely it is that your taste buds will detect it.
The other possible explanation for Paxlovid mouth is dry mouth. Studies suggest that taste changes caused by medications tend to happen when your mouth is dry. While dry mouth isn’t a listed side effect of Paxlovid, it’s a symptom that many people experience. And many other commonly used medications also cause dry mouth.
What are the other side effects of taking Paxlovid?
Paxlovid’s side effects are generally mild. Besides taste changes, you may experience diarrhea, headaches, or raised blood pressure. These should resolve once you finish the medication.
A more serious Paxlovid side effect to be aware of is liver damage. This complication wasn’t seen in Paxlovid’s clinical trials. But it’s a listed warning for ritonavir. Liver damage may be more likely to happen if you have existing liver problems. Because of this, it’s recommended that people with severe liver issues avoid taking Paxlovid.
How long does the bad taste in your mouth from Paxlovid last?
Paxlovid mouth should only last until you’re done taking the medication. As this COVID treatment starts to leave your system, side effects should begin fading. One dose of Paxlovid doesn’t last very long in your body. About 1 to 2 days after your last dose, the medication should be fully out of your system.
What it feels like: 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.
Interactions with other meds: Paxlovid interacts with hundreds of other medications. But many interactions can be managed with dosage adjustments.
How can you get rid of the bad taste in your mouth that Paxlovid causes?
The way to get rid of the bad taste that Paxlovid causes may be different for each person. What works for some people doesn’t always work for others.
In an exclusive interview with GoodRx Health, Christina Madison, PharmD, founder and CEO of The Public Health Pharmacist, provided some advice for managing Paxlovid mouth:
“Good oral hygiene and rinsing the mouth after dosing can assist with managing this adverse effect. Taking the dose with a flavored beverage [can help as well]. There are some studies that [those with ‘Paxlovid mouth’] have shown benefit from zinc supplementation.”
Here are a few additional tips that might help lessen or relieve the bad taste in your mouth:
Drinking plenty of fluids, especially citrus-flavored beverages
Chewing gum or ice
Sucking on hard candy
Brushing your teeth more often
Rinsing with a baking soda / water mixture
Avoiding smoking
Adding various spices to your food
And if these remedies don’t help, keep in mind that this side effect is temporary. There are some medications that may help with long-term taste disturbances. But because Paxlovid’s bitter taste is fast-passing and should resolve on its own, they likely wouldn’t be needed in this situation.
Should you be worried about having Paxlovid mouth?
No. Taste changes from Paxlovid aren’t known to be harmful. And there are no reports of Paxlovid mouth being a long-term problem. So while this side effect can be uncomfortable, it isn’t dangerous.
When should you see a healthcare professional about Paxlovid mouth?
If the bad taste from Paxlovid is causing you to throw up, it could pose a problem. Throwing up right after taking a medication can prevent your body from properly absorbing it. If you vomited shortly after taking a dose, contact a healthcare professional. Depending on how long it’s been between your dose and throwing up, you may need additional doses of Paxlovid.
You should also contact your primary care provider if the weird taste continues for more than a few days after your last dose. There may be something else causing or contributing to your taste changes. For example, COVID itself can cause taste changes that last longer.
Frequently asked questions
If you stop Paxlovid too early, your infection may not be fully treated. This could cause your symptoms to return or worsen. And it can raise your risk of developing severe symptoms or complications. It’s common for people to start feeling better within 1 to 2 days after starting Paxlovid. But for the medication to work its best, make sure to finish the entire 5-day course.
It’s possible to experience rebound (returning or worsening) COVID symptoms after finishing Paxlovid. Some people call this “Paxlovid rebound.” But it’s not a side effect of the medication, and it can happen even if you don’t receive any COVID treatment. Experts think rebound symptoms happen because of how some people’s immune systems clear the virus that causes COVID from the body.
If you experience mouth sores while taking Paxlovid, contact your primary care provider right away. These are potential symptoms of an allergic reaction to Paxlovid. While rare, it’s possible to have an allergic reaction to this COVID treatment. If this happens, you may need to stop Paxlovid and switch to a different treatment.
Yes, Paxlovid is worth taking — especially if you have a high risk of developing severe COVID symptoms. High-risk groups include older adults, pregnant women, and those with certain health conditions. COVID can cause serious complications, including hospitalizations and death. And taking Paxlovid helps lower the risk of these complications.
People who have severe liver or kidney disease should avoid Paxlovid. They may have a greater risk of side effects. You may also need to avoid Paxlovid if you take medications that severely interact with Paxlovid. In some cases, you may be able to temporarily stop an interacting medication while taking Paxlovid. But if you can’t stop taking it, you may not be able to take Paxlovid.
If you stop Paxlovid too early, your infection may not be fully treated. This could cause your symptoms to return or worsen. And it can raise your risk of developing severe symptoms or complications. It’s common for people to start feeling better within 1 to 2 days after starting Paxlovid. But for the medication to work its best, make sure to finish the entire 5-day course.
It’s possible to experience rebound (returning or worsening) COVID symptoms after finishing Paxlovid. Some people call this “Paxlovid rebound.” But it’s not a side effect of the medication, and it can happen even if you don’t receive any COVID treatment. Experts think rebound symptoms happen because of how some people’s immune systems clear the virus that causes COVID from the body.
If you experience mouth sores while taking Paxlovid, contact your primary care provider right away. These are potential symptoms of an allergic reaction to Paxlovid. While rare, it’s possible to have an allergic reaction to this COVID treatment. If this happens, you may need to stop Paxlovid and switch to a different treatment.
Yes, Paxlovid is worth taking — especially if you have a high risk of developing severe COVID symptoms. High-risk groups include older adults, pregnant women, and those with certain health conditions. COVID can cause serious complications, including hospitalizations and death. And taking Paxlovid helps lower the risk of these complications.
People who have severe liver or kidney disease should avoid Paxlovid. They may have a greater risk of side effects. You may also need to avoid Paxlovid if you take medications that severely interact with Paxlovid. In some cases, you may be able to temporarily stop an interacting medication while taking Paxlovid. But if you can’t stop taking it, you may not be able to take Paxlovid.
The bottom line
Paxlovid (nirmatrelvir / ritonavir) is an oral antiviral that can treat mild to moderate COVID-19. “Paxlovid mouth” is a term being used to describe a bad taste caused by the medication. This side effect is likely caused by the ritonavir component of Paxlovid. It’s not harmful and should resolve on its own after finishing the medication. Let your primary care provider know if taste changes continue after stopping Paxlovid.
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References
Cajacob, L., et al. (2022). Allergic contact stomatitis. Diseases of the Oral Mucosa.
Gerhart, J., et al. (2024). A comprehensive review of the clinical pharmacokinetics, pharmacodynamics, and drug interactions of nirmatrelvir/ritonavir. Clinical Pharmacokinetics.
Pfizer. (2024). Fact sheet for healthcare providers: Emergency use authorization for Paxlovid.
Pfizer Laboratories Div Pfizer. (2024). Paxlovid- nirmatrelvir and ritonavir [package insert].
Schiffman, S. S., et al. (1999). Effect of protease inhibitors on the sense of taste. Nutrition.
Schiffman, S. S. (2018). Influence of medications on taste and smell. World Journal of Otorhinolaryngology - Head and Neck Surgery.
ScienceDirect. (n.d.). Dysgeusia.
