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Paxlovid

nirmatrelvir / ritonavir
Used for COVID-19
Used for COVID-19

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.

Reviewed by:
reviewer
Connie Zheng, PharmD
reviewer
Kristianne Hannemann, PharmD
Last reviewed on November 8, 2024
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageCostContraindicationsAlternativesLatest newsReferencesPricesMedicare
basics-icon

What is Paxlovid (nirmatrelvir / ritonavir)?

What is Paxlovid (nirmatrelvir / ritonavir) used for?

  • 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

How Paxlovid (nirmatrelvir / ritonavir) works

Paxlovid (nirmatrelvir / ritonavir) is a combination of two protease inhibitors:

  • Nirmatrelvir treats COVID-19 by blocking a certain protease, which is a protein the virus needs to make copies of itself and continue to infect.

  • Ritonavir slows the breakdown of nirmatrelvir. This medication allows nirmatrelvir to stay in your body longer to fight COVID-19.

When does Paxlovid (nirmatrelvir / ritonavir) start working?
Time passed since treatment started:
HOURS
DAYS
WEEKS
MONTHS
Full effect

Drug Facts

Common BrandsPaxlovid
Drug ClassAntiviral
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only

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What are the side effects of Paxlovid (nirmatrelvir / ritonavir)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

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

Other Side Effects

  • High blood pressure
  • Muscle pain
  • Headache

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Severe allergic reaction: trouble breathing; rash; fever; swelling of the face, lips, or throat
  • Liver problems: dark urine, feeling tired, upset stomach or stomach pain, yellowing of the skin or whites of the eyes
When do Paxlovid (nirmatrelvir / ritonavir) possible side effects begin and end?
Time passed since treatment started:
HOURS
DAYS
WEEKS
MONTHS
Changes in taste (e.g., bitter taste)
Diarrhea
Muscle aches
Headache
High blood pressure

Source: DailyMed

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pros-and-cons

Pros and cons of Paxlovid (nirmatrelvir / ritonavir)

thumbs-up

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

thumbs-down

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

pharmacist-tips

Pharmacist tips for Paxlovid (nirmatrelvir / ritonavir)

pharmacist

  • You can take Paxlovid (nirmatrelvir / ritonavir) with or without food. Swallow the tablets whole. Don't chew, crush, or break the medications because it might not work as well.

    • Finish your full five-day course of Paxlovid (nirmatrelvir / ritonavir) even if you feel better before you're done. Stopping this medication too early can put you at risk for serious COVID-19 illness. Make sure to take steps to protect yourself and others while you're taking this medication in order to get well soon and to prevent others from getting sick with COVID-19.

      • If you missed a dose of Paxlovid (nirmatrelvir / ritonavir) and it's been less than 8 hours since the time you usually take it, then take your dose as soon as possible and continue with your regular schedule. But if more than 8 hours have passed since the time you usually take it, just skip this missed dose. Then, take your next dose at your regularly scheduled time. Never take two doses of Paxlovid (nirmatrelvir / ritonavir) to make up for a missed dose.

        • Some people notice a bitter taste in their mouth while taking Paxlovid (nirmatrelvir / ritonavir). This side effect should go away once you finish your course of medication. But if it's bothersome to you during Paxlovid (nirmatrelvir / ritonavir) treatment, try sucking on cinnamon candies or chewing gum to lessen the bitter taste from the pills.

          • Paxlovid (nirmatrelvir / ritonavir) can cause hormonal birth control medications to not work well. If you or your partner is currently taking hormonal birth control, use condoms or other birth control methods to prevent unintended pregnancies during the 5 days of treatment. It's recommended to continue using other forms of birth control until you've had one complete menstrual cycle after stopping Paxlovid (nirmatrelvir / ritonavir).

            • If your COVID-19 symptoms get worse, get medical help right away. This medication won't prevent all COVID-19 cases from getting worse. Call 911 if you experience symptoms such as worsening cough, trouble breathing, chest pain that doesn't go away, confusion, a hard time staying awake, and pale or blue-colored skin.

              • Let your healthcare team know if you're pregnant or thinking of becoming pregnant before taking Paxlovid (nirmatrelvir / ritonavir). This medication is likely safe to take during pregnancy, but more research is needed in this area. Your care team can talk with you about the benefits and risks of taking Paxlovid (nirmatrelvir / ritonavir) during pregnancy.

                • Tell your care team if you're breastfeeding before taking Paxlovid (nirmatrelvir / ritonavir). Studies suggest this medication can pass into breastmilk. But it's unclear how this affects breastmilk-fed babies. Your care team can discuss with you any concerns you might have about taking Paxlovid (nirmatrelvir / ritonavir) while nursing.

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                  faqs

                  Frequently asked questions about Paxlovid (nirmatrelvir / ritonavir)

                  How do I get Paxlovid (nirmatrelvir / ritonavir)?
                  Because Paxlovid (nirmatrelvir / ritonavir) is a prescription medication, you can only get it with a prescription from a healthcare professional (HCP). This means you might need to make an appointment at a clinic to see an HCP. Or, you might be able to get a prescription directly from the pharmacist, but not every community pharmacy offers this option. Before an HCP can prescribe Paxlovid (nirmatrelvir / ritonavir), they'll need to review your health records from the past year, including your liver and kidney function tests, and a list of all the medications you're currently taking. If you don't have this information or if the HCP has a hard time accessing your records, you might have trouble getting the Paxlovid (nirmatrelvir / ritonavir) prescription quickly. Talk with your healthcare team if you have more questions on how to get Paxlovid (nirmatrelvir / ritonavir).
                  Who should take Paxlovid (nirmatrelvir / ritonavir)?
                  Paxlovid (nirmatrelvir / ritonavir) isn't recommended for everyone. Currently, it's FDA-approved for people who have mild-to-moderate COVID symptoms and are at high risk for developing severe COVID-19 illness. The medication can only be prescribed for adults and children ages 12 years and older, and who've had COVID symptoms for less than 5 days.
                  Should I take Paxlovid (nirmatrelvir / ritonavir) if my symptoms are mild?
                  You can take Paxlovid (nirmatrelvir / ritonavir) if you've had mild COVID symptoms for 5 days or less. But this medication is only prescribed for people who are at high risk for developing severe COVID-19. This includes older adults or younger people who have certain medical conditions, such as asthma or a weakened immune system. Ask your healthcare team if you're not sure whether you need to take Paxlovid (nirmatrelvir / ritonavir).
                  Is Paxlovid (nirmatrelvir / ritonavir) safe?
                  Most people take Paxlovid (nirmatrelvir / ritonavir) without experiencing serious problems. This medication can cause some side effects, like diarrhea and changes in taste. But the symptoms are typically mild and go away with time. But Paxlovid (nirmatrelvir / ritonavir) might not be safe for everyone, including people who have liver or kidney problems, or people who are taking certain medications that have serious interactions with Paxlovid (nirmatrelvir / ritonavir). Ask your care team if Paxlovid (nirmatrelvir / ritonavir) is appropriate for you.
                  How long does Paxlovid (nirmatrelvir / ritonavir) stay in your system?
                  It takes a little more than a day for most of Paxlovid (nirmatrelvir / ritonavir) to leave your system after a dose. This is estimated based on the half-life of the medication and can differ for people who have kidney or liver problems, or who are taking medications that can interaction with Paxlovid (nirmatrelvir / ritonavir). Keep in mind that in order for Paxlovid (nirmatrelvir / ritonavir) to work well, you need to take this medication twice daily. Talk with your healthcare team if you have more questions about how long Paxlovid (nirmatrelvir / ritonavir) stays in your system.
                  Can I stop taking Paxlovid (nirmatrelvir / ritonavir)?
                  You're recommended to take Paxlovid (nirmatrelvir / ritonavir) by mouth twice daily for 5 days. If you stop taking this medication early, you're at higher risk for developing serious COVID-19 illness. If you want to stop Paxlovid (nirmatrelvir / ritonavir), let your healthcare team know. They can discuss your concerns with you and talk with you about your options.
                  Does Paxlovid (nirmatrelvir / ritonavir) cause rebound COVID?
                  Data shows that Paxlovid (nirmatrelvir / ritonavir) doesn't cause "rebound" COVID symptoms. Though rare, some people who took Paxlovid (nirmatrelvir / ritonavir) did experience a return of symptoms about 3-7 days after recovering from the initial infection. But research suggests the rebound symptoms are more likely triggered by the immune system fighting off the infection than by the medication. Keep in mind that rebound COVID have also been reported by people who've never taken an antiviral medication for COVID. If you experience rebound symptoms, you can recover at home by resting, drinking fluids, and taking over-the-counter medications to treat your symptoms.
                  Does Paxlovid (nirmatrelvir / ritonavir) prevent long COVID?
                  Some studies suggest that Paxlovid (nirmatrelvir / ritonavir) can lower the risk of long COVID, while others don't. Long COVID is a condition where people continue to have certain symptoms, such as tiredness or dizziness, 3 months or longer after the initial COVID infection. Currently, there aren't specific treatments that can prevent or treat long COVID. But if you have this condition, your healthcare team can recommend ways to manage your symptoms. Because Paxlovid (nirmatrelvir / ritonavir) can lower the risk of serious COVID-19 illness, it important to take this medication as prescribed, regardless of whether or not it can prevent long COVID.
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                  What are the risks and warnings for Paxlovid (nirmatrelvir / ritonavir)?

                  Paxlovid (nirmatrelvir / ritonavir) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

                  risk-warning

                  Serious interactions with other medications

                  • Risk factors: Taking medications that are removed from your body or activated by a specific liver protein | Taking medications that affect a specific liver protein

                    Paxlovid (nirmatrelvir / ritonavir) interacts with many medications because it blocks a specific liver protein that works to either remove or activate (turn on) certain medications in your body. Paxlovid (nirmatrelvir / ritonavir) can prevent your body from removing certain medications, such as simvastatin (Zocor) or lurasidone (Latuda). This can lead to dangerously high levels of these medications that stay in your body and cause potentially life-threatening side effects. Other medications, such as carbamazepine (Tegretol) and rifampin (Rifadin), cause your body to get rid of Paxlovid (nirmatrelvir / ritonavir) faster than normal if taken together. This causes Paxlovid (nirmatrelvir / ritonavir) to not work as well, and it puts you at risk for severe COVID-19 illness. Make sure your healthcare team is aware of all the medications you're currently taking before you start Paxlovid (nirmatrelvir / ritonavir). Ask your care team if you're not sure whether you can take Paxlovid (nirmatrelvir / ritonavir) with certain medications.

                    risk-warning

                    Severe allergic reaction

                    In some rare cases, life-threatening reactions are possible with Paxlovid (nirmatrelvir / ritonavir), such as anaphylaxis (closing of the throat). In addition, some people who have taken ritonavir (an ingredient in Paxlovid (nirmatrelvir / ritonavir)) have had severe skin reactions. If you experience a rash; fever; shortness of breath; or swelling in your face, lips, or tongue; get medical help as soon as possible.

                    risk-warning

                    Liver problems

                    • Risk factors: History of liver problems | Taking other medications that affect your liver

                      Paxlovid (nirmatrelvir / ritonavir) can cause liver injury or damage. Your risk is higher if you already have liver problems or you're taking medications that can damage your liver. Signs of liver problems include dark urine, feeling tired, upset stomach or stomach pain, and yellowing of your skin or the whites of your eyes. If you notice any of these symptoms, call your healthcare team immediately.

                      risk-warning

                      Risk of resistance to certain HIV medications

                      • Risk factors: Undiagnosed HIV infection | HIV infection that's not under control

                        Paxlovid (nirmatrelvir / ritonavir) contains ritonavir, a medication that's commonly used to treat human immunodeficiency virus (HIV). If you have HIV that's undiagnosed or not under control, taking Paxlovid (nirmatrelvir / ritonavir) can cause resistance to HIV medications that contain ritonavir or other protease inhibitors. This means that certain HIV medications won't work as well to fight off the HIV infection. If you think you have HIV, get tested right away. Early signs include fever, chills, rash, night sweats, and muscle aches. Symptoms of HIV in its later stages include very rapid weight loss; extreme tiredness; sores in the mouth or genitals; and swelling in the lymph nodes in the armpits, groin, or neck. Before you start any medications for HIV, let your healthcare team know if you've taken Paxlovid (nirmatrelvir / ritonavir) in the past so they can help decide the best HIV treatment for you.

                        dosage

                        Paxlovid (nirmatrelvir / ritonavir) dosage forms

                        The average cost for 1 carton of 30 tablets of 150mg/100mg of Paxlovid (nirmatrelvir / ritonavir) is $1451.50 with a free GoodRx coupon. This is 19.08% off the average retail price of $1793.72.
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                        Carton
                        DosageQuantityPrice as low asPrice per unit
                        20 tablets of 150mg/100mg1 carton$1415.78$1415.78
                        30 tablets of 150mg/100mg1 carton$1451.50$1451.50

                        Typical dosing for Paxlovid (nirmatrelvir / ritonavir)

                        Paxlovid (nirmatrelvir / ritonavir) comes as a pre-packaged course of medication. Each dose of this medication is made up of three tablets taken together: two 150 mg nirmatrelvir tablets and one 100 mg ritonavir tablet.

                        • Adults and children ages 12 years and older (who weigh at least 88 lbs): The typical dose is 300 mg of nirmatrelvir and 100 mg of ritonavir by mouth every 12 hours for 5 days.

                        Your dose might be different if you have kidney problems.

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                        Paxlovid (nirmatrelvir / ritonavir) contraindications

                        Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Paxlovid (nirmatrelvir / ritonavir) will not be safe for you to take.

                        • Taking other medications that are removed from your body or activated by a specific liver enzyme

                        alternatives

                        What are alternatives to Paxlovid (nirmatrelvir / ritonavir)?

                        There are a number of medications that your doctor can prescribe in place of Paxlovid (nirmatrelvir / ritonavir). Compare a few possible alternatives below.
                        Paxlovid (nirmatrelvir / ritonavir)
                        Used for:

                        • 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

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                        References

                        Best studies we found

                        Centers for Disease Control and Prevention. (2024). How to Protect Yourself and Others.

                        Centers for Disease Control and Prevention. (2024). Long COVID Basics.

                        Centers for Disease Control and Prevention. (2023). People with Certain Medical Conditions.

                        View All References (6)

                        Centers for Disease Control and Prevention. (2024). Types of COVID-19 Treatment.

                        HIV.gov. (2022). Symptoms of HIV.

                        Mother To Baby | Fact Sheets. (2022). Nirmatrelvir/ritonavir (Paxlovid®).

                        Pesko, B., et al. (2022). Safety and tolerability of Paxlovid (nirmatrelvir/ritonavir) in high-risk patients. Clinical Iinfectious Diseases.

                        Pfizer Laboratories Div Pfizer Inc. (2024). PAXLOVID- nirmatrelvir and ritonavir kit [package insert]. DailyMed.

                        U.S. Food and Drug Administration. (2023). FDA Approves First Oral Antiviral for Treatment of COVID-19 in Adults.

                        GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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