Seeing A Lot More COVID-19 Cases Lately?

Date: 10/27/22

Oral antiviral medications such as Paxlovid (nirmatrelvir/ritonavir) or Lagevrio (molnupiravir) have been FDAauthorized for emergency use to treat COVID-19. These oral treatments help prevent the COVID-19 virus from multiplying in the body, reducing risk of progression to severe illness. 

The NIH provides clear guidance on which therapeutics you should use. Consult their treatment guidelines for up-to-date recommendations.

Paxlovid (nirmatrelvir 300 mg/ritonavir 100 mg) is the first-line treatment for treating mild-to-moderate COVID-19. In the EPIC-HR trial, starting Paxlovid within 5 days of symptom onset reduced the risk of hospitalization or death by 89%.

Who should take Paxlovid? 

• Paxlovid can be offered to high-risk patients 12 years or older with mild to moderate COVID-19 who weigh at least 88 pounds. (See who is at high-risk: CDC high risk and FDA high risk)
• Paxlovid is not recommended for patients with severe renal (eGFR <30 mL/min) or severe hepatic (i.e., Child-Pugh Class C) impairment. Dosage adjustment is recommended in moderate renal impairment (eGFR >=30 to <60 mL/min). 
• Additionally, Paxlovid may have dangerous interactions with many commonly prescribed medications. Please consult treatment guidelines for more details.
• Beware of potential “COVID-19 rebound” after Paxlovid treatment

When Paxlovid or Remdesevir is not an option, oral twice-daily Lagevrio (800 mg molnupiravir) can be offered instead. When started within 5 days of symptom onset, molnupiravir reduced the risk of hospitalization or death by 30% in the MOVe-OUT trial (PDF). 

Who should take Lagevrio?

• Lagevrio can be offered to high-risk patients 18 years or older with mild to moderate COVID-19. It’s only recommended when Paxlovid is not accessible or clinically appropriate.
• Lagevrio is not recommended for pregnant and lactating patients. Learn more. 

Is cost a concern? Don’t worry – anti-viral medications for COVID-19 are entirely covered for patients at no cost. This includes any co-pay or deductible for their appointment with you.

Are antivirals available near me? 

Check the therapeutic locator to determine where you can send your patients to receive their medication.

Oral antivirals are now widely available and are additional therapeutic options for you in the care of your patients with COVID-19, regardless of vaccination status. When oral treatment options are not accessible or clinically appropriate, IV treatment options include IV remdesivir, monoclonal antibody bebtelovimab, or convalescent plasma. Consider referring your patients to local ID specialists or clinics early for these treatments if available.