Experiences with

Paxlovid

Paxlovid is an antiviral medicine that works by stopping the virus that causes COVID-19 from growing and spreading in the body.

It's used to treat early COVID-19 infection and help to prevent more severe symptoms.

Paxlovid is a combination of 2 medicines called nirmatrelvir and ritonavir. Nirmatrelvir stops the virus from growing and spreading, and ritonavir helps nirmatrelvir from being broken down in your body long enough to do its job.

It comes as tablets. You'll need to start taking them as soon as possible after you have tested positive for COVID-19 and within 5 days of your symptoms starting.

Paxlovid is only available on prescription. However, you will only be eligible to have the medicine if you're in the highest risk group.

If you test positive for COVID-19 and are eligible, call your GP surgery, NHS 111 or hospital specialist as soon as possible. This is so they can consider referring you for an assessment for COVID-19 treatment.

Find out more about how to get treatments for COVID-19.

Who can take Paxlovid

Most adults aged 18 years and older can take Paxlovid.

You may be eligible for Paxlovid if all these apply:

• you're aged 18 or over
• you're in the highest risk group
• you've tested positive for COVID-19 – find out who can get a free COVID-19 lateral flow test
• you've had COVID-19 symptoms within the last 5 days

Paxlovid is not suitable for some people. Tell your doctor before starting to take this medicine if you:

• are pregnant, trying to get pregnant or breastfeeding
• have ever had an allergic reaction to Paxlovid, or any other medicine
• have problems with your kidneys
• have problems with your liver
• are intolerant to lactose or galactose – nirmatrelvir contains a lot of lactose
• have lactase deficiency or glucose-galactose malabsorption

There are a lot of medicines that may affect the way that Paxlovid works. Tell your doctor which medicines you are taking.

Dosage and strength

Nirmatrelvir comes as 150mg tablets and ritonavir comes as 100mg tablets.

One Paxlovid dose is:

• 2 nirmatrelvir tablets
• 1 ritonavir tablet

You'll take 1 dose (2 tablets of nirmatrelvir and 1 tablet of ritonavir) twice a day for 5 days.

How to take it

It's important that you start taking Paxlovid within 5 days of getting COVID-19 symptoms.

Swallow the tablets whole with a drink of water. Do not chew, break or crush the tablets. You can take them with or without food.

Take one dose of 3 tablets in the morning and one dose of 3 tablets in the evening for 5 days.

Leave around 12 hours between your morning dose and evening dose.

How long to take it for

Take Paxlovid for 5 days. Even if you start to feel better, it's important you complete the course.

If you forget to take it

It's important not to skip a dose as Paxlovid is most effective when taken early on.

If you forget to take one of your tablets but remember within 8 hours, take the missed dose as soon as you can. Still take your next dose at the usual time.

If you forget to take your dose and it's been more than 8 hours, skip the missed dose and take your next dose at the usual time.

Do not take 2 doses to make up for a missed one.

If you take too much

• you take more than your prescribed dose of Paxlovid

Go to 111.nhs.uk or call 111

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the Paxlovid packet or leaflet inside it, any remaining medicine, and any other medicines you take.

Do not stop taking Paxlovid before you have finished all 5 days of the course without talking to your doctor first.

If you stop taking Paxlovid, it may no longer protect you from the severe symptoms of COVID-19.

Common side effects

These common side effects of Paxlovid happen in up to 1 in 10 people. There are things you can do to help cope with them:

There are no known serious side effects with Paxlovid.

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to Paxlovid.

These are not all the side effects Paxlovid. For a full list, see the leaflet inside your medicines packet.

Paxlovid and pregnancy

Paxlovid is not recommended in pregnancy because little is known about its effects on the baby.

Do not take Paxlovid if you are pregnant. If you are contacted and offered the medicine, tell them that you are pregnant. They may be able to offer you other treatments that can be taken in pregnancy.

Paxlovid can stop combined oral contraceptive pills ("the pill") from working properly. If you are taking Paxlovid, it's important to use effective barrier contraception (a condom, female condom, diaphragm or cap) for the full 5 days of treatment and until you've had 1 full menstrual cycle.

If you're pregnant it's important you have the COVID-19 vaccine to help prevent the risk of severe illness from COVID-19.

Contact your doctor if you become pregnant while taking Paxlovid, or shortly after, and report it to the UK COVID-19 Antivirals in Pregnancy Registry by phoning 0344 892 0909, or ask your doctor to do this for you.

The manufacturers advise that breastfeeding is not recommended during treatment with Paxlovid and for 7 days after the last dose.

Ritonavir passes into breast milk in tiny amounts, but it is not known how much nirmatrelvir passes into breast milk.

Talk to your doctor if you are breastfeeding as specialist advice is available to them. They can discuss your individual situation with you and the risks and benefits of taking Paxlovid while breastfeeding.

Paxlovid and fertility

It's not known whether taking Paxlovid will affect fertility in either men or women.

Cautions with other medicines

Some medicines do not mix well with Paxlovid. Tell your doctor if you're taking:

• medicines such as methylphenidate or dexamfetamine for attention deficit hyperactivity disorders (ADHD)
• painkillers such as morphine, fentanyl, methadone, pethidine, buprenorphine or other medicines similar to morphine
• medicines for heart conditions and irregular heartbeats such as digoxin, amiodarone, flecainide or ranolazine
• cancer treatments such as afatinib, abemaciclib, apalutamide, ceritinib, dasatinib, nilotinib, vincristine, vinblastine, encorafenib, fostamatinib, ibrutinib or venetoclax
• medicines used to prevent blood clots (anticoagulants) such as warfarin, apixaban, dabigatran or rivaroxaban
• carbamazepine, lamotrigine or phenytoin, used for epilepsy
• medicines for depression or anxiety such as amitriptyline, fluoxetine, imipramine, nortriptyline, paroxetine or sertraline
• allergy medicines, such as fexofenadine or loratadine
• antibiotics (antibacterials) such as rifabutin, rifampicin, erythromycin, fusidic acid, atovaquone, bedaquiline, delamanid, clarithromycin or sulfamethoxazole/trimethoprim
• antifungals such as ketoconazole, voriconazole or itraconazole
• medicines for HIV or AIDS such as amprenavir, atazanavir, darunavir, fosamprenavir, efavirenz, maraviroc, raltegravir or zidovudine
• medicines for mental health or mood disorders, such as clozapine, pimozide, haloperidol, risperidone, quetiapine or lurasidone
• medicines for asthma and other lung-related problems such as chronic obstructive pulmonary disease (COPD), such as salmeterol or theophylline
• medicines for high blood pressure (hypertension) such as amlodipine, diltiazem or nifedipine
• medicines for high blood pressure in the blood vessels that supply the lungs, such as bosentan or riociguat
• medicines for hepatitis C virus infection such as glecaprevir/pibrentasvir
• medicines used to lower cholesterol such as atorvastatin, simvastatin, fluvastatin, pravastatin, rosuvastatin or lomitapide
• medicines used to suppress your immune system such as ciclosporin, tacrolimus or everolimus
• medicines for erectile dysfunction (also known as impotence) such as sildenafil, tadalafil, avanafil or vardenafil
• medicines used as sedatives or to help sleep such as alprazolam, buspirone, clonazepam, flurazepam, midazolam or zolpidem
• steroids used to treat inflammation, such as budesonide, dexamethasone, fluticasone propionate, prednisolone or triamcinolone
• bupropion for smoking cessation
• oral or patch contraceptives containing ethinylestradiol
• levothyroxine for underactive thyroid gland (hypothyroidism)
• colchicine for gout
• alfuzosin for prostate problems
• cisapride for stomach problems

Paxlovid and COVID-19 vaccines

There is no evidence that Paxlovid affects the COVID-19 vaccine.

COVID-19 treatments do not replace vaccinations. Vaccines are given to help your immune system fight a future COVID-19 infection.

The COVID-19 vaccine is not recommended within 4 weeks of having COVID-19.

Mixing Paxlovid with herbal remedies and supplements

Do not take St John's wort, the herbal remedy for depression, while you are being treated with Paxlovid. This is because it may make your course of treatment less effective.

There is not enough information to say that other herbal remedies or supplements are safe to take with Paxlovid. They are not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Related links

HealthUnlocked contains information from NHS Digital, licensed under the current version of the Open Government Licence