Health Tips

COVID-19 Treatment: Paxlovid

Q1. What is Paxlovid?

Paxlovid is the first oral antiviral medication that is being approved by the Ministry Of Health (MOH) Malaysia to be used in the treatment of Covid - 19. The drug was granted an emergency use authorization (EUA) by the Food and Drug Administration (FDA).

Q2. When did it start being used in Malaysia?

The usage of Paxlovid in Malaysia started on 15th April 2022 and since then it has shown a positive impact in reducing the severity of the infected COVID-19 patient.

Q3. How does Paxlovid work?

Paxlovid is an antiviral treatment that combines two different drugs, which are 2 tablets of nirmatrelvir (150mg) and 1 tablet of ritonavir (100 mg). Nirmatrelvir, blocks a crucial enzyme needed by the COVID virus to produce functional virus particles. The COVID virus that is released from the cells after receiving nirmatrelvir treatment could no longer penetrate healthy cells in the body, which stops the infection. Ritonavir, a medication formerly used to treat HIV/AIDS is now used to enhance the levels of antiviral drugs. 

As a COVID-19 medication, Ritonavir essentially stops the metabolism of Nirmatrelvir in the liver, allowing it to act longer and more effectively, providing it a boost to help tackle the infection.

Q4. Who is eligible for Paxlovid?

The eligibility requirements for starting oral antiviral (Paxlovid) medication in patients with mild disease (categories 2 and 3) in Malaysia are as follow :

• Age more than 60 years old

• Having any comorbidities (suffer from any other chronic illness such as hypertension or diabetes mellitus)

• Immunocompromised

• Obesity

• Current or ex-smoker

• Unvaccinated or incomplete vaccination

Q5. When should Paxlovid be taken?

Following a COVID-19 diagnosis, Paxlovid should be taken as soon as possible (within 5 days of symptoms). It is administered in order to lessen the number and intensity of symptoms or prevent a serious infection that could result in hospitalization or even death.

Q6. How should Paxlovid be taken?

1 dosage of Paxlovid equals 2 tablets of Nirmatrelvir and 1 tablet of Ritonavir, and it should be taken twice (morning and night) a day for 5 days. Take the tablets with a glass of water. Avoid chewing, breaking, or crushing them. You can take them with or without food. Leave around 12 hours between your morning dose and evening dose.

It is also advantageous that the pills are supplied in a "dose card," which is basically a pharmaceutical blister pack that enables you to punch out the pills as needed.

Q7. What should be done in case of a missed dose?

Take Paxlovid as soon as you remember if you forget to take a dosage but realize it within eight hours of when you typically do.

If you miss a dose by more than 8 hours, skip it and take the subsequent dose at the scheduled time. 

Paxlovid shouldn't be used in additional doses to make up for missed ones. Consult your healthcare provider if you're unsure about what to do.

Q8. How long should Paxlovid be taken?

The whole course of Paxlovid is 5 days. Remember that even if you feel better, do not stop taking Paxlovid without consulting your doctor first. Paxlovid may no longer shield you against the severe COVID-19 symptoms if you stop taking it.

Q9. Who is contraindicated for Paxlovid?

Some people should not take Paxlovid. Before beginning to take this medication, let your doctor know if you:

• Are pregnant, might be pregnant, or plan to get pregnant.

• Ever experienced an allergic reaction to Paxlovid or any other medication.

• Suffer from kidney diseases.

• Suffer from liver diseases.

• Are lactose or galactose intolerant as Nirmatrelvir contains a significant amount of lactose.

• Have glucose-galactose malabsorption or lactase deficiency.

Q10. How much does Paxlovid cost?

The antiviral drug Paxlovid will be available for free to Covid-19 patients at government hospitals or chosen private health facilities. However, patients are still subject to consultation charges and other related charges determined by the private health facility,

Q11. Does Paxlovid work against the Omicron variant?

Clinical studies for Paxlovid were conducted prior to the emergence of Omicron and later sub variants like BA.5, however Pfizer claims the medication is effective against the highly contagious variant. This is supported by three laboratory studies, two of which were carried out by Pfizer and one of which was carried out in collaboration with the Icahn School of Medicine at Mount Sinai. Peer-reviewed medical journals have not yet published the results of these researches.

Q12. What are the possible side effects of Paxlovid?

Liver concerns : If you have any of the following signs and symptoms of liver problems such as loss of appetite, jaundice (yellowing of the skin and whites of the eyes), black urine, light-colored feces, itchy skin, and abdominal pain, contact your doctor right away.

Drug resistance for HIV : Paxlovid may prevent some HIV medications from performing as well in the future if you have an untreated HIV infection.

Aside from those mentioned above, other possible side effects include:

• Altered sense of taste.

• Diarrhea.

• High blood pressure.

• Muscle aches.

The side effects of Paxlovid don't end here. Paxlovid has not been used much. There may be other adverse effects that are still unknown up until today.

Q13. What to consider before taking Paxlovid?

• Mention to your healthcare physician about every medication you take.

• Some medications may not work with Paxlovid and, when used simultaneously, may have negative side effects that are potentially serious.

• If you take or have recently taken any other medications, including prescription and over-the-counter drugs, vitamins, and herbal supplements, let your doctor or pharmacist know.

• Never start taking a new medication without first consulting your doctor. If it is safe to take Paxlovid with other medications, your healthcare professional would let you know.

• Mention to your healthcare physician if you are pregnant, you might be pregnant, or you plan to get pregnant.

• Paxlovid is not recommended for use during pregnancy. Consult your doctor for advice and clarifications.

• You should avoid getting pregnant (by using contraception or refraining from sexual activity) while taking Paxlovid and for 7 days after treatment ends.

• Mention to your healthcare physician if you are using any type of contraception.

• Extra caution should be taken if you use birth control tablets since Paxlovid may impair how well they work. 

• During treatment with Paxlovid and for seven days after it is completed, it is advised that you abstain from sexual activity and use condoms in addition to your regular method of contraception. 

• Mention to your healthcare physician if you are currently breastfeeding.

• During treatment and for seven days following the final Paxlovid dose, breastfeeding is not recommended. 

• This is due to the uncertainty around whether Paxlovid passes into breast milk and affects the unborn child. Before using this medication, let your healthcare professional know that you are breastfeeding.

Q14. Can Paxlovid replace the vaccine? 

No, and no! Even when more medications become available, vaccinations are still a critical element of prevention.

Q15. What is Paxlovid rebound and how common is it?

Some individuals who have finished a 5-day Paxlovid regimen have reported experiencing a temporary recurrence of COVID symptoms. These "COVID-19 rebound" instances had negative test results right after Paxlovid treatment but tested positive or experienced symptoms between two and eight days later. The symptoms of COVID rebound are often modest and transient; they subside in 3 to 5 days. 

Currently, there is still no advice to repeat or extend the Paxlovid course or add any additional particular antiviral medication. When experiencing rebound symptoms, a person should stay at home for the next 24 hours. Re-isolation for a further seven days is not legally required.

Attention : The facts and datas in this article were correct when it was first published. We advise you to check the websites of the Centers for Disease Control & Prevention (CDC), World Health Organization (WHO), Ministry Of Health (MOH) Malaysia and your state and local governments for the most up-to-date information regarding COVID-19 because it changes rapidly everyday.

Written by Anas Fikri, MB BCh;
Medically reviewed by Nur Ariffin, MBBS UniSZA

References:

Ministry Of Health Malaysia, Paxlovid - Antiviral untuk merawat jangkitan COVID19. https://covid-19.moh.gov.my/semasa-kkm/2022/03/paxlovid-antiviral-untuk-merawat-jangkitan-covid-19

NHS UK, Paxlovid, an antiviral medicine to treat coronavirus (COVID-19) : https://www.nhs.uk/medicines/paxlovid/

Yale Medicine, 13 Things To Know About Paxlovid, the Latest COVID-19 Pill. https://www.yalemedicine.org/news/13-things-to-know-paxlovid-covid-19

Written by

DOC2US Editorial Team