What are the side effects of Paxlovid?

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Key points to remember

  • Paxlovid can cause side effects such as muscle pain, nausea, and taste disturbance.
  • Many drugs can interact with Paxlovid, so it’s important to tell your doctor what medications you’re taking.
  • You should not take Paxlovid if you have a known allergy to nirmatrelvir or ritonavir, or severe liver or kidney disease.

The use of Paxlovid is strongly recommended by the World Health Organization (WHO) for those at highest risk of hospitalization due to COVID-19. It has the ability to reduce the risk of hospitalization or death by almost 90% in unvaccinated people, immunocompromised people and people over 65 years of age.

However, this lifesaving drug might not be recommended for some people who are eligible for a prescription due to its potential drug interactions and side effects. Here’s what you need to know before taking Paxlovid.

Paxlovid Side Effects

Like any other medicine, Paxlovid can cause side effects that differ from person to person.

Paxlovid is a combination of two different drugs — nirmatrelvir and ritonavir — that has few concerning side effects, Lewis Nelson, MD, chairman of the department of emergency medicine at Rutgers New Jersey Medical School, told Verywell.

Some of the possible side effects of Paxlovid include the following:

  • Allergic reactions
  • liver problems
  • HIV drug resistance
  • Diarrhea
  • Muscle aches
  • Taste alteration
  • High blood pressure

There are anecdotal reports of people experiencing a relapse of COVID-19 symptoms after taking Paxlovid. However, these still need to be investigated further.

“Symptom recurrence is an ill-defined phenomenon that does not appear to be more common than in those who did not take the drug,” Nelson said. “This suggests that it is not related to Paxlovid, but more likely to COVID. It has been suggested that starting the drug too early prevents an adequate immune system response, which increases the possibility of recurrence of the disease. sickness.

At this time, further research is needed to find out whether potential cases of recurrence of symptoms are caused by the timing of taking Paxlovid, a high viral load, a compromised immune system unable to clear the virus or other factors.

“We’re starting to see a rebound in symptoms after a five-day course of Paxlovid, but it’s still effective in reducing COVID-19 hospitalizations and deaths,” Mahdee Sobhanie, MD, infectious disease physician at the Ohio State University Wexner Medical Center, says Verywell. “Rebound symptoms are something we will have to watch closely and try to figure out how to interpret these symptoms.”

What drugs interfere with Paxlovid?

The main concerns with Paxlovid are potential drug interactions, experts said. Taking Paxlovid with certain drugs may cause life-threatening side effects, increase or decrease the effectiveness of the drugs, or change the way one or both drugs work.

“It’s important to tell your doctor about other medications you’re taking because the ritonavir component of nirmatrelvir will affect the levels of your home medication in your body,” Sobhanie said.

Many drugs can interact with Paxlovid, including:

  • Colchicine
  • Alfuzosin
  • Carbamazepine
  • Ranolazine
  • Lovastatin
  • Triazolam
  • Apalutamide
  • Sildenafil
  • Dihydroergotamine
  • Rifampin

The National Institutes of Health (NIH) has a more comprehensive list of drugs that may have drug interactions with Paxlovid. In cases where the risks of the drug interaction outweigh the potential benefits, an alternative COVID-19 therapy should be prescribed. If clinically appropriate, the medications you are taking may be temporarily suspended or adjusted.

“There are many drugs that are metabolized by a liver enzyme called CYP3A that is inhibited by one of the components of Paxlovid,” Nelson said. “Inhibition of drug metabolism can lead to unpredictable and potentially dangerous blood levels of these other drugs.”

What this means for you

Tell your doctor about all medications you are taking to ensure that there will be no clinically relevant drug interactions or dangerous side effects with ritonavir boosted nirmatrelvir.

Who should not take Paxlovid?

According to Nelson, the following people are not recommended to take Paxlovid:

  • People without proper indications for the use of Paxlovid
  • Those with a known allergy to either component of the combination medicine, nirmatrelvir or ritonavir
  • Patients with severe liver or kidney disease

The WHO also advises against the use of Paxlovid in patients at low risk of hospitalization because the benefits of the drug are negligible.

“[Paxlovid] is definitely not a benign drug,” Karen Lin, MD, MS, associate dean for global health and professor in the Department of Family Medicine and Community Health at Rutgers Robert Wood Johnson Medical School, told VeryWell. “I usually talk at length with patients who might meet the criteria, and after discussion some patients chose not to get it.”

To understand how Paxlovid may affect you, be sure to tell your healthcare provider if you:

  • Have a potential drug interaction
  • are pregnant or planning to become pregnant
  • Breastfeed
  • Have liver or kidney disease
  • Take combined hormonal contraceptives
  • Have an untreated HIV infection

It is essential that you discuss your medical history with a qualified healthcare professional so that they can provide you with optimal healthcare and keep you well informed of the potential impacts of Paxlovid.

“There’s still a lot to learn about COVID, especially with treatment,” Sobhanie said. “But we are in a better position than two years ago thanks to the use of vaccines, monoclonal antibodies and antivirals.”

The information in this article is current as of the date indicated, which means that more recent information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

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