Oral antiviral drugs are helping turn the tide of the Covid-19 pandemic by reducing the risk of serious illness, hospitalizations and deaths from the virus.
When taken within five days of the onset of symptoms, these prescription pills can stop the virus from multiplying, reduce the amount of virus in your body, and help your immune system fight off disease.
HealthyWomen spoke to Christina Nguyen MPAP, PA-C, a Physician Assistant and Clinic Manager at Carbon Health in Los Angeles about when, where and how to access these life-saving drugs.
HealthyWomen: What are the oral antiviral treatments for Covid-19?
Christina Nguyen: There are two oral antivirals that are now approved by the Food and Drug Administration (FDA) for use in emergencies: Paxlovid and Lagevrio. Both are available by prescription. Paxlovid is the first choice recommendation for patients who test positive for Covid and meet the guidelines.
HealthyWomen: What are the guidelines for who can use these antivirals?
Christina Nguyen: Currently, these drugs can be used within five days of the onset of symptoms and in the case of a positive Covid test. Because all medicines have risks and benefits, there are other limitations as well.
Currently, the Centers for Disease Control and Prevention (CDC) recommends oral antivirals for people who are more likely to develop severe Covid disease. This includes people over the age of 50 (recently lowered from 65), people who are not up to date on Covid vaccines/boosters and people with certain health conditions that may increase their risk of serious illness.
The list of health conditions that qualify a person for antiviral Covid treatment is very long. These include obesity (BMI over 30), a sedentary lifestyle, depression, anxiety, substance use disorders, cancer, heart disease, diabetes and immune system disorders. It’s a very comprehensive list.
As the majority of the population could fit under one of these qualifications, it is often a matter of weighing the risks and benefits with a healthcare provider (HCP) to help you decide whether you should take an antiviral for Covid.
HealthyWomen: So can people who are unvaccinated, as well as those who are not up to date on Covid vaccine doses/boosters, get oral antivirals?
Christina Nguyen: Yes.
HealthyWomen: Are There Any Risks With These Drugs? Is there anyone who shouldn’t take them?
Christina Nguyen: Only people over the age of 18 can use Legavrio. Paxlovid cannot be used by children under the age of 12 or anyone weighing less than 88 pounds. Paxlovid is also not recommended for people with severe kidney or liver problems.
There are many drug interactions with Paxlovid, meaning people taking certain medications need to avoid it. For example, if a person is taking a blood thinner that they cannot safely stop taking, then that person is not a good candidate for Paxlovid because a dangerous drug interaction could occur.
In terms of family planning, Paxlovid may make hormonal contraception less effective, so patients should use an alternative method to prevent pregnancy. And Lagevrio is not recommended for use during pregnancy as it may harm the fetus.
Another risk with any drug is anaphylaxis, a severe allergic reaction to an ingredient in the drug.
As for side effects, both drugs can cause stomach upset, and some people say Paxlovid leaves a metallic or bitter taste in the mouth.
The doctor who prescribes your oral antiviral medication can go through the full list of risks and side effects with you and answer any questions.
HealthyWomen: Can you talk a little bit about rebound infections?
Christina Nguyen: In a rebound Covid, symptoms go away but then mysteriously return because virus levels in the body rise again. It can happen to anyone but seems to be more common in people taking Paxlovid.
What patients notice is that they take Paxlovid and their symptoms go away completely. You then test negative. But within a few days, they get symptoms again.
One theory is that the drug is not always able to capture all of the virus, and once the drug is gone from the body, the remaining virus reactivates.
HealthyWomen: Where can people get these oral antivirals? Can pharmacists prescribe them?
Christina Nguyen: If you test positive for Covid or notice symptoms and you have an HCP, you can check with him about prescribing an oral antiviral.
Your local health department is another great resource whether you have an HCP or not. For example, the Los Angeles Department of Health offers free oral antivirals and offers free telemedicine appointment options on its website, so you don’t have to go to a clinic to get a prescription.
You can also search for a test-to-treat location near you. Test to Treat is a program that allows people to get tested for Covid and receive an oral antiviral in one place.
Just last month, the FDA authorized pharmacists to prescribe Paxlovid to people who have tested positive for Covid within five days (with certain limitations). The pharmacist only needs access to the patient’s health information to ensure they are a good candidate for the drug.
HealthyWomen: You mentioned that these drugs are free from your health department. Are they free everywhere?
Christina Nguyen: All public health departments should make these drugs available free of charge. Visiting your HCP or some test-to-treat facilities (e.g. emergency care) may require you to pay for the visit but not for the medication.
HealthyWomen: How Accessible Are These Drugs?
Christina Nguyen: They’re generally widely available at the moment, although they may be harder to come by for people in rural areas. To address this issue, the Health Resources and Services Administration (HRSA) has advanced a program called the Rural Health Clinic COVID-19 Therapeutics Program to address and ensure access and allocation of supplies to rural clinics.
Unfortunately, the same disparities and inequalities that exist in healthcare overall are also affecting access to Covid treatments, particularly for people of color. I and other vendors are working very hard to fill these gaps.
HealthyWomen: Anything else you want to let people know about oral Covid antiviral drugs?
Christina Nguyen: If you feel ill, contact an HCP immediately — your general practitioner, public health department, or test-to-treat location. You only have a five-day window, and you don’t want it to close before you can get those helpful drugs.
Paxlovid Patient Information Sheet
Lagevrio patient information sheet
This resource was created with the support of Pfizer.