Paxlovid is a prescription antiviral pill manufactured by Pfizer and currently considered to be the most effective at-home treatment for mild to moderate cases of Covid-19. It decreases the chances of hospitalization or death for high risk patients by 89%. 

If you test positive for Covid-19, you can get a prescription consultation from Dr. B, have the prescription delivered to your pharmacy, then take a course of 30 pills at home until you recover. Paxlovid is provided for free by the U.S. government for as long as Covid-19 continues to be a public health emergency. It must be taken within five days of the onset of Covid-19 symptoms. 

Molnupiravir (or Lagevrio) is another prescription antiviral that treats mild to moderate Covid-19 in high-risk patients. It’s manufactured by Merck and shares similarities with Paxlovid including a course of pills taken over five days and the need to start treatment within 5 days of symptoms beginning. The medication is also provided for free.

However Molnupiravir is less effective than Paxlovid at preventing serious illness. It decreases the chances of hospitalization or death for high risk patients by only 30-50%. This is still significant and a good option for patients who may not qualify for Paxlovid due to pre-existing conditions or conflicts with medication. (Paxlovid has many drug interactions, while Molnupiravir has very few.)

The FDA has designated Molnupiravir as a backup option if no other Covid-19 treatments are available or appropriate.

Paxlovid and Molnupiravir are at-home treatments for high-risk patients experiencing mild to moderate Covid-19 symptoms. You may be eligible for a prescription consultation if you:

• Have experienced Covid-19 symptoms for 5 days or less
• Have a positive Covid-19 PCR or at-home antigen test 
• Are 18 or older

• Are a high-risk patient with one of the following conditions:

  • Asthma
  • Cancer
  • Cerebrovascular disease
  • Chronic lung diseases limited to:
  • • Interstitial lung disease
    • Pulmonary embolism
    • Pulmonary hypertension
    • Bronchiectasis
    • COPD (chronic obstructive pulmonary disease)
  • Cystic fibrosis
  • Diabetes, type 1 and type 2
  • Disabilities
  • • Attention-Deficit/Hyperactivity Disorder (ADHD)
    • Cerebral Palsy
    • Congenital malformations (birth defects)
    • Limitations with self-care or activities of daily living
    • Intellectual and developmental disabilities
    • Learning Disabilities
    • Spinal Cord Injuries
  • Heart conditions (such as heart failure, coronary artery disease, or cardiomyopathies)
  • HIV (human immunodeficiency virus)
  • Neurologic conditions limited to dementia
  • Mental health disorders limited to:
  • • Mood disorders, including depression
    • Schizophrenia spectrum disorders
  • Obesity (BMI ≥25 kg/m2)
  • Primary Immunodeficiencies
  • Recent pregnancy
  • Physical inactivity
  • Smoking, current and former
  • Solid organ or hematopoietic cell transplantation
  • Tuberculosis
  • Use of corticosteroids or other immunosuppressive medications
  • Unvaccinated or more than 6 months without a booster

According to the CDC, a small percentage of patients may experience “Paxlovid rebound” where Covid-19 symptoms briefly return 2-8 days after initial recovery. Researchers are still trying to understand why this is and whether it’s tied to Paxlovid or other factors. However the medication continues to be recommended as the most effective treatment for early-stage treatment of mild to moderate Covid-19 among high risk patients. 

For those that do experience rebound Covid-19, the symptoms are usually milder and there are no reports of progression to severe disease or a need for additional treatment. That being said, patients may still be contagious and will need to continue isolating to avoid passing the virus to others. 

We will continue to update this information as new data and guidance becomes available.

 For Paxlovid, patients take two doses each day, spaced 12 hours apart, for five days. A dose of Paxlovid contains two pink pills (Nirmatrelvir) and one white pill (Ritonavir). All three should be taken together. 

For Molnupiravir, patients also take two doses each day, spaced 12 hours apart, for five days. A dose of Molnupiravir contains four red-colored capsules. All four should be taken together.

Pills / capsules should be swallowed with a full glass of water, not chewed, broken or crushed. It’s important to finish the full course of the medication, even if symptoms begin to improve.

Paxlovid is typically well-tolerated. Any side effects are generally mild, and include the following: 

• Altered or impaired sense of taste
• Diarrhea
• Increased blood pressure
• Muscle aches

Molnupiravir is also typically well-tolerated. Any side effects are generally mild, and include the following: 

• Diarrhea
• Nausea
• Dizziness

The following medications can be taken with Paxlovid, but may cause side effects. Paxlovid should only be taken with these medications if you are under the in-person supervision of your primary care doctor. (We’ve included examples of popular drugs in each category, but there may be other brands or generics not listed here.) 

• Anticancer: Abemaciclib, Ceritinib, Dasatinib, Ibrutinib, Neratinib, Nilotinib, Venetoclax
• Antidepressants: Bupropion (Wellbutrin), Trazodone
• Antifungals: Ketoconazole (Nizoral, Xolegel, Extina), Isavuconazonium Sulfate (Cresemba), Itraconazole (Sporanox)
• Antiviral for treatment of Hepatitis C: Elbasvir, Grazoprevir, Ombitasvir, Paritaprevir, Dasabuvir, Sofosbuvir, Velpatasvir, Voxilaprevir
• HIV treatment: Amprenavir, Atazanavir, Darunavir, Fosamprenavir, Indinavir, Nelfinavir, Saquinavir, Tipranavir
• Calcium channel blockers: Amlodipine (Norvasc) Diltiazem (Cardizem, Cartia, Dilacor XR, Diltia XT, Tiamate)
• Cyclosporine (Cyclosporine, Restasis)
• Digoxin (Digox, Lanoxin Pediatric, Lanoxin)
• Ethinyl estradiol (present in many birth control pills)
• Felodipine (Plendil)
• Isradipine (Dynacirc)
• Nicardipine (Cardene IV)
• Nifedipine (Adalat, Procardia, Procardia XL)
• Nisoldipine (Sular)
• Verapamil (Calan, Covera-HS, Isoptin, Verelan)
• Methadone (Diskets, Methadone Intensol, Methadose)
• Oral steroids (Prednisone, Methylprednisone, Dexamethasone, Hydrocortisone, Betamethasone)
• Quetiapine (Seroquel)
• Rivaroxaban (Xarelto)
• Sirolimus (Rapamune)
• Tacrolimus (Protopic, Envarsus XR, Astagraf XL)
• Warfarin (Jantoven, Coumadin)

Paxlovid has negative interactions with many drugs. If you are taking any of the following medications, Paxlovid is not the right treatment for you and you’ll want to follow up with your primary care provider to discuss alternate options.

• Alpha1 adrenoreceptor antagonist: Alfuzosin (Uroxatral)
• Analgesics: Pethidine (Meperidine, Demerol), Piroxicam (Feldene), Propoxyphene
• Antianginal: Ranolazine (Ranexa)
• Antiarrhythmics: Amiodarone, Dronedarone (Multaq), Flecainide (Tambocor), Propafenone (Rythmol), Quinidine
• Anticancer: Apalutamide (Erleada)
• Anticonvulsant: Carbamazepine (Tegretol), Phenobarbital (Luminal), Phenytoin (Dilantin)
• Anti-gout: Colchicine
• Antimycobacterials: Rifampin
• Antipsychotics: Lurasidone (Latuda), Pimozide (Orap), Clozapine (Clozaril)
• Endothelin receptor antagonists: Bosentan
• Ergot derivatives: Dihydroergotamine (DHE), Ergotamine (Ergomar), Methylergonovine (Methergine)
• Hepatitis C direct acting antivirals: Glecaprevir/Pibrentasvir (Mavyret, Maviret)
• Long-acting beta-adrenoceptor agonist: Salmeterol (Serevent Diskus)
• Narcotic analgesics: Fentanyl, Methadone (Diskets)
• PDE5 inhibitor: Sildenafil when used for pulmonary arterial hypertension (PAH) or erectile disorder (Viagra, Revatio)
• Sedative/hypnotics: Triazolam (Halcion), Oral Midazolam (Versed)
• Statins: Atorvastatin (Lipitor), Fluvastatin (Lescol XL), Lovastatin (Altoprev), Pitavastatin (Livalo, Zypitamag), Pravastatin (Pravachol), Rosuvastatin (Crestor, Ezallor), Simvastatin (Zocor, Vytorin)
• St. John’s Wort

Consultation: Dr. B is offering $15 doctor consultations for Paxlovid and Molnupiravir prescriptions as part of our ongoing mission to improve access to Covid-19 care..

Medication: The U.S. government is also providing these treatments for free at pharmacies across the country. The drug will be free of charge for as long as Covid-19 remains a public health crisis.