COVID -19 Provider Information
COVID Treatment Update:
Last December, the FDA issued an emergency use authorization for Paxlovid (nirmatrelvir/ritonavir; Pfizer) and Lagevrio (molnupiravir; Merck) for treatment of mild-to-moderate COVID-19 infections.
Both therapies are now widely available in community pharmacies. And while infection and hospitalization rates have declined, higher-risk patients are still getting sick and requiring hospitalization. Early treatment with Paxlovid and other treatments can make a difference.
COVID-19 Therapies: Tools and Treatments
Infusion Centers Offering COVID Therapeutic Treatment
When to Prescribe?
Lagevrio and Paxlovid should be started within 5 days of symptoms onset.
For patients who:
- Test positive for COVID-19 (not currently approved for pre- or post-exposure prophylaxis).
- Are high risk for progression to severe COVID-19, including hospitalization or death, including1:
- Older Adults
- Chronic Kidney, liver or lung disease
- Dementia or Alzheimer’s
- Diabetes
- A disability
- Heart Condition
- HIV Infection
- Tuberculosis
- Mental Health Conditions
- Overweight or Obese
- Physically inactive
- Pregnancy
- Sickle cell disease or thalassemia
- Current or former smoker
- Transplant recipient
- Stroke or cerebrovascular disease
- Substance use disorder
- Immunocompromised condition or weakened immune system
- Are adults (Paxlovid can be prescribed to children ages 12 and older weighing at least 40 kg).
- Lagevrio should be used only when treatment with another therapy is not appropriate or accessible.
When NOT to Prescribe?
- Lagevrio and Paxlovid should not be used as pre- or post-exposure prophylaxis or prevention of COVID-19.
- Certain medications may interact with Paxlovid. Check interactions here.
- Patients with severe liver and/or kidney impairment should not take Paxlovid.
- Lagevrio should not be prescribed to children. Children ages 12 and older (weighing at least 40 kg) are approved to take Paxlovid.
- Patients requiring COVID-19 related hospitalization should not start therapy with one of these medications.
- Contraindications for Paxlovid and Lagevrio are listed below.
|
Paxlovid |
Lagevrio |
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Less than 12 years old or less than 40 kg |
Less than 18 years old (may affect bone and cartilage growth) |
|
Requires hospitalization due to COVID-19 |
Requires hospitalization due to COVID-19 |
|
Severe renal impairment (eGFR < 30 mL/min)* |
Pregnancy (not recommended, could be considered in certain individuals) |
|
Severe hepatic impairment (Child-Pugh Class C) |
Breastfeeding |
|
History of hypersensitivity reaction to nirmatrelvir or ritonavir or any other components |
|
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Co-administration with CYP3A metabolized drugs or inducers of CYP3A (see notes below for list of Drug-Drug Interactions) |
* Dose reduction for moderate renal impairment (eGFR ≥30 to <60 mL/min): 150mg nirmatrelvir (one 150 mg tablet) with 100 mg ritonavir (one 100 mg tablet), with both tablets taken together twice daily for 5 days
How effective is therapy?
Clinical trials showed:
- Paxlovid .reduced hospitalization or death risk by 88%
- Lagevrio reduced hospitalization or death risk by 30%
Because Lagevrio is less effective, Paxlovid is preferred. Lagevrio is reserved for patients who are not good candidates for other treatment options.
What are common adverse reactions?
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Paxlovid |
Lagevrio |
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Which treatment should I choose?
What is the treatment schedule?
Both drugs should be started within 5 days of symptom onset.
Paxlovid (ritonavir – nirmatrelvir): nirmatrelvir 300 mg with ritonavir 100 mg orally twice daily for 5 days. For those with moderate renal impairment (eGFR ≥30 to <60 mL/min): 150 mg nirmatrelvir (one 150 mg tablet) with 100 mg ritonavir (one 100 mg tablet), with both tablets taken together twice daily for 5 days.
Lagevrio: molnupiravir 800 mg orally twice daily for 5 days
Which pharmacies have treatments?
Both Paxlovid and Lagevrio are now available at over 50,000 pharmacies across the country.
