COVID-19 Outpatient Treatment

Oral antiviral treatments for COVID-19 - Paxlovid and Lagevrio

Oral antiviral treatments are taken by mouth to treat mild to moderate symptoms of COVID-19. Paxlovid was formally approved by the Food and Drug Administration (FDA) on May 25, 2023. The FDA has issued an emergency use authorization (EUA) for Lagevrio (molnupiravir). Both of these medications are effective treatments for the COVID-19 infection.

When are Paxlovid and Lagevrio used?

Paxlovid and Lagevrio are used for patients who have symptoms like runny nose, cough, or sore throat from COVID-19. They are not used for prevention, in other words for patients who have been exposed to COVID-19 but have not contracted the virus. Paxlovid is considered somewhat more effective, although sometimes due to drug interactions, or other issues, Lagevrio must be used.

Paxlovid and Lagevrio can be obtained only when you have COVID-19. Your clinical team is not allowed to prescribe these medications "just in case" you test positive during a trip or another time when it could be helpful.

How are Paxlovid and Lagevrio given?

Both Paxlovid and Lagevrio are pills that are taken by mouth twice a day for 5 days. They are available by prescription only.

When should Paxlovid or Lagevrio be given?

For individuals at higher risk, Paxlovid and Lagevrio should be taken as soon as symptoms develop. They can only be started during the first 5 days of symptoms. If your symptoms are already improving, treatment may not be necessary.

Can I get Paxlovid or Lagevrio if I've been vaccinated and then got COVID-19?

Yes. These treatments are available for everyone with COVID-19 infection who is at risk for severe disease.

If I have not been vaccinated, can I get Paxlovid or Lagevrio?

Yes. The antiviral treatments may be more helpful if you have not been vaccinated.

How effective are these oral antiviral treatments?

Researchers at Mass General Brigham and other hospitals have found that Paxlovid significantly reduces chances of being hospitalized or dying from COVID-19. Lagevrio also reduces chances of being hospitalized or dying from COVID-19.

Who is eligible for Paxlovid?

Paxlovid therapy is available for patients ages 12 years and older who:

• Weigh at least 40 kilograms (a little over 88 pounds) AND
• Have symptoms of COVID-19 AND
• Are within 5 days of the start of symptoms AND
• Have a health condition that makes them more likely to experience severe COVID-19 infection.

Paxlovid can interact with other medications. Please let your care team know all the medications and supplements you are taking.

Paxlovid should not be used without specific discussion with your care team if you:

• Have had a transplant and must take tacrolimus, cyclosporine, everolimus, or sirolimus
• Have severe kidney or liver disease
• Require certain anticoagulant medications (clopidogrel, rivaroxaban, or others)
• Take many chemotherapy medications
• Take St. John’s wort

There are other effective options for patients who have COVID-19 who cannot take Paxlovid. Contact your care team to understand what your best option might be.

Who is eligible for Lagevrio?

Lagevrio therapy is available for patients ages 18 years and older who:

• Have symptoms from COVID-19 AND
• Are within 5 days of the start of symptoms AND
• Are not pregnant AND
• Have a health condition that makes them more likely to have severe COVID-19 infection.

Please note: There are some additional considerations for patients and their partners who are able to become pregnant. Please check with your doctor about the need for birth control (contraception). If you are pregnant, please talk with your healthcare provider before starting treatment.

We usually use Paxlovid first as it appears to be more effective, although sometimes drug interactions necessitate the use of Lagevrio.

Are these medications expensive for me?

Initially, these medications were covered by the US government, but they are now commercially distributed so you could have a significant copayment. There are some programs that may help you pay for Paxlovid and if you have a high copay.

How do I get Paxlovid or Lagevrio if I have COVID-19?

If you think you might be eligible for treatment, please contact your primary care or specialty care team. They can prescribe treatment.

Remdesivir

Remdesivir is an FDA-approved medicine that interferes with how the COVID-19 virus replicates. It can help people with COVID-19 recover faster and reduces the chances of developing severe COVID-19.

How is Remdesivir given?

Remdesivir is given by 3 daily intravenous (IV) infusions. It’s not a pill. These days, it is hard to find a place to obtain these infusions. We often use oral pills, above.

When should Remdesivir be given?

Remdesivir works best when given early at least within the first seven days of symptoms. If you are already improving, treatment is probably not necessary.

How good is Remdesivir therapy?

Remdesivir has been shown to be the most effective therapy to reduce the chance of hospitalization and help people improve faster.

Who is eligible to get Remdesivir?

Remdesivir is available for patients ages 12 years and older who:

• Weigh at least 40 kg (a little over 88 pounds) AND
• Have symptoms of COVID-19 AND
• Are within 7 days of the start of symptoms AND
• Have a health condition that makes them more likely to have severe COVID-19 infection.

Is Remdesivir expensive for me?

Initially, this medication was covered by the US government, but this is now commercially distributed, so you could have a significant copayment.

How do I get Remdesivir if I have COVID-19?

If you think you might be eligible, please contact your primary care provider or specialist. They can refer you for treatment. Please note that due to the extremely limited number of places to provide IV therapy, most patients referred will be able to receive the treatment.

Do not go to urgent care or the emergency room for any of these therapies. They are not available at those locations. There are specific clinics designed to give this therapy.

I have been referred for this therapy. What happens next?

We have limited quantities of Remdesivir available. If you are able to get the therapy, we will contact you with information and instructions. For patients who are on Patient Gateway, we will send a Patient Gateway message if we determine that we cannot offer treatment. If you don't have access to Remdesivir, you may wish to take one of the treatments in pill form discussed above.