Antiviral Treatment for Covid-19 in Nebraska

Paxlovid & Molnupiravir

Treatment of mild-to-moderate COVID-19 is becoming more accessible to vulnerable people who need it most. On Dec. 22 and 23, the FDA granted emergency use authorization (EUA) to Pfizer’s oral antiviral Paxlovid (nirmatrelvir co-packaged with ritonavir) and Merck’s Covid-19 oral antiviral Molnupiravir.

This was welcome news since these oral antivirals are an at-home COVID-19 treatment option for those who are high risk of severe illness.

These medications also help fill the gap left by the two most commonly available monoclonal antibodies used to treat COVID-19, which, unfortunately, have proven to be less effective against the rapidly spreading omicron variant.

Both Paxlovid and molnupiravir will be available by prescription only at Kohll’s Pharmacy. These antiviral pills won't be available by prescription to everyone, though, and the eligibility criteria differs for each. Both of these antivirals are not available at the majority of pharmacies. Kohll’s Rx developed a physician order form to be completed and faxed to Kohll’s Rx. The order form allows the physician to be able to order both medications if the patient qualifies for both. Whichever medication is available will be dispensed.

Pfizer's Paxlovid will be available to people who:

• Have tested positive for COVID-19 and have not yet been admitted to the hospital and
• Are high risk for developing severe COVID-19 and
• Are 12 years of age or older (and at least 88 pounds)

Merck's molnupiravir will be available to people who:

• Have tested positive for COVID-19 and have not yet been admitted to the hospital and
• Are high risk for developing severe COVID-19 and
• Have no alternative FDA-authorized COVID-19 treatment options accessible to them or that are clinically appropriate for them and
• Are 18 years of age or older

Both the Pfizer and Merck COVID-19 pills are antivirals, working to keep the SARS-Cov-2 virus from replicating properly — thereby reducing viral load, which can help reduce symptom severity.

However, each pill does so in a slightly different manner.

How Pfizer's COVID-19 pill, Paxlovid, works and is administered

Paxlovid consists of two pills taken together, nirmatrelvir and ritonavir.

Nirmatrelvir prevents key proteins that the virus needs to make more copies of itself from functioning properly. It's taken in combination with ritonavir, which helps keep nirmatrelvir from being broken down before it has completed its job.

When studied in clinical trials, Paxlovid reduced COVID-19-related hospitalizations by almost 90%.

How Paxlovid is administered:

• Three tablets (two tablets of nirmatrelvir and one tablet of ritonavir) taken together orally twice daily for five days

How Merck's COVID-19 pill, molnupiravir, works and is administered

• Molnupiravir works by introducing mistakes into the virus' genetic code, preventing the virus from replicating properly.
• When studied in clinical trials, molnupiravir reduced COVID-19-related hospitalizations by 30%.

How molnupiravir is administered:

• Four tablets taken orally every 12 hours for five days

Do I still need to take COVID-19 antiviral pills if I'm not feeling sick yet?

If you've tested positive for COVID-19 and meet the criteria above, call your doctor as soon as possible to discuss whether this treatment may be right for you.

For antiviral pills to be most effective, they need to be taken as early in the disease course as possible and within five days of symptom onset. The sooner the better — even if you're not feeling symptoms yet.

Are there potential side effects to taking COVID-19 antiviral pills?

Side effects of Paxlovid include:

• Impaired sense of taste
• Diarrhea
• High blood pressure
• Muscle aches

Paxlovid is not recommended for people who have severe kidney or liver impairment.

Side effects of molnupiravir include:

• Diarrhea
• Nausea
• Dizziness

Molnupiravir is not recommended for use during pregnancy, unless your doctor determines that your individual benefit of taking this drug outweighs the known risks.

Covid-19 pills vs. COVID-19 vaccines: Do I still need to get vaccinated?

Neither Paxlovid nor molnupiravir is authorized for pre-exposure or post-exposure prevention of COVID-19, and neither can substitute the need for vaccination.

We know the vaccines are safe, effective and our best defense against the virus. Even if you've had COVID-19, get vaccinated. The immunity offered by vaccination is stronger and lasts longer than natural immunity.

Plus, data shows that unvaccinated adults are twice as likely to get reinfected with COVID-19 than those who get vaccinated after recovering from their illness.