New COVID-19 Treatment Options: What You Need to Know

Aaron S. Weinberg MD, MPhil
May 4, 2022
5 mins

One of the best ways to prevent severe illness from COVID-19 is to get vaccinated (including getting all recommended boosters). In addition, the FDA (U.S. Food and Drug Administration) has recently granted two oral antiviral treatments — Paxlovid and molnupiravir — emergency use authorization, to be prescribed for people who have mild to moderate COVID-19 symptoms and who are at high risk for developing severe COVID-19 disease.

Most vaccinated people who fall ill with COVID-19 will develop mild systems that can be treated at home with over-the-counter medicines. (For more, read “How to Treat COVID-19 at Home: A Complete Shopping Checklist.”) But with these prescription treatment options now available, new questions are being asked. Here’s what you need to know: 

+ Who is eligible for treatment with these medications? 

Both Paxlovid (from Pfizer) and molnupiravir (from Merck) are available only by prescription. They are only for people who developed symptoms within the past five days and who are at high risk for severe COVID-19 illness — to find out whether you are eligible, make an appointment with a healthcare provider.

With the FDA’s emergency use authorization, Paxlovid was made available for people who meet the following criteria:

     • Tested positive for COVID-19 and have not yet been admitted to the hospital 

     • Are at high risk for developing severe COVID-19 

     • Are 12 years old or older

     • Weigh at least 88 pounds

     • Developed symptoms within the past five days

And molnupiravir was made available to people who meet the following criteria:

     • Tested positive for COVID-19 and have not yet been admitted to the hospital 

     • Are at high risk for developing severe COVID-19 

     • Have no alternative FDA-authorized COVID-19 treatment options available to them 

     • Are 18 years old or older

     • Developed symptoms within the past five days 

+What's the difference between these two medications?

Both Paxlovid (from Pfizer) and molnupiravir (from Merck) are antivirals. They work to keep the virus that causes COVID-19 from replicating. This reduces a person’s viral load, which can help reduce symptom severity.

Each medication achieves this in a slightly different way. 

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

Nirmatrelvir disrupts a protease function that is necessary for the virus’s survival, causing the virus to die. Ritonavir helps keep nirmatrelvir from being broken down before it has completed its job.

Paxlovid is administered via three tablets (two tablets of nirmatrelvir and one tablet of ritonavir) taken orally twice daily for five days.

Molnupiravir works by introducing mistakes into the virus’s genetic code, thus preventing the virus from replicating properly. This drug looks like a building block in the virus’s RNA genetic code, and when the virus tries to replicate and make more copies of itself, the block gets inserted into the viral code — and because it’s a fake block, the code doesn’t work and the virus dies.

Molnupiravir is administered via four tablets taken orally every 12 hours for five days.

There are some other important differences between the two antiviral medications: 

nirmatrelvir and ritonavir

     • Paxlovid has many common known interactions with other medications (which must be evaluated before a physician can decide to prescribe it), but moluniparvir has no known interactions.

     • Paxlovid is not recommended for people with very advanced renal or liver disease. 

     • Molnupiravir is not recommended for children or for people who are pregnant.

+ Can I take these medications if I’ve tested positive but have not developed symptoms yet?

If you've tested positive for COVID-19, make an appointment with your healthcare provider as soon as possible to discuss whether this treatment may be right for you. (Antiviral treatment is currently indicated only for people who have active symptoms.) 

For antiviral pills to be most effective, they need to be taken as early in the course of the disease as possible. 

+ How effective are these treatments? 

While data is still somewhat limited, in one study Paxlovid was found to reduce hospital admission or death by about 88 percent in people who had COVID-19 (compared with placebo), as long as they had received the medication within five days of symptom onset. 

Molnupiravir has a lower efficacy rate than Paxlovid; the rate of reduced hospitalization or death was shown in one study to be about 30 percent (compared with placebo); however, newer data is indicating a greater rate of reduction.

+ Do these medications protect against infection with COVID-19?

These medications are currently prescribed only for the treatment of symptoms and active infection. They are not currently recommended for prophylactic (preventive) use; however, studies in this area are ongoing.

+ Why are these medications only for people with mild to moderate symptoms, and not severe symptoms?

These medications are meant to be prescribed on an outpatient basis. People with severe symptoms of COVID-19 will likely need a higher level of care, such as oxygen support and other interventions, in addition to close monitoring. 

+ If I take these medications after developing COVID-19 symptoms, do I still need to isolate for the recommended amount of time?

Yes. These medications alleviate COVID-19 symptoms and can prevent the progression of the illness, but you should isolate as recommended for all people who contract COVID-19, to avoid spreading the virus. Follow these current isolation guidelines from the CDC (U.S. Centers for Disease Control and Prevention). 

+ Do these medications have side effects?

Some people have experienced side effects with these medications, including:

     • Altered or impaired sense of taste (with Paxlovid)

     • Increased blood pressure (with Paxlovid)

     • Dizziness (with molnupiravir)

     • Diarrhea 

     • Gastrointestinal discomfort or distress

In addition, Paxlovid interacts with many common medications, including over-the-counter medications, so it’s important to discuss all of your current medications and supplements with your healthcare provider before starting a treatment course. 

+ Now that these treatments are available, do I still need to get vaccinated? 

Yes. These medications do not prevent infection by or transmission of COVID-19. The best way to protect yourself (both from infection and from severe illness if you do become infected) and the people around you is to stay up-to-date with all vaccinations and boosters. 

Carbon Health Complete COVID-19 Care

Carbon Health is a leader when it comes to providing comprehensive COVID-19 care for patients. From testing and vaccination to medication, treatment, and aftercare, our care teams are prepared to get patients the care they need, when they need it. If you have questions or concerns about COVID-19, download the Carbon Health app or visit carbonhealth.com to make a virtual or in-person appointment with a healthcare provider, or visit our COVID-19 Care Center.

Carbon Health’s medical content is reviewed and approved by healthcare professionals before it is published. But note that our knowledge and understanding of COVID-19 are developing and changing very rapidly; if you have questions or concerns about COVID-19 precautions, treatments, and vaccinations, please talk to your healthcare provider.


Aaron S. Weinberg MD, MPhil

Aaron S. Weinberg, MD, MPhil, is Director of Program Development at Carbon Health and triple board-certified in Pulmonary, Critical Care, and Internal Medicine.


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