You'll start to see Rxs for two new oral antivirals to treat COVID-19, Paxlovid (nirmatrelvir/ritonavir) or molnupiravir.
Either is an option for patients with mild to moderate COVID-19 who are at high risk of developing serious illness (age 65 or older, diabetes, etc)...regardless of vaccination status.
Be ready to handle these Rxs correctly...and ensure safe use.
Paxlovid will be first-line...since it seems more effective.
Verify the patient's age and weight. Paxlovid is for patients age 12 and over...who weigh at least 40 kg (88 lb).
Expect most patients to take 3 tablets... 2 nirmatrelvir tabs plus 1 ritonavir tab...bid for 5 days. They come in a blister pack.
But check sigs and Rx notes closely.
Some patients with kidney disease need a lower dose. They'll take just ONE nirmatrelvir tab bid...but the ritonavir dose won't change.
In this case, discard one AM and PM nirmatrelvir tab from all 5 blister cards...and cover empty blisters with manufacturer stickers.
Update patient profiles with current meds...and notify your pharmacist about drug interaction alerts. Paxlovid may impact blood levels of clopidogrel, statins, and many other meds.
Molnupiravir will be used when other treatments aren't available.
It's for patients age 18 and up...and is 4 caps bid for 5 days.
Ask patients about their pregnancy status. Pregnant patients should generally avoid molnupiravir...since animal studies suggest it may cause birth defects.
Patients with reproductive potential must use reliable contraception during use...and for 4 DAYS afterward in women, and at least 3 MONTHS afterward in men.
Keep in mind, Paxlovid or molnupiravir should be started within 5 days of symptom onset.
To help find stock, use the govt COVID-19 Therapeutics Locator.
Clarify that patients don't currently have to pay for these meds.
But follow pharmacy guidance when billing. For example, you may need to submit a professional service code...to try to get reimbursed for the cost of pharmacist counseling and dispensing.
Remind patients who are prescribed Paxlovid or molnupiravir to use delivery, drive-through, or curbside services...to limit exposure.
Compare COVID-19 oral antivirals to injectable monoclonal antibodies with our chart, Treatments of Interest for COVID-19.
- https://www.fda.gov/media/155050/download (1-27-22)
- N Engl J Med. 2021 Dec 16. doi: 10.1056/NEJMoa2116044
- https://www.covid19treatmentguidelines.nih.gov/therapies/statement-on-therapies-for-high-risk-nonhospitalized-patients/ (1-27-22)
- https://www.covid19treatmentguidelines.nih.gov/therapies/statement-on-patient-prioritization-for-outpatient-therapies/ (1-27-22)
- https://www.covid19treatmentguidelines.nih.gov/therapies/statement-on-paxlovid-drug-drug-interactions/ (1-27-22)