Nirmatrelvir-RitonavirNirmatrelvir/Ritonavir

About Nirmatrelvir-Ritonavir

Paxlovid is two medicines packed together: nirmatrelvir, an antiviral that blocks an enzyme the COVID-19 virus needs to multiply, and ritonavir, a booster that raises the amount of nirmatrelvir in the blood. The FDA approved it in May 2023 for mild to moderate COVID-19 in adults at high risk of progressing to severe illness, including hospitalization or death. The approval covers adults only (the label says the right dose for children has not been established), and it is not approved to prevent COVID-19. Treatment starts as soon as possible after diagnosis and within 5 days of symptom onset. The usual dose is two nirmatrelvir 150 mg tablets with one ritonavir 100 mg tablet, together twice a day for 5 days.

The boxed warning is about drug interactions. Ritonavir strongly blocks CYP3A, a liver enzyme that clears many medicines, so other drugs can build up and cause severe, life threatening or fatal effects; the prescriber must review every medicine first. It must not be combined with certain drugs that depend on that enzyme, such as some heart rhythm medicines, ergot drugs, and triazolam or midazolam by mouth, or with drugs that speed the enzyme up, such as rifampin, carbamazepine and St. John’s wort. Other warnings cover serious allergic and skin reactions, liver injury, and HIV drug resistance in people with uncontrolled or undiagnosed HIV. The most common side effects are an altered sense of taste and diarrhea.

Kidney function sets the dose pack. Moderate kidney impairment calls for nirmatrelvir 150 mg with ritonavir 100 mg twice a day; severe impairment, including hemodialysis, calls for 300 mg with 100 mg once on day 1, then 150 mg with 100 mg once a day on days 2 to 5, given after dialysis on dialysis days. It is not recommended in severe liver impairment. Ritonavir weakens combined hormonal birth control, so a backup method is used. Data in pregnancy are too limited to judge risk.

Taking Nirmatrelvir-Ritonavir

How to take it

Take the nirmatrelvir and ritonavir tablets together, twice a day at about the same times, for 5 days, with or without food. Swallow the tablets whole; do not chew, break or crush them. Finish the full course.

If you miss a dose

If you are 8 hours late or less, take the missed dose as soon as you remember and then return to your usual schedule. If you are more than 8 hours late, skip it and take the next dose at the usual time; do not double a dose.

Storage

Keep the tablets in their original pack at room temperature, away from heat and moisture, and out of reach of children.

Interactions to know about

Tell the prescriber and pharmacist about every medicine and supplement, including St. John’s wort, and about HIV, kidney or liver disease, pregnancy or breastfeeding. If you use hormonal birth control, also use a non-hormonal method while taking it and until one menstrual cycle after stopping.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Nirmatrelvir-Ritonavir differs from pharmacy to pharmacy

Paxlovid is a brand from a single maker, so quotes are for the same product priced as a brand, and differences come from each pharmacy’s cash pricing. A course is one dose pack, with no larger package to spread the cost.

The three dose packs are different products. A pharmacy that stocks only the standard pack may need to order a kidney dose pack, which can change the quote and delay the start.

Ways to pay less for Nirmatrelvir-Ritonavir without insurance

• Ask whether the exact dose pack on your prescription is in stock today, since treatment must start within 5 days of symptoms.
• Compare quotes from more than one pharmacy.
• Ask the maker whether its patient assistance or savings program applies to someone paying cash; many copay programs require commercial insurance.
• Bring a full list of your medicines and supplements so interactions are sorted out before the fill.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Nirmatrelvir-Ritonavir

1. 1.Do any of my medicines or supplements interact with my Paxlovid?
2. 2.Which tablets from my dose pack do I take at each dose?
3. 3.What should I do about my hormonal birth control during and after my course?
4. 4.Which side effects mean I should stop taking it and call my prescriber right away?

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