COVID -19 Provider Information

COVID Treatment Update:

Last December, the FDA issued an emergency use authorization for Paxlovid (nirmatrelvir/ritonavir; Pfizer) and Lageviro (molnupiravir; Merck) for treatment of mild-to-moderate COVID-19 infections.

Both therapies are now widely available in community pharmacies. And while infection and hospitalization rates have declined, higher-risk patients are still getting sick and requiring hospitalization. Early treatment with Paxlovid and other treatments can make a difference.

Oral Therapies for COVID-19: Tools and Resources

When to Prescribe?

Lageviro and Paxlovid should be started within 5 days of symptoms onset.

For patients who:

  • Test positive for COVID-19 (not currently approved for pre- or post-exposure prophylaxis).
  • Are high risk for progression to severe COVID-19, including hospitalization or death, including1:
    • Older Adults
    • Chronic Kidney, liver or lung disease
    • Dementia or Alzheimer’s
    • Diabetes
    • A disability
    • Heart Condition
    • HIV Infection
    • Tuberculosis
    • Mental Health Conditions
    • Overweight or Obese
    • Physically inactive
    • Pregnancy
    • Sickle cell disease or thalassemia
    • Current or former smoker
    • Transplant recipient
    • Stroke or cerebrovascular disease
    • Substance usedisorder
    • Immunocompromised condition or weakened immune system

  • Are adults (Paxlovid can be prescribed to children ages 12 and older weighing at least 40 kg).
  • Lageviro should be used only when treatment with another therapy is not appropriate or accessible.

When NOT to Prescribe?

  • Lageviro and Paxlovid should not be used as pre- or post-exposure prophylaxis or prevention of COVID-19.
  • Certain medications may interact with Paxlovid. Check interactions here.
  • Patients with severe liver and/or kidney impairment should not take Paxlovid.
  • Lageviro should not be prescribed to children. Children ages 12 and older (weighing at least 40 kg) are approved to take Paxlovid.
  • Patients requiring COVID-19 related hospitalization should not start therapy with one of these medications.
  • Contraindications for Paxlovid and Lageviro are listed below.

Paxlovid

Lageviro

Less than 12 years old or less than 40 kg

Less than 18 years old (may affect bone and cartilage growth)

Requires hospitalization due to COVID-19

Requires hospitalization due to COVID-19

Severe renal impairment (eGFR < 30 mL/min)*

Pregnancy (not recommended, could be considered in certain individuals)

Severe hepatic impairment (Child-Pugh Class C)

Breastfeeding

History of hypersensitivity reaction to nirmatrelvir or ritonavir or any other components

Co-administration with CYP3A metabolized drugs or inducers of CYP3A (see notes below for list of Drug-Drug Interactions)

* Dose reduction for moderate renal impairment (eGFR ≥30 to <60 mL/min): 150mg nirmatrelvir (one 150 mg tablet) with 100 mg ritonavir (one 100 mg tablet), with both tablets taken together twice daily for 5 days

How effective is therapy?

Clinical trials showed:

  • Paxlovid .reduced hospitalization or death risk by 88%
  • Lageviro reduced hospitalization or death risk by  30%

Because Lageviro is less effective, Paxlovid is preferred. Lageviro is reserved for patients who are not good candidates for other treatment options.

What are common adverse reactions?

Paxlovid

Lageviro

  • Diarrhea
  • Diarrhea
  • Dysgeusia
  • Nausea
  • Hypertension
  • Dizziness
  • Myalgia

 


Which treatment should I choose?

This is dependent on the individual patient. Paxlovid is generally preferred, but due to more contraindications to use and drug interactions, may not be a good option for all patients. In these instances, Lageviro is preferred.

What is the treatment schedule?

Both drugs should be started within 5 days of symptom onset.

Paxlovid (ritonavir – nirmatrelvir): nirmatrelvir 300 mg with ritonavir 100 mg orally twice daily for 5 days. For those with moderate renal impairment (eGFR ≥30 to <60 mL/min): 150 mg nirmatrelvir (one 150 mg tablet) with 100 mg ritonavir (one 100 mg tablet), with both tablets taken together twice daily for 5 days.

Lageviro: molnupiravir 800 mg orally twice daily for 5 days

Which pharmacies have treatments?

Both Paxlovid and Lageviro are now available at over 50,000 pharmacies  across the country.

 
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