Lethe200
Senior Member
- Location
- San Francisco Bay Area
New Antiviral Pills Help Treat Covid. Here’s How to Get Them.
Here are some of the most common questions about the new antiviral pills, and how the new program “test to treat” works.
NY Times March 25, 2022 (Note: edited for length)
What are antiviral drugs and how do they work?
Antiviral medications have been around since the 1960s in the form of pills, intravenous solutions, ointments and even eye drops. They exist for only a handful of viruses, including H.I.V., the herpes simplex viruses, hepatitis B and C viruses, influenza A and B, and now the coronavirus. Tamiflu is one of the most well-known antivirals.
Most antivirals work by suppressing a virus’s ability to infect and multiply in your cells, said Dr. Rajesh Gandhi, infectious diseases physician at Massachusetts General Hospital. This helps the body fight off an active infection by easing the symptoms and shortening the length of the illness.
But the exact way an antiviral does this depends on the treatment you use. Some antivirals prevent viruses from spreading to healthy cells by blocking the receptors on cell surfaces. Others inhibit the machinery that a virus needs to make copies of itself once it has already barged inside your cells. Because of this, it has been notoriously difficult for researchers to develop antiviral medicines that blunt viral replication without harming the human cells they hide inside, Dr. Gandhi said.
What antiviral treatments are available for Covid-19?
There are two oral antiviral therapies currently available to treat Covid-19 in the United States. (The FDA has also cleared an intravenous antiviral medication from Gilead Sciences called remdesivir, but it is usually administered at a clinic or infusion center.)
One, called Paxlovid, was developed by Pfizer and was the first oral treatment authorized for high risk Covid-19 patients ages 12 and older in December. It is prescribed as three pills taken twice a day for five days.
The second drug, called Molnupiravir, was developed by Merck and was granted emergency use authorization just one day after the Pfizer treatment in December. Molnupiravir, taken as four pills taken twice a day for five days, is available for high-risk adults ages 18 and older.
How effective are Covid antivirals?
Both Paxlovid and molnupiravir have been shown to reduce hospitalization and death from Covid-19 if taken early on in the course of an infection. “They are most effective when used within a few days of the onset of symptoms,” Dr. Gandhi said.
In a Pfizer trial published December 2021 and conducted before the Omicron wave, Paxlovid reduced the risk of hospitalization and death in high-risk, unvaccinated people by 88% when given within five days of symptom onset.
Molnupiravir has been shown to be less effective. One analysis from Merck, also published that same month, showed it reduced the risk of hospitalization and death in high-risk, unvaccinated adults with Covid-19 by only 30% if taken within five days of symptom onset.
Because of this lower efficacy, Dr. Gandhi said that “most clinicians, including myself, prefer Paxlovid if it’s available and if a person doesn’t take any other medications that make Paxlovid a problem for them.”
Who is eligible for antiviral pills?
Not everyone who tests positive for Covid-19 will get a prescription for antiviral pills. To be eligible, you must test positive and have symptoms that started within five days or fewer. You must also be at increased risk of developing severe Covid-19.
Those who are asymptomatic, or who have symptoms but are not higher risk, will not be eligible.
While this may seem like very specific criteria, many people in the United States do have medical conditions that would qualify them for the high-risk category. That includes all adults 65 and older, as well as those of any age with certain health conditions like heart disease, cancer, diabetes or obesity.
It’s important that you get treatment within five days of the start of your symptoms. That’s soon because people often don’t test the first day they have symptoms. You might feel a little bit lousy and think maybe you just have a cold that’ll go away. But if you wait more than five days, you will no longer be able to take the oral medicines.
Although federal guidelines prioritize treatment for those who are unvaccinated or who are not fully vaccinated and boosted, your vaccination status will not affect your eligibility.
How do I get antiviral pills for Covid-19?
First, you must test positive with a P.C.R. or rapid test. This can be done at home, at a regular health care provider’s office, at a testing site or at one of the pharmacy chains, community health centers, long-term-care facilities or VA clinics participating in the “test to treat” program.
If you test positive at a participating location that dispenses antivirals and has an authorized medical provider, you can get a Covid-19 pill prescription (if eligible) and fill it on the spot. If you test positive at a different testing site or through an at-home testing kit, you can schedule an online or in-person visit with a provider at a “test to treat” location to get and fill a prescription as well.
Just like with other medications, your regular health care provider can call in a prescription to a pharmacy for you. A federal “test to treat” website, expected to go live soon, will include locations that test for the coronavirus and dispense antiviral treatments on the spot.
How much do the drugs cost?
Covid-19 antiviral pills are free of charge – for now. This may change once federal supplies start to run out. The pandemic relief money that covered Covid-19 testing and treatment for the uninsured ended late Tuesday, and it is unclear if Congress will approve new funding to extend the program.
Should I worry about any side effects?
Most people who take Paxlovid don’t experience serious side effects, though some may have diarrhea, muscle pain or an altered sense of taste. These, coincidentally, can also be symptoms of Covid-19. Paxlovid should not be given to those with serious liver disease.
Certain medications or supplements, including painkillers, statins and even St. John’s Wort, may have adverse interactions with Paxlovid. So you may be advised to hold off on taking them for a week while being treated. But for some medications, like drugs that regulate heart rhythm, abstaining for a week may not be possible. In those cases, your doctor may recommend molnupiravir for Covid-19 instead.
Molnupiravir has no known interactions with other medications. Possible side effects can include diarrhea, nausea and dizziness. The drug is not authorized for anyone under 18 years old because it may affect bone and cartilage growth. Molnupiravir cannot be used during pregnancy because of the potential harm to the fetus.
For this reason, doctors may also recommend that sexually active men and women of childbearing age use contraception during treatment and for a period afterward (three months for men and four days for women). Those who are breastfeeding should consider pumping and discarding breast milk during treatment and for four days after the last dose.
Do I still need to get vaccinated after taking an antiviral drug?
Absolutely. Experts recommend that everyone, regardless of whether you’ve had Covid-19 or received antiviral medication in the past, get a primary vaccine series and booster shot to protect against the coronavirus. (Some people with weakened immune systems are now eligible for a fourth dose.)
The anti-virals are NOT meant to be a substitute for vaccination. Nor are they meant to be a substitute for isolation if you’re sick with symptoms. You should still follow the same isolation guidelines as everyone else to reduce the chances of infecting others.
Here are some of the most common questions about the new antiviral pills, and how the new program “test to treat” works.
NY Times March 25, 2022 (Note: edited for length)
What are antiviral drugs and how do they work?
Antiviral medications have been around since the 1960s in the form of pills, intravenous solutions, ointments and even eye drops. They exist for only a handful of viruses, including H.I.V., the herpes simplex viruses, hepatitis B and C viruses, influenza A and B, and now the coronavirus. Tamiflu is one of the most well-known antivirals.
Most antivirals work by suppressing a virus’s ability to infect and multiply in your cells, said Dr. Rajesh Gandhi, infectious diseases physician at Massachusetts General Hospital. This helps the body fight off an active infection by easing the symptoms and shortening the length of the illness.
But the exact way an antiviral does this depends on the treatment you use. Some antivirals prevent viruses from spreading to healthy cells by blocking the receptors on cell surfaces. Others inhibit the machinery that a virus needs to make copies of itself once it has already barged inside your cells. Because of this, it has been notoriously difficult for researchers to develop antiviral medicines that blunt viral replication without harming the human cells they hide inside, Dr. Gandhi said.
What antiviral treatments are available for Covid-19?
There are two oral antiviral therapies currently available to treat Covid-19 in the United States. (The FDA has also cleared an intravenous antiviral medication from Gilead Sciences called remdesivir, but it is usually administered at a clinic or infusion center.)
One, called Paxlovid, was developed by Pfizer and was the first oral treatment authorized for high risk Covid-19 patients ages 12 and older in December. It is prescribed as three pills taken twice a day for five days.
The second drug, called Molnupiravir, was developed by Merck and was granted emergency use authorization just one day after the Pfizer treatment in December. Molnupiravir, taken as four pills taken twice a day for five days, is available for high-risk adults ages 18 and older.
How effective are Covid antivirals?
Both Paxlovid and molnupiravir have been shown to reduce hospitalization and death from Covid-19 if taken early on in the course of an infection. “They are most effective when used within a few days of the onset of symptoms,” Dr. Gandhi said.
In a Pfizer trial published December 2021 and conducted before the Omicron wave, Paxlovid reduced the risk of hospitalization and death in high-risk, unvaccinated people by 88% when given within five days of symptom onset.
Molnupiravir has been shown to be less effective. One analysis from Merck, also published that same month, showed it reduced the risk of hospitalization and death in high-risk, unvaccinated adults with Covid-19 by only 30% if taken within five days of symptom onset.
Because of this lower efficacy, Dr. Gandhi said that “most clinicians, including myself, prefer Paxlovid if it’s available and if a person doesn’t take any other medications that make Paxlovid a problem for them.”
Who is eligible for antiviral pills?
Not everyone who tests positive for Covid-19 will get a prescription for antiviral pills. To be eligible, you must test positive and have symptoms that started within five days or fewer. You must also be at increased risk of developing severe Covid-19.
Those who are asymptomatic, or who have symptoms but are not higher risk, will not be eligible.
While this may seem like very specific criteria, many people in the United States do have medical conditions that would qualify them for the high-risk category. That includes all adults 65 and older, as well as those of any age with certain health conditions like heart disease, cancer, diabetes or obesity.
It’s important that you get treatment within five days of the start of your symptoms. That’s soon because people often don’t test the first day they have symptoms. You might feel a little bit lousy and think maybe you just have a cold that’ll go away. But if you wait more than five days, you will no longer be able to take the oral medicines.
Although federal guidelines prioritize treatment for those who are unvaccinated or who are not fully vaccinated and boosted, your vaccination status will not affect your eligibility.
How do I get antiviral pills for Covid-19?
First, you must test positive with a P.C.R. or rapid test. This can be done at home, at a regular health care provider’s office, at a testing site or at one of the pharmacy chains, community health centers, long-term-care facilities or VA clinics participating in the “test to treat” program.
If you test positive at a participating location that dispenses antivirals and has an authorized medical provider, you can get a Covid-19 pill prescription (if eligible) and fill it on the spot. If you test positive at a different testing site or through an at-home testing kit, you can schedule an online or in-person visit with a provider at a “test to treat” location to get and fill a prescription as well.
Just like with other medications, your regular health care provider can call in a prescription to a pharmacy for you. A federal “test to treat” website, expected to go live soon, will include locations that test for the coronavirus and dispense antiviral treatments on the spot.
How much do the drugs cost?
Covid-19 antiviral pills are free of charge – for now. This may change once federal supplies start to run out. The pandemic relief money that covered Covid-19 testing and treatment for the uninsured ended late Tuesday, and it is unclear if Congress will approve new funding to extend the program.
Should I worry about any side effects?
Most people who take Paxlovid don’t experience serious side effects, though some may have diarrhea, muscle pain or an altered sense of taste. These, coincidentally, can also be symptoms of Covid-19. Paxlovid should not be given to those with serious liver disease.
Certain medications or supplements, including painkillers, statins and even St. John’s Wort, may have adverse interactions with Paxlovid. So you may be advised to hold off on taking them for a week while being treated. But for some medications, like drugs that regulate heart rhythm, abstaining for a week may not be possible. In those cases, your doctor may recommend molnupiravir for Covid-19 instead.
Molnupiravir has no known interactions with other medications. Possible side effects can include diarrhea, nausea and dizziness. The drug is not authorized for anyone under 18 years old because it may affect bone and cartilage growth. Molnupiravir cannot be used during pregnancy because of the potential harm to the fetus.
For this reason, doctors may also recommend that sexually active men and women of childbearing age use contraception during treatment and for a period afterward (three months for men and four days for women). Those who are breastfeeding should consider pumping and discarding breast milk during treatment and for four days after the last dose.
Do I still need to get vaccinated after taking an antiviral drug?
Absolutely. Experts recommend that everyone, regardless of whether you’ve had Covid-19 or received antiviral medication in the past, get a primary vaccine series and booster shot to protect against the coronavirus. (Some people with weakened immune systems are now eligible for a fourth dose.)
The anti-virals are NOT meant to be a substitute for vaccination. Nor are they meant to be a substitute for isolation if you’re sick with symptoms. You should still follow the same isolation guidelines as everyone else to reduce the chances of infecting others.
