Would you take Paxlovid (Covid antiviral)

[Shelydon]

I have Covid-- I am pretty sick, but not more than the flu.  My doctor called in Paxlovid if I wanted to take it.  I guess I feel like maybe I am not sick enough, but maybe it will cut time off my illness? 

[Pam in CT]

What concerns or reservations are holding you back?

 

(I just finished a round of it today)

[Shelydon]

 

1 minute ago, Pam in CT said:

What concerns or reservations are holding you back?

 

(I just finished a round of it today)

Honestly, not sure.  I guess I am worried about side effects. 

[AmandaVT]

I took it with very mild symptoms and I was happy I did. Symptoms were gone quickly - I had been worried they would worsen. I have asthma and was not looking forward to a round of bronchitis. My only side effect was a bad taste in my mouth for a few hours after each dose. I tested negative on day 5 and had no rebound symptoms. Hope you feel better quickly whether you take it or not!

[Pawz4me]

Yes, I would take it if my doctor(s) recommended it. But I'm immunocompromised, so YMMV.

[Shelydon]

1 minute ago, AmandaVT said:

I took it with very mild symptoms and I was happy I did. Symptoms were gone quickly - I had been worried they would worsen. I have asthma and was not looking forward to a round of bronchitis. My only side effect was a bad taste in my mouth for a few hours after each dose. I tested negative on day 5 and had no rebound symptoms. Hope you feel better quickly whether you take it or not!

Thanks.  I have asthma as well.  I think I'll give it a try

[Pam in CT]

The only side effect I experienced was a bitter / acrid taste in my mouth, which I guess is pretty common.

I've been rapid testing daily since my husband is living in our in law apartment in hopes of avoiding it.  Today (day 5 of the Paxlovid, and day 7 since I first tested positive) I was *almost* clear, but a faint line appeared at the 15th minute, so I expect to be clear tomorrow.

I was pretty sick before I started it (I'm as vaxxed as can be; no underlying conditions or complications). My doctor warned that in about 30% of cases, symptoms clear with Paxlovid but then get a "Paxlovid rebound" once the patient finishes the 5 day protocol. We'll see if that happens, but I figured I was 100% miserable (not go-to-the-ER sick, but definitely exhausted-by-the-effort-of-flipping-the-laundry, bad sore throat and bad headaches) and therefore a 30% chance of rebound symptoms was preferable to continuation of 100% miserable, kwim?

Hope you feel better soon.

[stephanier.1765]

I'm glad you asked and I'm happy with the responses. My mother's doctor called in a prescription for her and I'm hoping she has the same great results. She will have to stop taking her cholesterol medication for ten days and she was warned about the yucky taste in the mouth but of those are pretty minor compared to what can happen. I sure wish my father could have gotten some but it's too late now.

BTW, I'm pretty proud of my 77 yo mother, who has only had a smart phone for a couple of months, was able to manage on her own to set up a virtual appointment. She said it only worked in the bathroom 🤷‍♀️ but I'm impressed nonetheless.

[dsmith]

I didn't bother with it as I could tell I was less sick than with seasonal flu. If I had asthma or was currently on a dmt for MS I probably would have. If mil tests positive we will definitely ask for it, or dh as a smoker. What I did do was immediately start taking Mucinex (the regular, guinanesin only) 400 mg every 4 hours with a full glass of water. This has saved me from developing pneumonia/ bad bronchitis in the past, and they sent my brother home with it after being hospitalized with covid, so I decided better safe than sorry. 

[Shelydon]

4 minutes ago, Pam in CT said:

The only side effect I experienced was a bitter / acrid taste in my mouth, which I guess is pretty common.

I've been rapid testing daily since my husband is living in our in law apartment in hopes of avoiding it.  Today (day 5 of the Paxlovid, and day 7 since I first tested positive) I was *almost* clear, but a faint line appeared at the 15th minute, so I expect to be clear tomorrow.

I was pretty sick before I started it (I'm as vaxxed as can be; no underlying conditions or complications). My doctor warned that in about 30% of cases, symptoms clear with Paxlovid but then get a "Paxlovid rebound" once the patient finishes the 5 day protocol. We'll see if that happens, but I figured I was 100% miserable (not go-to-the-ER sick, but definitely exhausted-by-the-effort-of-flipping-the-laundry, bad sore throat and bad headaches) and therefore a 30% chance of rebound symptoms was preferable to continuation of 100% miserable, kwim?

Hope you feel better soon.

I feel pretty awful.  Congestion, super sore throat, and having an illness irritates my asthma and makes me cough.  But my 02 sats are perfect and I can do things.  I am not THAT sick, IYKWIM.   Two of my kids tested positive too.  They feel better than I do.  We are all vaxxed and boosted.

[whitestavern]

I would not but I wasn’t even sick enough to call my dr and I don’t have any underlying health conditions. Plus I’d not want to deal with a potential rebound infection. 

[AmandaVT]

16 minutes ago, Shelydon said:

I feel pretty awful.  Congestion, super sore throat, and having an illness irritates my asthma and makes me cough.  But my 02 sats are perfect and I can do things.  I am not THAT sick, IYKWIM.   Two of my kids tested positive too.  They feel better than I do.  We are all vaxxed and boosted.

My good friend also has asthma and had similar symptoms. She didn't call in time for Paxlovid and she's still dealing with symptoms - she had a positive test the last week of April, so it's closing in on 6 weeks. 

[Shoeless]

Yes, I would take it. My sister has Covid, got paxlovid, and was better in about a week. Sense of smell is still compromised, but she can taste. 

She said the paxlovid made her nauseated to the point of being unable to sleep, so her doctor called in zofran, which helped. She feels the benefits of paxlovid outweighed the negatives. 

[Farrar]

I might be on the fence. The two main issues with it… the extension of testing positive and the gastrointestinal stuff… would weigh against it if I wasn’t feeling that sick. If it was flu level though, I’d take it.

[Elona]

I'd reccomend it. I got a prescription on my second day, and though I hadn't been horrible I'll those first two days, my heartrate was really high. On the third day, justbefore starting it, o got worse pretty quick and it scared me.

I had a terrible taste in my mouth for 20 hours of every day. I suggest getting a very minty gum!

My symptoms improved a lot during the 5 days I was on it, but as soon as I completed the course I went downhill. The Paxlovid got me past the worst symptoms though. I was mostly just incredibly exhausted and getting a cough for the following 2 weeks - I was basically bed bound for a total of nearly three weeks, and I hate to think how it could have gone if I hadn't taken the Paxlovid.

I finally figured out that lots of vitamin C throughout the day was key to getting my energy back.

Good luck!

[TCB]

39 minutes ago, whitestavern said:

I would not but I wasn’t even sick enough to call my dr and I don’t have any underlying health conditions. Plus I’d not want to deal with a potential rebound infection. 

If you listen to TWIV they say that the rebound thing is actually a function of the natural disease, without Paxlovid, in about 30% of cases.

[Spryte]

I would take it, but I’m immune compromised and currently being treated for an abx resistant infection — having anything on top of that would be nightmare-ish. But I would take it nervously, and I’m fairly sure my doc would order some blood work to make sure everything was good (specifically LFTs, though that’s just me, I haven’t heard anything about elevated LFTs and Paxlovid).

[Ausmumof3]

Do you have added risk factors? It can extend your period of contagious time so you may need to isolate for longer. If that doesn’t worry you then go for it. I am also seeing some concerns that overuse will accelerate virus evolution possibly making it less effective for vulnerable people. I haven’t looked into those claims to know if they have a sound basis or not. If you’re high risk I’d ignore that and take it obviously.

Edited June 7, 2022 by Ausmumof3

[Catwoman]

2 hours ago, Shelydon said:

I have Covid-- I am pretty sick, but not more than the flu.  My doctor called in Paxlovid if I wanted to take it.  I guess I feel like maybe I am not sick enough, but maybe it will cut time off my illness? 

I hope the Paxlovid works quickly and that you feel much better very soon!

[itsheresomewhere]

For me- no.  

[wathe]

 Personally, I wouldn't take it. I am fully vaccinated, under age 60, not immune-compromised, and no other risk factors.   The limited evidence available suggests that there may be no meaningful benefit for someone like me.

If I were unvaccinated or immune compromised, and didn't have significant drug-drug interaction risks,  I would take it.

EPIC-HR showed 89% Relative Risk Reduction in disease specific hospitalization and death, but was limited to unvaccinated patients with at least one risk factor, during delta, and the analysis was done on those who started their course within 3 days of symptoms.  This trial was Pharma-funded and pharma-run, and, IMO, tweaked to favour a favourable outcome.  The drug was approved based on data from this study.

EPIC-SR enrolled vaccinated patients and also enrolled patients without risk factors.  Interim analysis (press release) showed primary outcome of symptom reduction was not met, and secondary outcome of decreased hospitalization and death was not statistically significant.  

Very recent real world study based on Israeli medical records showed 46% RRR on a population that was about 75% vaxed.  But subgroup analysis showed non-significance for age <60.  Significant limitations and confounders - big differences between the population that got treatment (higher SES, Jewish) vs did not (lower SES, Arab) etc.  

My prediction is that the evidence will eventually show that this drug doesn't make a meaningful difference in outcome for vaccinated, under-60-year-olds who don't have risk factors.

Drug interactions are numerous and problematic. 

Side effects:  dysgeusia (bad taste in mouth) 100% in real world (vs 20% reported in Pfizer trial), nausea, vomiting, diarrhea, headache, hypertension.

Rebound after Paxlovid  is a thing.  I don't think anyone is sure what to make of it yet.

[Clarita]

I'm not going to take it because my COVID isn't so bad. No fever, my nose drips once every 30min and I cough 3 times a day. The isolation/quarantine is worse than my symptoms.

[Grace Hopper]

Sorry I didn’t read all the replies - and I may be too late for my contribution to matter. I was just in with my doc this morning, asking about covid stuff, and she said that she is seeing really good results with paxlovid and that none of her patients have reported the sort of side effects that many reported with tamiflu (which was my concern since I did not enjoy the one time I took tamiflu).

 

I hope you feel better soon!

[Shelydon]

I have had two doses so far.  My sore throat has greatly improved.  Still have significant cough and congestion, but I generally feel better.

[YaelAldrich]

Out of the three of us who had COVID recently my DH took it and the DD and I did not.  I called our state's Paxlovid telehealth line ( I love living in Massachusetts!).  They said with the liver stuff I have I might not want to and to contact my liver specialist.  I decided my run of COVID wasn't that bad.  I encouraged my DH to take it because I hoped he would become COVID negative faster so he could go to Japan.  It did help and he was negative 3 days faster than the rest of us.  He feels fine and so do the rest of us who didn't take Paxlovid.  He did have the bad taste side effect.  He complained about that a lot. 🙄

[Amethyst]

Yes I would take it. 

[73349]

I'd be inclined to take it in hopes of averting a worsening of symptoms, unless my doctor had any concerns that it would be unsuitable for me.

[skimomma]

I just had Covid and am still suffering the aftereffects, but I would not have taken it if it was an option (it was not).  The risk of extended isolation and the side effects are concerning for me.  I had a "mild" case but am still dealing with annoying, but not debilitating, aftereffects and I am under 60, triple vexed, and in good health, so I am guessing it would not have made much difference.  If this turns into long covid, I will be singing a different tune.   

[Shelydon]

I feel hugely better 24 hours after starting the first dose.  I too had "mild" symptoms, but I am glad I started it.  I have zero side effects so far. Sore throat is gone and cough has greatly reduced. 

[Catwoman]

I'm so glad you're feeling so much better, @Shelydon!!!

[Ting Tang]

I hate being sick, and I am still afraid of suffering through Covid.  I will probably take it.  I mean at one point my husband ordered Ivermectin on the Internet to have on hand, and I talked him into canceling the order, LOL.  (We have not been on the same page, though he did get his two Pfizer doses, refuses to be boosted now.)  I will probably beg for it.  I don't quite understand the whole rebound thing---does it sometimes not clear enough out, and the virus replicates?  Maybe that sounds stupid, but I feel it is worth a chance.

Edited June 7, 2022 by Ting Tang

[Pam in CT]

re "Paxlovid rebound"

3 hours ago, Ting Tang said:

I hate being sick, and I am still afraid of suffering through Covid.  I will probably take it.  I mean at one point my husband ordered Ivermectin on the Internet to have on hand, and I talked him into canceling the order, LOL.  (We have not been on the same page, though he did get his two Pfizer doses, refuses to be boosted now.)  I will probably beg for it.  I don't quite understand the whole rebound thing---does it sometimes not clear enough out, and the virus replicates?  Maybe that sounds stupid, but I feel it is worth a chance.

I think (?) the theory is that the Paxlovid is tamping down the symptoms, but you haven't really recovered yet, it's just that you aren't feeling the effects because they're being sort of artificially suppressed. Like if you dose a kid with a fever with Advil and ship them off to school -- they're still sick, they just aren't manifesting the fever because of the Advil.  So when the Paxlovid course ends, the suppressed symptoms "come back."  If you hadn't suppressed them they'd have been with you all along.

That's how I understood my physician anyway; maybe I got it wrong.

[Elona]

10 minutes ago, Pam in CT said:

re "Paxlovid rebound"

I think (?) the theory is that the Paxlovid is tamping down the symptoms, but you haven't really recovered yet, it's just that you aren't feeling the effects because they're being sort of artificially suppressed. Like if you dose a kid with a fever with Advil and ship them off to school -- they're still sick, they just aren't manifesting the fever because of the Advil.  So when the Paxlovid course ends, the suppressed symptoms "come back."  If you hadn't suppressed them they'd have been with you all along.

That's how I understood my physician anyway; maybe I got it wrong.

The way Paxlovid works is that it stops the virus from replicating so fast, giving the immune system a chance to fight it off. But, if you have a large viral load to begin with or if your immune system isn't great, you might not fully clear the infection before the 5 day course is finished - apparently there are some parts of the body where there drug works better than others, and the theory is that the virus in those 'hiding places' might be springing back. Sorry I can't link to the articles I read explaining all of this. I did a lot of research when I was taking it!

[Ting Tang]

Well, it's too bad they can't be given another round.  I believe I read it could have some serious side effects, but at this point, I haven't read anything experiences of that.

[Spryte]

I think there was a mention upthread about liver concerns and Paxlovid. Can anyone elaborate on that?

I looked it up on LiverTox and it scores an E, so they haven’t seen much of an issue with it, but it’s new so their info may not be perfectly up to date. (LiverTox, for anyone who needs it, is the database of meds that my liver doc recommends — great resource.)

 

[YaelAldrich]

On 6/7/2022 at 12:15 PM, YaelAldrich said:

Out of the three of us who had COVID recently my DH took it and the DD and I did not.  I called our state's Paxlovid telehealth line ( I love living in Massachusetts!).  They said with the liver stuff I have I might not want to and to contact my liver specialist.  I decided my run of COVID wasn't that bad.  I encouraged my DH to take it because I hoped he would become COVID negative faster so he could go to Japan.  It did help and he was negative 3 days faster than the rest of us.  He feels fine and so do the rest of us who didn't take Paxlovid.  He did have the bad taste side effect.  He complained about that a lot. 🙄

And I change my mind.  DH tested negative all week after taking Paxlovid.  He started coughing yesterday and we just tested not expecting anything.  It came up positive fast and dark.  He is angry!!!

[YaelAldrich]

2 minutes ago, Spryte said:

I think there was a mention upthread about liver concerns and Paxlovid. Can anyone elaborate on that?

I looked it up on LiverTox and it scores an E, so they haven’t seen much of an issue with it, but it’s new so their info may not be perfectly up to date. (LiverTox, for anyone who needs it, is the database of meds that my liver doc recommends — great resource.)

 

It's similar to one of the antivirals I'm on for chronic HepB.  They said the drug that keeps the antiviral in my liver longer would also increase that effect for my regular antiviral.  She didn't outright forbid it; she just suggested I talk to my liver specialist before going on it.  And seeing what my DH is now going through, I'm glad I didn't push it.  

[Longtime Lurker]

I took Paxlovid when I had covid (beginning of May) but I'm not sure I would take it again. I did not seek it out; I got a call from our local hospital's antibody clinic. I qualified due to my history of thyroid cancer. The clinic got my info from urgent care, where I went to get a throat culture because my sore throat was so awful. I was negative for strep, positive for covid 😞 I was unsure about taking it and definitely felt undeserving, but I took it because of DS24 (severe autism, functions at a 2-year-old level). The 89% reduction in hospitalization and death was important given that I am DS's primary caregiver (although DH does a lot of the care now that he is retired). I did not start it until the evening of Day 4 when my sore throat had already started to improve, so I'm not sure how much it actually helped. I had the terrible taste side effect but no other issues. I did not have a rebound, possibly because I had already started to recover when I started the Paxlovid. DH took Paxlovid also and did end up with a small rebound of symptoms (he did not re-test, just isolated as a precaution), but he is high risk so it was definitely worth it for him. Because I knew it was available (having come down with covid a few days ahead of him), I was able to get it more quickly for him, which was good but also may have led to the rebound.

[Arcadia]

8 hours ago, Spryte said:

I think there was a mention upthread about liver concerns and Paxlovid. Can anyone elaborate on that?

I looked it up on LiverTox and it scores an E, so they haven’t seen much of an issue with it, but it’s new so their info may not be perfectly up to date. (LiverTox, for anyone who needs it, is the database of meds that my liver doc recommends — great resource.)

 

 

8 hours ago, YaelAldrich said:

It's similar to one of the antivirals I'm on for chronic HepB.  They said the drug that keeps the antiviral in my liver longer would also increase that effect for my regular antiviral.  She didn't outright forbid it; she just suggested I talk to my liver specialist before going on it.  And seeing what my DH is now going through, I'm glad I didn't push it.  

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-first-oral-antiviral-treatment-covid-19
“Using Paxlovid in people with uncontrolled or undiagnosed HIV-1 infection may lead to HIV-1 drug resistance. Ritonavir may cause liver damage, so caution should be exercised when giving Paxlovid to patients with preexisting liver diseases, liver enzyme abnormalities or liver inflammation. “

[Spryte]

12 minutes ago, Arcadia said:

 

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-first-oral-antiviral-treatment-covid-19
“Using Paxlovid in people with uncontrolled or undiagnosed HIV-1 infection may lead to HIV-1 drug resistance. Ritonavir may cause liver damage, so caution should be exercised when giving Paxlovid to patients with preexisting liver diseases, liver enzyme abnormalities or liver inflammation. “

Thanks! And — yikes! I may revise my previous answer. I’ve had damage caused by a med (or the vaccine, we aren’t sure which), and it’s not a happy place to be. I don’t know if I’d take Paxlovid now.

[Shelydon]

I finished my last dose yesterday.  Only side effect was mild bad taste in the mouth.  I tested negative after 4 days on the meds. Except for loss of taste and smell, I feel normal.

[Catwoman]

9 minutes ago, Shelydon said:

I finished my last dose yesterday.  Only side effect was mild bad taste in the mouth.  I tested negative after 4 days on the meds. Except for loss of taste and smell, I feel normal.

Yay!!! I’m so glad you’re feeling better and testing negative!

[stephanier.1765]

My mother is still testing positive and had no improvements in symptoms at all. She might have even worsened a bit but she won't admit that. At 77, instead of getting better, maybe it kept her out of the hospital. There is no way of knowing, of course. But I'm ready for them both to be better. My father is also still testing positive, looks positively grey, and has pink eye in both eyes. He also is still fighting a lot of congestion. If nothing else, I hope going through this puts a fire under his butt to get a primary care doctor.

[Kassia]

@stephanier.1765 I'm so sorry.  😞  I hope things turn around very soon.  

[Elona]

49 minutes ago, Shelydon said:

I finished my last dose yesterday.  Only side effect was mild bad taste in the mouth.  I tested negative after 4 days on the meds. Except for loss of taste and smell, I feel normal.

So lucky that your side effects were mild! Based on my own experience of getting worse shortly after I finished the Paxlovid, I suggest taking it fairly easy for several days if you can, just to give yourself the best odds of a solid recovery. Even though I tested negative, I still got worse, I don't know why. Glad you got a negative test though, that is a relief!

[Mom_to3]

Here is a post about this by an ER doc at Brigham Women who has been  pretty good throughout the pandemic. https://insidemedicine.bulletin.com/we-are-misusing-paxlovid-most-young-and-vaccinated-people-don-t-benefit-who-does/

I still haven't decided for myself.

His bulletin is usually worthwhile reading fyi.

Edited June 12, 2022 by Mom_to3

[wathe]

4 hours ago, Mom_to3 said:

Here is a post about this by an ER doc at Brigham Women who has been  pretty good throughout the pandemic. https://insidemedicine.bulletin.com/we-are-misusing-paxlovid-most-young-and-vaccinated-people-don-t-benefit-who-does/

I still haven't decided for myself.

His bulletin is usually worthwhile reading fyi.

Yes.  His opinion pretty much matches mine, though I lean even more pessimistic.  The  Pfizer trial that everyone quotes (EPIC-HR, 89% RRR) had real flaws and tweaks that could make the numbers look better than they probably actually are.

Edited June 13, 2022 by wathe

[KSera]

3 hours ago, Mom_to3 said:

Here is a post about this by an ER doc at Brigham Women who has been  pretty good throughout the pandemic. https://insidemedicine.bulletin.com/we-are-misusing-paxlovid-most-young-and-vaccinated-people-don-t-benefit-who-does/

I still haven't decided for myself.

His bulletin is usually worthwhile reading fyi.

Link isn't working for me, but I will try again later because @wathe is usually pretty on target with these things, so if she agrees, it's worth the read :).

 

[Lisa]

I would take it. I've heard it has good results.

[Laura Corin]

9 hours ago, Mom_to3 said:

Here is a post about this by an ER doc at Brigham Women who has been  pretty good throughout the pandemic. https://insidemedicine.bulletin.com/we-are-misusing-paxlovid-most-young-and-vaccinated-people-don-t-benefit-who-does/

I still haven't decided for myself.

His bulletin is usually worthwhile reading fyi.

Thanks.  Very interesting and convincing article.  As a reasonably fit double vaccinated and boosted person under 65, I don't think I would seek it out.