Indications for Paxlovid
Assists in determining if Paxlovid (ritonovir-boosted nirmatrelvir) is appropriate therapy in a COVID positive adult patient.
In the United States, Paxlovid (ritonovir-boosted nirmatrelvir), is now approved by the Food and Drug Administration (FDA) for the treatment of mild-to-moderate COVID-19 in adults who are at high risk of progression to severe disease.
An Emergency Use Authorization (EUA) is in place for the use of Paxlovid in pediatric patients >12 years of age and weighing at least 40kg who have mild-to-moderate COVID-19 and who are at high risk of progression to severe disease.
Drug approval status may vary by country and is subject to change.
Prescribing Information for Paxlovid (ritonavir-boosted nirmatrelvir)
- eGFR >60 mL/min: Nirmatrelvir 300mg with ritonavir 100mg PO twice daily for 5 days.
- eGFR ≥30 mL/min to <60 mL/min: Nirmatrelvir 150mg with ritonavir 100mg PO twice daily for 5 days.
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eGFR <30 mL/min, including those requiring dialysis:
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Day 1: Nirmatrelvir 300mg and ritonavir 100mg once daily.
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Days 2-5: Nirmatrelvir 150mg and ritonavir 100mg once daily.
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If patient receives hemodialysis, administer Paxlovid after hemodialysis session.
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- Severe hepatic impairment (Child-Pugh Class C): This medication is not recommended.
- Paxlovid is recommended for COVID-19 positive patients in the nonhospitalized setting who are at high risk of progression to severe COVID-19 disease.
- Paxlovid is also recommended for hospitalized patients who were hospitalized for another reason, but who are found to have mild-moderate COVID-19 disease and are at high risk of progression to severe illness.
- Manufacturer information may change, be sure to follow the most recent prescribing information and package instructions.
- Paxlovid may interact with many patient medications. It is important to take a complete medication history and review potential interactions. The CDC recommends using the Liverpool Covid-19 Drug Interactions checker.
- Additional treatment guidance exists for patients who may be pregnant or lactating available from the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine.
- Paxlovid is not appropriate for all patients, for the latest on other available oral and IV treatment regimens, please visit the Infectious Diseases Society of America's COVID-19 guidelines page.