Help Limit Delays and Confusion With Paxlovid Rxs

Please see the FDA announcement authorizing pharmacists to prescribe Paxlovid with certain limitations.

You play a key role in preventing problems with Paxlovid (nirmatrelvir/ritonavir) Rxs for COVID-19.

High-risk patients with a positive COVID-19 test should start Paxlovid within 5 days of symptom onset.

Help ensure timely access...and avoid Rx mishaps.

Continue to check strengths, sigs, and notes closely during order entry. Most patients will get the Paxlovid 300 mg/100 mg dose pack...and take 2 nirmatrelvir tabs plus 1 ritonavir tab bid for 5 days.

But some patients with kidney disease may need the 150 mg/100 mg pack...with just 1 nirmatrelvir tab and 1 ritonavir tab bid for 5 days.

If you don’t have the 150 mg pack for these patients, discard one AM and PM tab of nirmatrelvir from all 5 cards in the 300 mg pack.

Review Rxs for “fill by” dates. If needed, use the COVID-19 Therapeutic Locator to find stock of Paxlovid...so the patient can start therapy without delays.

Stay alert for repeat courses or Paxlovid Rxs with refills. There’s currently no evidence that additional treatment is needed for rare “COVID-19 rebound”...the return of symptoms or a positive test within about a week of finishing Paxlovid.

Verify the current med list for patients getting Paxlovid.

If needed, assist with entering meds into an interaction checker, such as COVID19-DrugInteractions.org...especially if your pharmacy software doesn’t include Paxlovid yet. Interactions can be serious.

For example, most statins (simvastatin, etc) should be held while on Paxlovid and for 3 to 5 days after...to prevent statin toxicity.

And patients on Eliquis (apixaban) may need a lower dose of this blood thinner...or a different COVID-19 med (molnupiravir, etc).

Be aware, patients still don’t have to pay for Paxlovid.

If there’s a co-pay or reject, work with your pharmacist or the payer to override it...so patients can get the med right away.

Refer patients reporting a bitter, metallic, or unusual taste to your pharmacist for advice. “Paxlovid mouth” resolves after treatment...and frequent liquids or hard candy may help.

Key References

  • https://www.fda.gov/media/155050/download (6-22-22)
  • https://www.covid19-druginteractions.org/checker (6-22-22)
  • https://www.idsociety.org/globalassets/idsa/practice-guidelines/covid-19/treatment/idsa-paxlovid-drug-interactions-resource-5-6-22-v1.1.pdf (6-22-22)
  • https://emergency.cdc.gov/han/2022/pdf/CDC_HAN_467.pdf (6-22-22)
Pharmacy Technician's Letter. July 2022, No. 380710



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