Questions remain about Paxlovid eligibility and use

When the antiviral drug Paxlovid was approved by the Food and Drug Administration in late 2021, many experts hailed it as a game-changing treatment for high-risk patients battling COVID-19. But the rollout has been hampered by concerns about side effects, and confusion about just who is eligible to receive the drug. 

Paxlovid is meant to be taken within several days of developing COVID-19 symptoms. The treatment was designed to keep patients from having to be hospitalized.

The FDA granted an emergency use authorization for anyone ages 12 and older at high risk for severe disease.

But some experts believe the treatment has been underused. A lack of public awareness, along with polarized reactions to vaccines and treatments, may have played a part.

According to The New York Times, physician resistance is another factor in stagnant prescription rates.

Some doctors are concerned about potential side effects from Paxlovid, including how it may interact with other drugs, along with what has become known as “COVID-rebound,” when some symptoms return after seemingly subsiding.

Dr. Brent McQuaid is the director of critical care medicine for Cone Health.

He questions whether COVID rebound can solely be attributed to use of the drug.

"That concern for rebound of COVID after taking Paxlovid, I believe has a story that has taken on a life of its own without a robust base of data to support it," says McQuaid. 

McQuaid says he witnessed symptom rebound in patients before Paxlovid came along and that it may just be COVID taking its natural course.

One issue for those seeking Paxlovid has been eligibility, with many patients who request the treatment being told simply they do not qualify.

Dr. McQuaid says this might be traced back to the language in the emergency use authorization (EUA), which he believes is open to interpretation.

"The way the EUA reads, it's hard to find somebody in the United States who's not eligible," says McQuaid. "I mean, the criteria are pretty broad."

McQuaid believes many providers are interpreting the EUA in a literal fashion, and for the most part, limiting prescriptions to those 65 and older, and/or considered high-risk. He says that patients should have a conversation with their provider if they believe they deserve access to a prescription.

And McQuaid offers one more message for those looking to temper a potential bout with COVID.

"Vaccination, vaccination, vaccination," says McQuaid.  "It's really the best first-line therapy to prevent things from getting worse."