In December 2021, the U.S. Food and Drug Administration (FDA) issued emergency use authorization for two new oral medications to treat COVID-19. Molnupiravir is sold under the brand name Lagevrio, and a combination of nirmatrelvir tablets and ritonavir tablets is packaged together as Paxlovid.

Approval for emergency use is not the same as full FDA approval. It takes into account current scientific evidence to allow new treatments when the benefits are likely greater than the risks.

Oral Treatments Can Protect Against Severe COVID-19

The emergency use authorization request for molnupiravir relied on data from a clinical study on how the medication reduces the risk for severe COVID-19. In the study, participants were given either molnupiravir or a placebo, which resembles a treatment but has no real health effects. The study found that people treated with molnupiravir were 30 percent less likely to develop severe COVID-19 resulting in hospitalization or death compared to those who received the placebo treatment.

Similarly, the effectiveness of combining nirmatrelvir and ritonavir has also been supported by clinical trials. One clinical study treated participants with either nirmatrelvir and ritonavir or a placebo. The data indicated that people treated with the nirmatrelvir/ritonavir combination were 88 percent less likely than the placebo group to be hospitalized with or die from COVID-19.

How Do Paxlovid and Molnupiravir Work?

Paxlovid is a combination of two medicines — nirmatrelvir and ritonavir. Nirmatrelvir works by stopping SARS-CoV-2, the virus that causes COVID-19, from reproducing. Ritonavir keeps nirmatrelvir from being broken down by the body, allowing it to act longer with fewer doses.

Molnupiravir also prevents the SARS-CoV-2 virus from replicating properly. Molnupiravir creates errors in the virus' genetic code to stop it from reproducing.

Who Should Take Molnupiravir or Paxlovid?

Paxlovid and molnupiravir are both recommended for mild to moderate cases of COVID-19, particularly for people who are at a higher risk of hospitalization or death from the virus. While molnupiravir is only authorized for use in adults, Paxlovid can be taken by both adults and children who are at least 12 years old and weigh more than 88 pounds.

Molnupiravir is not recommended for people who are pregnant or may become pregnant. Paxlovid has not been studied in people who are pregnant or breastfeeding.

Paxlovid is not recommended for people with severe liver or kidney problems. It’s also not recommended for people who take certain medications that can cause incompatible drug interactions, particularly if you cannot stop taking your current medication while you take Paxlovid. Ask your doctor for advice about your situation.

Neither Paxlovid nor molnupiravir are a substitute for a COVID-19 vaccine. Individuals are strongly encouraged to get vaccinated to maintain the best defense against COVID-19.

Talk With Others Who Understand

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