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Remdesivir vs. Paxlovid for COVID-19: A guide

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To this day, SARS-CoV-2 infections are affecting many people worldwide. Paxlovid and remdesivir are two antivirals that may help.
Medically reviewed by Philip Ngo, PharmD
Written by Lily Frew
Updated on

Since the novel coronavirus was first detected, millions of people worldwide have contracted it and died, and even more have been affected by it in some way.

But medication is helping to bring down that number. Now you can take pills at home or get injections at the hospital that can help stop the infection from getting worse.

“We’ve got quite a few tools in our arsenal, and hopefully over the next few months we’ll see even more,” said William Schaffner, MD. He’s an infectious disease expert at the Vanderbilt University Medical Center in Nashville, Tennessee.

Paxlovid and remdesivir are two options that the Food and Drug Administration (FDA) has approved for COVID-19. They may have different benefits and side effects.


A group of people outside wearing medical masks, representing remdesivir and Paxlovid treatment for COVID-19.
PeopleImages/Getty Images

Remdesivir (Veklury) is a type of drug called an antiviral. This means it is effective against different viruses, including those causing Ebola, measles, and mumps.

Remdesivir, which is given intravenously by a healthcare professional, works by stopping the virus from reproducing in your body.

In October 2020, remdesivir became the first medication to receive FDA approval for the treatment of COVID-19. At first, it was available only to people in the hospital. But the FDA has since approved it for anyone who is at high risk of severe COVID-19.

According to some research, remdesivir reduces mortality for people hospitalized with COVID-19, particularly those who do not require ventilation. Other research, on the other hand, finds that it is more useful in reducing the risk of hospitalization and death in people with a high risk.

But like all medications, remdesivir has potential side effects. These may include:

  • hypotension (low blood pressure)
  • anemia
  • nausea, vomiting, and diarrhea
  • headache and dizziness
  • hyperglycemia (high blood sugar)

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Ritonavir-boosted nirmatrelvir (Paxlovid)

In December 2021, Paxlovid (the branded form of a medication containing ritonavir and nirmatrelvir) became the first antiviral pill authorized by the FDA to treat COVID-19. It’s intended for people ages 12 and older who have mild to moderate cases of COVID-19 but also have a high risk of worsening symptoms or complications.

The aim is to prevent COVID-19 from progressing in those instances.

“These newer antivirals are intended for higher-risk individuals,” said Schaffner, who noted that each medical center has its own criteria for which patients are eligible. This might apply to older adults, people with underlying health conditions, or people living with a lowered immune system.

For Paxlovid to be effective, you should take it within 5 days of contracting the virus — though sooner is better. A study from Pfizer, the company that makes Paxlovid, found that taking the medication at the onset of COVID-19 reduced hospitalization and death by nearly 90% compared with a placebo.

As with many COVID-19 medications, Paxlovid was at first available only under an FDA emergency use authorization. This is a faster approval process that helps treat serious health threats quickly.

Emergency use medications have been shown to be effective, and they’ve undergone safety testing. Some of these medications will go on to get full approval. Others will have their emergency use status removed as better medications arrive.

But from 2023, Paxlovid will be available commercially for more than just emergency use. This may mean that you will stay seeing copays for the medication, as the government will no longer be covering its cost.

While Optum Perks can’t help with copay costs, its drug coupons and prescription Discount Card can help reduce the costs of your medications.

The most common adverse effects of Paxlovid include:

  • dysgeusia (a foul taste in the mouth)
  • diarrhea
  • hypertension (high blood pressure)
  • myalgia (muscle pain)

Paxlovid may also interact with other drugs, including antiarrhythmics like amiodarone (Pacerone) and statins like simvastatin (Zocor)

Which to use

These two medications are very different, and doctors will prescribe them based on a variety of factors. Key differences between them include:

  • Method of administration: Remdesivir is given intravenously, whereas Paxlovid is an oral tablet.
  • Where you get them: Remdesivir is injected by doctors, whereas you can take Paxlovid yourself at home.
  • When to take them: Remdesivir is given at any time after infection, whereas Paxlovid should be taken within 5 days.
  • Age: Remdesivir can be given to anyone older than 28 days weighing more than 3 kilograms (about 6.6 pounds), whereas Paxlovid is approved for people older than age 12 years.
  • Cost: Remdesivir is a generic medication, whereas Paxlovid is a brand-name medication. Brand-name medications are often more expensive than generic versions.

You’re unlikely to be given a choice about what medication to take. Doctors will prescribe them depending on your individual condition.

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Other options

Since the FDA approved remdesivir and Paxlovid, several other medications have been studied for their effectiveness.


The FDA has approved several different vaccines to prevent severe COVID-19 illness. While they may not prevent infection entirely, they generally can reduce its severity if you do contract the coronavirus. This reduces deaths and the overall healthcare burden.

Vaccine recommendations vary depending on different individual factors.

In general, as of 2023, people ages 12 or older should get an updated vaccine, regardless of whether they received a previous vaccine prior to 2023. This should be 1 dose of Moderna, 1 dose of Pfizer, or 2 doses of Novavax. At the moment, no boosters are needed after this dose, but this is subject to change as we learn more.


This second oral antiviral pill was authorized shortly after Paxlovid. Molnupiravir is a generic medication. It’s used to treat mild to moderate COVID-19 in people ages 18 years and older who are at increased risk for severe illness.

As with Paxlovid, molnupiravir is available only by prescription. You should begin taking it after a positive COVID-19 test and within 5 days of symptom onset. Its use is limited to situations in which other COVID-19 treatments aren’t available or appropriate.

Unlike Paxlovid, molnupiravir is not recommended if you’re pregnant and has no known drug interactions.


While the previous medications are antivirals, sotrovimab (Xevudy) is a monoclonal antibody. This type of medication helps the immune system recognize and respond more effectively to viruses. Sotrovimab must be given intravenously soon after symptoms develop.

Research finds that it is effective against mild to moderate COVID-19, including different variants of the virus.


Paxlovid and remdesivir are two antiviral medications used to treat COVID-19. Remdesivir is given intravenously by a doctor, but Paxlovid is a tablet that you can take at home.

Alongside these possible treatments, you should consider getting a vaccine to prevent serious illness from the SARS-CoV-2 virus.

Download the free Optum Perks Discount Card to save up to 80% on some prescription medications.

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