Updated April 26, 2022, to reflect the ready availability of the pills

The Food & Drug Administration has authorized for emergency use two pills  — Molnupiravir and Paxlovid — for the treatment of COVID-19. What do the COVID pills do? Are they a cure? COVID-19 expert Dr. Gonzalo Bearman explains what we can expect from the COVID-19 pills.

What do the COVID-19 pills do?

The COVID-19 pills are antiviral medications. They don’t protect you from getting the virus, but they do attack the virus if you’re infected. The pills keep the virus from multiplying and spreading throughout your body. If taken soon enough, the pills prevent mild to moderate symptoms from turning severe or deadly. 

A major advantage of the COVID pills is that you can take the pills at home rather than undergoing more complex IV therapy at a hospital or clinic. IV therapy, in the form of monoclonal antibody therapy or the drug remdesivir, has been the primary treatment available for COVID-19 until now. Taking a pill is much easier than IV infusion, is more convenient and costs a lot less. 

What is the significance of the COVID-19 pills?

With approval of these pills, the world has its first treatment for mild to moderate COVID-19. This means you won’t have to wait until you’re severely ill before starting treatment. 

By taking the pills within five days of your first symptoms, when symptoms are still mild to moderate, you will likely avoid severe COVID-19. COVID-19 could become a treatable disease, like the flu, rather than a potentially fatal illness.

The COVID-19 pills are effective against all of the currently known COVID-19 variants, including omicron. This is not the case with most monoclonal antibody therapies.  

What's the link to testing?

The COVID pills are only good if taken within five days of your first symptoms — so the sooner you are diagnosed with COVID-19, the greater the likelihood you will get the pills in time. That's why testing is so important.  If you have any symptoms of COVID-19, get tested as soon as possible. Please visit the Virginia Department of Health for a list of COVID-19 testing sites near you or pick up a test kit from your local pharmacy.

Who are the COVID pills for? 

Molnupiravir and Paxlovid are authorized by the Food and Drug Administration for people with mild-to-moderate COVID-19 who are not hospitalized but are at high risk of severe COVID-19.  Molnupiravir is authorized for adults 18 and older. Paxlovid is authorized for anyone age 12 and older. 

What’s the difference between the two COVID pills?

The major difference is in efficacy:

Molnupiravir lowers the risk of hospitalization or death by about 30% in COVID-19 patients at risk for severe illness if given within five days of the first symptoms. Paxlovid, reduces this risk by 88%. Because the efficacy of Paxlovid is so much greater than that of Molnupiravir, Paxlovid is expected to be the pill of choice except in times of shortage. There are other differences:

One is that the means by which Molnupiravir attacks the SARS-CoV-2 virus might cause the virus to mutate. The resultant variant(s) could reduce the efficacy of our current vaccines and treatments. The other is that Molnupiravir may prove hazardous to fetal development if taken during pregnancy. If you think you might possibly be pregnant, tell your doctor. You should not take Molnupiravir if you're pregnant, you might be pregnant, you're thinking of getting pregnant or you are breastfeeding.  

Paxlovid, however, isn't perfect. Paxlovid poses a risk of serious interactions with other medications. These include birth control pills, blood thinners, blood pressure and cholesterol pills, HIV medication, cancer treatments, transplant anti-rejection medications, steroids and over-the-counter herbal supplements. Be sure to review your list of medications with your pharmacist or doctor before taking Paxlovid. 

Are there other possible side effects with either pill?

For Paxlovid, possible side effects include:

• Liver problems
• Resistance to HIV medicines
• Altered sense of taste
• Diarrhea
• High blood pressure 
• Muscle aches

Paxlovid might affect how well your birth control pills work. Tell your doctor if you are on birth control pills. 

Possible side effects of Molnupiravir include diarrhea, nausea and dizziness. As mentioned above, Molnupiravir might harm a developing fetus. Do not take Molnupiravir if you are pregnant or breastfeeding. 

How many COVID pills do you have to take?

For Paxlovid, you take three pills twice a day for five days. For Molnupiravir, you take four pills every 12 hours over five days. 

Are the COVID pills available now? How do I get them?

The pills are now readily available. You can pick up the pills at  most pharmacies after receiving a positive COVID-19 test result from either your doctor or a home test kit. You take the pills as directed at home while you isolate.  

Are the COVID pills free?

The pills are covered by insurance. 

Now that we have pills to treat COVID-19, do we still need to get vaccinated or boosted? 

Despite the pills’ effectiveness at keeping symptoms from progressing, the pills are not 100% effective. You could be one of the few who does not recover. It’s better to get vaccinated and boosted to avoid getting COVID-19 in the first place.

Keep in mind that although the pills reduce your risk of getting severely ill, you’re still infected and can pass the disease onto others. It’s best to avoid the disease in the first place through vaccination.  

Read about other COVID-19 treatments. 

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