The reality of Paxlovid rebound

As new cases of COVID-19 continue to rise, people are eager to learn about treatments for the disease. Paxlovid, a new oral treatment, can help individuals with mild to moderate COVID-19 who are at risk for severe complications avoid hospitalization and death.

However, some people who have recovered from the disease using Paxlovid have experienced what they are calling “rebound COVID-19.” This is a recurrence of the illness that usually occurs two to eight days after completing the five-day course of the medication. It’s important to note that rebound COVID-19 can also occur in people not treated with Paxlovid.

According to Ashkan Khabazian, PharmD, an emergency medicine clinical pharmacist at Sharp Memorial Hospital, most people who experience a post-Paxlovid rebound case have mild, recurrent COVID-19 symptoms. Some may have a positive COVID-19 test result with no symptoms. There have been no reports of severe disease due to complications of a rebound case of COVID-19.

The particulars about Paxlovid
The U.S. Food and Drug Administration (FDA) approved the use of Paxlovid for individuals who’ve tested positive for COVID-19, are age 12 or older, weigh at least 88 pounds, and who are at high risk for severe COVID-19. This includes people age 65 and older and people with underlying conditions.

Paxlovid, composed of two medications, works best to reduce symptoms and decrease the risk of severe illness and hospitalization when taken within five days of first experiencing COVID-19 symptoms. There are three Paxlovid pills that must be taken twice a day for five days.

“It’s important to take the pills for the entire treatment course,” says Khabazian. “And self-isolate while you do so.”

What to do when experiencing rebound COVID-19
If you have a recurrence of COVID-19 after completing the five-day course of Paxlovid, the Centers for Disease Control and Prevention (CDC) recommends following general COVID-19 guidance regarding isolation, even if you’ve isolated after your initial infection.

This includes:

• Restart isolation and isolate again for at least five days.

• End your re-isolation period after five full days only if your fever has resolved for 24 hours without the use of fever-reducing medication and if symptoms are improving.

• Wear a mask for a total of 10 days after your rebound symptoms started.

How to get a Paxlovid prescription
If you get a positive COVID-19 test result, Khabazian recommends contacting your doctor to see if a prescription for Paxlovid is right for you. Pharmacists can also screen patients to see if they are eligible for Paxlovid and prescribe the medication. Inform your doctor or pharmacist of any medications you are already taking before starting Paxlovid to avoid potentially dangerous drug interactions.

Common side effects of Paxlovid may include diarrhea, dysgeusia (altered taste) and muscle aches. However, most patients tolerate Paxlovid well.

“These possible side effects are less impactful than severe COVID-19 side effects, which can lead to death,” says Khabazian.

Get COVID-19 vaccine information and access to COVID-19 resources from Sharp.