ToolsCalculators
Indications for Paxlovid (nirmatrelvir/ritonavir)
Checklist of eligibility criteria for outpatient COVID-19 antiviral therapy.
Indications for Paxlovid (nirmatrelvir/ritonavir)
Confirmed SARS-CoV-2 infection (positive test)
Mild-to-moderate disease, not hospitalised for severe/critical COVID-19
Symptom onset within the last 5 days
Age >=12 years and weight >=40 kg
At least one risk factor for progression to severe COVID-19
eGFR >=30 mL/min (>=60 for full dose; 30-59 needs dose reduction)
No severe hepatic impairment (not Child-Pugh C)
No contraindicated drug-drug interactions
ResultCandidate
All listed criteria are met; nirmatrelvir/ritonavir is a reasonable option, with dose reduction if eGFR is 30-59 mL/min. Review the full interaction list before prescribing.
When to use
- Deciding whether an outpatient with COVID-19 qualifies for nirmatrelvir/ritonavir.
Formula
All of: confirmed infection, non-severe disease, symptom onset <=5 days, age >=12 and >=40 kg, a progression risk factor, acceptable renal and hepatic function, and no contraindicated interactions.
Pearls and pitfalls
- Ritonavir is a potent CYP3A inhibitor; screen every concomitant drug for interactions before prescribing.
- Do not start beyond 5 days of symptoms or for a patient hospitalised for severe COVID-19.