What You Need to Know About Paxlovid Rebound
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If you get sick with COVID and are eligible to take Paxlovid, the antiviral medication will likely help you avoid severe disease. However, once you start feeling better, there is a risk that you may start to feel COVID symptoms again before you’re fully recovered. This is a phenomenon known as Paxlovid rebound.
First of all, don’t panic. The risk of Paxlovid rebound is not a reason to not take Paxlovid. We’ve asked our infectious disease experts about everything you need to know about this phenomenon, and what to do if it happens to you.
What is Paxlovid?
Paxlovid is an antiviral that treats COVID-19, says Linda Yancey, M.D., an infectious diseases specialist at Memorial Hermann Hospital. “It is a combination drug containing nirmatrelvir and ritonavir. Nirmatrelvir inhibits viral replication and ritonavir helps to boost that effect,” she explains.
The main purpose of taking Paxlovid is to prevent progression to more severe illness, meaning hospitalization and need for supportive oxygen therapy, etc., explains Andrew Handel, M.D., pediatric infectious diseases expert from Stony Brook Children’s Hospital.
Who is Paxlovid for?
Paxlovid is reserved for people who are at higher risk of having severe disease (typically older adults or people with underlying medical problems, such as high blood pressure, type 2 diabetes, underlying lung problems, or those otherwise immunocompromised and at higher risk of more severe covid), says Dr. Handel. The medication should also be used for anyone over the age of 65 or anyone who is unvaccinated, adds Brittany Kunza, M.D., a physician with PlushCare. Paxlovid is for mild to moderate COVID, adds Dr. Yancey. “[Paxlovid] is mostly used in the outpatient setting, while drugs like remdesivir are used on hospitalized patients,” she clarifies.
What is Paxlovid rebound?
After Paxlovid came to the market and people started using it, some patients would get better and then after feeling better, they would feel recurrent symptoms and would test positive after testing negative for COVID, says Dr. Handel, “so the thought is there’s a rebound viral infection as opposed to a new covid infection for people on Paxlovid.”
More specifically, Paxlovid rebound describes a case where the patient has had the full five-day course of treatment and then develops the return of symptoms or tests positive after having tested negative, says Dr. Yancey.
If a Paxlovid rebound occurs, it can happen two to eight days after completing the five-day course of Paxlovid, adds Dr. Kunza. “The symptoms are generally mild, and they do not warrant a second round of Paxlovid.”
How common is Paxlovid rebound?
What you might not know is that a rebound from COVID-19 can occur with or without the use of Paxlovid, says Dr. Kunza.
Dr. Handel explains that there can rebound for people who never took Paxlovid or antivirals, so there is a subset of people who are infected with COVID that will experience that same phenomenon. “Originally, the concern was this was something specific for Paxlovid, but it turns out that may actually happen to many people who have COVID, we just weren’t testing for it before.”
Dr. Handel says that we still don’t know exactly how common Paxlovid rebound is but it’s estimated to be around 10% of Paxlovid users. “Paxlovid rebound isn’t more common with some populations than others,” he adds. As for immunocompromised people, they may just require a longer course of antiviral treatment to properly treat the infection, and won’t necessarily experience Paxlovid rebound at a higher rate, Dr. Handel explains.
When to see a doctor about Paxlovid rebound
People who experience Paxlovid rebound very rarely go on to have more severe illness, so the vast amount of people who have rebound do not go on to have hospitalizations or go on to have more severe COVID, says Dr. Handel. “What they will experience is the recurrence of typical COVID symptoms like fever, cough, runny nose, things of that nature, but without the risk of having severe illness.”
With that being said, if you’ve taken Paxlovid and you feel better but start to feel worse again, you should speak to your doctor at that point and you may want to take another covid test, says Dr. Handel. “It’s also a good idea to isolate yourself at that point because you want to make sure that you won’t pass the virus on to someone else.”
Big picture: it is very important going into this year's cold and flu season to get the COVID booster, the flu shot, and the RSV vaccine if you are over 65 or pregnant, says Dr. Yancey. “We have a wonderful number of weapons against these viruses. Let’s get everyone protected!”
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