Yes, there are several medicines available for COVID-19, including pills you can take at home. The most effective and widely used is Paxlovid, an antiviral pill that reduced the risk of severe illness by 89% in its initial clinical trial. Two other antivirals, remdesivir (brand name Veklury) and molnupiravir (brand name Lagevrio), are also available. The catch with all of them: they work best when started early, ideally within the first few days of symptoms.
Paxlovid: The Main Antiviral Pill
Paxlovid is the go-to treatment for most people with COVID-19 who are at higher risk of getting seriously ill. It’s a five-day course of pills taken twice daily at home, no hospital visit required. The FDA has fully approved it for adults and authorized it for adolescents 12 and older who weigh at least 88 pounds.
You need to start it within five days of your first symptoms, and sooner is better. To qualify, you generally need at least one risk factor for severe COVID. The biggest ones are being over 65 (with risk climbing sharply after 75), having multiple chronic health conditions, being immunocompromised, or not being up to date on vaccinations.
One important consideration: Paxlovid interacts with a lot of common medications. One of its ingredients, ritonavir, changes how your liver processes other drugs, which can make some medications build up to unsafe levels. Blood thinners like rivaroxaban are a hard no. Statins (cholesterol drugs) need to be paused during treatment and for five days after. Blood pressure medications, anxiety drugs like alprazolam and diazepam, pain medications like oxycodone, and even hormonal birth control can all be affected. Out of the 100 most commonly prescribed drugs, only two have interactions severe enough to rule out Paxlovid entirely, but many others require temporary dose changes. Your prescriber will need a full list of everything you take.
COVID Rebound After Paxlovid
About one in five people who take Paxlovid experience what’s called viral rebound: they feel better and test negative, then test positive again and may have returning symptoms. A Harvard Medical School study found that 20.8% of Paxlovid users had this rebound, compared to just 1.8% of people who didn’t take the drug. Rebound doesn’t mean the treatment failed. It typically resolves on its own, but it can mean a few extra days of feeling sick and potentially being contagious again.
Remdesivir: The IV Option
Remdesivir (Veklury) is the only antiviral approved for both hospitalized and non-hospitalized COVID patients, but it requires an IV infusion, which limits its convenience. Each infusion takes 30 to 120 minutes and must be given in a healthcare setting equipped to handle allergic reactions.
For people who aren’t hospitalized but are at high risk of getting worse, the treatment course is three days of infusions, started within seven days of symptoms. For hospitalized patients, treatment runs five to ten days depending on severity. Because it requires multiple trips to an infusion center, remdesivir is less practical than Paxlovid for most outpatients, but it’s a useful alternative for people who can’t take Paxlovid due to drug interactions.
Molnupiravir: A Less Effective Backup
Molnupiravir (Lagevrio) is another oral antiviral, but it sits lower on the priority list. In its clinical trial, it reduced the combined risk of hospitalization or death by about 30%, far less than Paxlovid’s 89%. It remains authorized only under emergency use, not fully approved.
The bigger concern is safety in pregnancy. Animal studies showed potential for fetal harm, so molnupiravir is not recommended for pregnant individuals. People who can become pregnant are advised to use effective contraception during treatment and for four days after the last dose. Molnupiravir is generally reserved for situations where Paxlovid and remdesivir aren’t options.
What About Monoclonal Antibodies?
Monoclonal antibodies were a major part of COVID treatment earlier in the pandemic, but most have lost their effectiveness against current variants. The virus has mutated enough that these lab-made antibodies no longer bind well to it. Products like Evusheld are no longer authorized in the U.S. The antiviral pills and remdesivir, which work by disrupting the virus’s ability to copy itself rather than targeting its outer surface, have held up much better against new variants.
One exception is tocilizumab, which is still used in hospitals for severe cases. It doesn’t target the virus directly. Instead, it dials down the overactive immune response that can cause life-threatening inflammation in the lungs.
How to Get Treated Quickly
The single most important thing to know about all these treatments is that timing matters. Paxlovid needs to be started within five days of symptoms. Remdesivir’s outpatient window is seven days. Every day you wait reduces how well they work.
If you test positive and have risk factors for severe illness, contact your doctor or a telehealth provider right away. Many pharmacies and urgent care clinics can also prescribe Paxlovid. The goal is to get a prescription filled and start treatment as close to symptom onset as possible, not to wait and see if you get worse.
Cost varies depending on your insurance. The federal programs that once covered COVID treatments for the uninsured ended in 2023 when funding was rescinded. Pfizer has run its own patient assistance program for Paxlovid, but availability and eligibility can change, so it’s worth asking your pharmacy about options if cost is a barrier.