New COVID pills aim to prevent severe illness after infections, but they're not for everyone

·5 min read

(This story has been updated to correct information about possible interactions with other medications.)

Iowa pharmacies have started distributing new pills to treat COVID-19, but supplies will be tight for a while, and the treatments won't be prescribed for everyone who tests positive for the coronavirus.

The pills, developed by the drug companies Pfizer and Merck, aim to prevent people from becoming severely ill after infection with the coronavirus.

The medications recently received emergency authorization from federal regulators. They are arriving just as the two main versions of a previous form of treatment, called monoclonal antibodies, are losing effectiveness against the dominant strain of the coronavirus.

Here are some questions and answers about the new medications.

How do the COVID pills work?

The new pills aim to interfere with the coronavirus before it can severely sicken infected people. The two medications take different paths, but both seek to interrupt the virus' ability to replicate itself.

Andrew Miesner, a pharmacy professor at Drake University, said early studies suggest the Pfizer version, called Paxlovid, has a better success rate with fewer safety concerns than the Merck version, called Molnupiravir.

How can I get COVID pills?

The medications require a prescription. They are starting to be distributed to pharmacies and clinics, but Iowa has only received a few thousand courses so far. The Iowa Department of Public Health, which is coordinating the allocations, expects the supply to increase in the coming months as manufacturing ramps up.

More: 'We're in a critical moment' to slow omicron COVID spread, UI Hospitals leader tells Iowans

Who is eligible for COVID pills?

Patients must be at least 12 years old and weigh at least 88 pounds to be eligible for the Pfizer pills, and at least 18 years old to be eligible for the Merck pills. For either medication, they also must have symptomatic COVID-19, plus other health issues that make them particularly susceptible to severe illness.

When should I take them?

The treatments aim to tamp down the coronavirus before it can run wild in your body, so it's best to start taking them as soon as possible after infection. They are only to be prescribed within five days of onset of mild to moderate COVID symptoms.

Miesner, who also works as a pharmacist at Broadlawns Medical Center, said the need for speed adds to the importance of making COVID tests readily available, so people can determine if they're infected with the virus before it's too late to start the medication. He said he hopes the government will consider allowing pharmacists to order the pills without a doctor's prescription, so patients could get the medication immediately if they test positive for the coronavirus at a pharmacy.

What are the limitations?

Concerns have been raised about potential genetic side-effects from the Merck pills, including a slight chance they could alter patients' DNA or spark new variants of the virus. It is not to be taken by pregnant women.

The Paxlovid version of the pills, made by Pfizer, include a warning that they can have interactions with other types of medication. The U.S. Food and Drug Administration has said that for the Molnupiravir version of the pills, made by Merck, “no drug interactions have been identified based on the limited available data.”

Can I stockpile the pills just in case I need them?

No. Please don't try. Health care leaders are aiming to distribute the small supplies they have to the patients who need them most. The pills are only to be prescribed after a patient has COVID symptoms.

Does the arrival of these new COVID treatments mean I shouldn't bother getting vaccinated?

Heck no. "Vaccines remain the best option for reducing the risk of severe illness and death from COVID-19," said Sarah Ekstrand, a spokesperson for the Iowa Department of Public Health.

What else is available to prevent severe COVID-19 symptoms?

For more than a year, doctors have been prescribing monoclonal antibodies, which are given by infusion. Those treatments can prevent or shorten the duration of severe COVID in many patients. However, the two most common versions of monoclonal antibodies are not effective against the omicron variant of the coronavirus, which has become the dominant strain nationally. The third version of monoclonal antibody treatment, called Sotrovimab, is still working, but it is in short supply.

Ekstrand said the state also expects to start receiving a medication called "EVUSHELD," which is a shot to prevent infections in people who have serious immune system problems and who have medical reasons not to take COVID vaccinations.

Will the new antiviral pills become ineffective against future variants of the coronavirus?

Miesner said the new pills take a more general approach to block coronaviruses than the monoclonal antibody treatments do, so it should be harder for new strains of the virus to evade them. But it could happen, just as some bacteria have evolved to evade antibiotics, he said.

Will these pills hasten the end of the pandemic?

Probably not. They could ease the strain on hospitals, if they prevent severe illness in significant numbers of people who are infected, Miesner said. But they won't stop the virus' spread.

At some point, COVID-19 will become a routine, seasonal illness, and the new antiviral pills could become a common tool, like the antiviral medication Tamiflu is for the flu, Miesner said. He hopes that day could arrive later this year, but he hesitates to give a firm prediction.

"I'm just a pharmacist," he said. "My crystal ball is broken."

Tony Leys covers health care for the Register. Reach him at or 515-284-8449.

This article originally appeared on Des Moines Register: Iowa pharmacies begin distributing new pills to treat COVID-19

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