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[In the Pipeline](https://www.science.org/blogs/pipeline "In the Pipeline") - Covid-19 # Paxlovid, Personally - 11 May 2022 - 12:00 AM ET - 5 min read - [Comments](https://www.science.org/content/blog-post/paxlovid-personally#disqus_thread) Share: - [Facebook](https://www.science.org/#facebook "Facebook") - [Share on X](https://www.science.org/#x "Share on X") - [Linked In](https://www.science.org/#linkedin "Linked In") - [Reddit](https://www.science.org/#reddit "Reddit") - [Wechat](https://www.science.org/#wechat "Wechat") - [Whatsapp](https://www.science.org/#whatsapp "Whatsapp") - [Email](https://www.science.org/#email "Email") When I wrote this recent update on Paxlovid, I had no idea how relevant I was going to find my own blog post very shortly. Starting last Friday I began to show what felt like spring-cold respiratory symptoms, which kept getting nastier each day. A rapid antigen test on Saturday was negative, but in retrospect that was too early, because an RT-PCR test on Monday came back positive for SARS-CoV-2 (at which point a second antigen test was indeed a bright, glowing positive as well). So I made it a bit over two years without getting infected, but the latest variant has indeed caught up with me - as it seems to be catching up with plenty of people here in the Northeast, including plenty who have already been around that track before. I've been watching the Boston wastewater mRNA counts for some time - while they are (fortunately) nowhere close to the levels that they hit during the earlier Omicron spike, they are climbing. Case numbers are a more problematic indicator than ever these days, of course, since home testing leaves even more cases officially unreported. But the wastewater readout is hard to dodge: everyone sheds viral mRNA if they're infected, and everyone goes to the bathroom. I went back and forth on the question of whether to take Paxlovid, and finally decided to go ahead although there's no well-controlled evidence either way for its use in vaccinated patients like me. My reasoning (which is similar to several other people that responded to a Twitter post of mine on the subject) was that one of the main things I would want to avoid is "long Covid" type sequels to the infection. Those and other undesirable systemic effects of the infection are likely to be tied to (among other things) viral load and the time needed to clear the infection - you would have to guess that the more virus you are exposed to for a longer time, the more problems are that you could be facing. Other factors are that I am not, in fact, the proverbial spring chicken. Earlier this year I had my 60th birthday, and while that's not tremendously old, it ain't the first bloom of youth, either. And [ever since a bout](https://www.science.org/content/blog-post/pipeline-11016) of double pneumonia a few years back, I have been rather protective of my respiratory system, since my lungs took some damage that is still easily visible to radiologists. I cannot say enough bad things about bacterial pneumonia, by the way. Zero out of five stars, would not try again, and if it weren't for modern antibiotics this blog might have come to an abrupt halt in early 2016 along with everything else I was doing, such as breathing. One of the interesting things about the coronavirus pandemic is that the viral infection did not seem to provide an easy ramp into bacterial infection - there's no telling how many more deaths we would have had so far if that had been a common sequel (as it was in the 1918 influenza epidemic, which also took place under worse public health conditions in general). So with Paxlovid being a newsworthy topic right in the subject matter of this site, I'll give a personal report. As with any decision for pharmaceutical intervention, there are pros and cons. Above I gave some of the reasons to go ahead, but there are several downsides. One is drug interactions. Paxlovid is the umbrella name for the combination of the Pfizer protease inhibitor ([nirmatrelvir](https://en.wikipedia.org/wiki/Nirmatrelvir)) and plenty of [ritonavir](https://en.wikipedia.org/wiki/Ritonavir). That second drug, while it got its start as an antiviral protease inhibitor for HIV therapy, does nothing whatsoever against the coronavirus *per se*. Ritonavir is a tremendous inhibitor of one of the main metabolic enzymes in the liver, though ([CYP3A4](https://en.wikipedia.org/wiki/CYP3A4)), and that inhibition is needed to keep the blood levels of the actual drug up to a useful range. Ritonavir still serves the same function in other antiviral cocktails, for HIV and for hepatitis C, since CYP3A4 is a common clearance mechanism. That means that you'd better check to make sure that you're not taking any drugs already that get cleared by that enzyme, though, or you're suddenly going to find yourself taking a heck of a lot more of them. Some pretty common medications are in that category, and this is one of the reasons that the Paxlovid package insert is roughly as long as *Ulysses,* and in about 6-point font as well. There are antifungals, antidepressants, anticoagulants, analgesics, antipsychotics, calcium-channel blockers, HMG-CoA reductase inhibitors and more, and you're either going to have to get off many of these for the five days of Paxlovid or watch things extremely carefully. Fortunately, the antihypertensives I take are not on the list. The second consideration is of course the potential side effects of the drug itself, or the two drugs themselves. The ones spotted in the clinical trials seem to have translated well into what's shown up in broader use, and they range from annoying (and fairly common) to rare and potentially serious. Now, that second category is applicable to basically every single prescription and over-the-counter drug available, so you have to look into the details. A common side effect is said to be a metallic taste, and I can confirm that. Within thirty minutes to an hour after taking my first dose, I could feel a sensation as if my salivary glands had started secreting dilute tonic water. It's odd, and I wouldn't choose to live with it for the rest of my life, but it's no great hardship since it disappears when the Paxlovid disappears. Diarrhea is also on the list, and while I haven't experienced that, I do know someone who discontinued taking the drug for just that reason. The rare-but-serious side effect to look out for is just what came up along the way in [yesterday's blog post](https://www.science.org/content/blog-post/hepatitis-mystery), though: drug-induced liver damage. That would appear to be down to the ritonavir, and it's a warning common to every drug combination using it. The signs of acute liver tox are classic and nearly universal: jaundice (yellowing of the skin and eyes, due to uncleared bilirubin from the liver's attempts to reprocess broken-down red blood cells), itchy skin, no appetite, dark urine, and outright pain in the right upper abdomen. This stuff means an immediate halt to taking the drug, of course, but the good news is that such cases almost always clear up due to the liver's self-repair mechanisms. I have of course seen no signs of any of this so far, but it's generally not possible to predict who might show such hepatotoxicity, so you do have to keep it in mind. Walking around poking your liver to see if it hurts is not a productive monitoring method, but between my wife and me we should be able to notice if I start changing colors. Mind you, she's also Covid-positive and now taking Paxlovid, too, so I'll need to make sure that she's not yellowing out on me, either. The family that Paxlovids together. . . hunts for rhymes to pharmaceutical brand names together, I guess. So that's the situation around here. I will say that since I started taking the drug, my coughing (etc.) seems to have cleared up greatly, although it's not possible to say what the course would have been without taking the drug, either. But it was enough of a plausible *post hoc ergo propter hoc* to make me think that it is likely a real effect. I plan to continue on the five day course (three pills each morning, three each evening) while watching for any trouble, and I'll report anything interesting. I am of course unhappy to have caught the virus, although I will say that I'm glad that I missed its earlier iterations and made it to the point to where there's an actual antiviral I can take. And for what it's worth, there's a psychological benefit to that. Most of the time with viral infections you frankly just have to lie there, drink liquids, and wait for it to be over (and that goes for the mild ones as well as the severe ones, unfortunately). I am very glad (thanks to the team at Pfizer) to be able to jam a wrench into the viral replication machinery that's trying to colonize my cells - it feels good to fight back. *** ## Comments Please enable JavaScript to view the [comments powered by Disqus.](https://disqus.com/?ref_noscript) #### IN THE PIPELINE Derek Lowe’s commentary on drug discovery and the pharma industry. An editorially independent blog, all content is Derek’s own, and he does not in any way speak for his employer. ## YOU MAY ALSO LIKE 4 Dec 2025 - [Derek Lowe](https://www.science.org/content/author/derek-lowe "Derek Lowe") [Fixing A Reaction](https://www.science.org/content/blog-post/fixing-reaction "Fixing A Reaction") 2 Dec 2025 - [Derek Lowe](https://www.science.org/content/author/derek-lowe "Derek Lowe") [Complete Regulatory Chaos](https://www.science.org/content/blog-post/complete-regulatory-chaos "Complete Regulatory Chaos") 17 Dec 2025 - [Derek Lowe](https://www.science.org/content/author/derek-lowe "Derek Lowe") [Where Are They Now: Verge Genomics](https://www.science.org/content/blog-post/where-are-they-now-verge-genomics "Where Are They Now: Verge Genomics") 8 Dec 2025 - [Derek Lowe](https://www.science.org/content/author/derek-lowe "Derek Lowe") [A Sandmeyer Replacement](https://www.science.org/content/blog-post/sandmeyer-replacement "A Sandmeyer Replacement") [View More](https://www.science.org/blogs/pipeline) ## Categories [Covid-19](https://www.science.org/topic/blog-category/covid-19) ## ARCHIVES Select Year: View Posts ## Recommended[Close](https://www.science.org/content/blog-post/paxlovid-personally) 18 Jan 2022 [Discovering Paxlovid](https://www.science.org/content/blog-post/discovering-paxlovid "Discovering Paxlovid") 5 Jan 2022 [Making Paxlovid](https://www.science.org/content/blog-post/making-paxlovid "Making Paxlovid") 16 May 2022 [Personal Paxlovid Update](https://www.science.org/content/blog-post/personal-paxlovid-update "Personal Paxlovid Update") 14 Dec 2021 [Pfizer's Paxlovid Holds Up](https://www.science.org/content/blog-post/pfizer-s-paxlovid-holds "Pfizer's Paxlovid Holds Up") [Skip slideshow](https://www.science.org/content/blog-post/paxlovid-personally#afterSlideshow-j3n) ###### [Follow Us](https://www.science.org/content/page/science-family-journals-social-media) - 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