Paxlovid and travellers
July 27th, 2022Paxlovid®= combination of Nirmatrelvir (N) and Ritonavir (R)
Paxlovid is a COVID-19 medication that is a combination of two antiviral drugs. It is used for the treatment of early COVID-19 in persons who are severely immunosuppressed. The goal is to make COVID sufferers less likely to progress to severe COVID-19 which requires hospitalisation. In a trial undertaken in unvaccinated adults, it was found to be about 90% effective at stopping this severe progression.
Paxlovid has to be taken as soon as possible after the COVID-19 diagnosis, and definitely within the first 5 days. It only works in the early stages of COVID-19, when there is not much virus in the body. The N medication works by stopping the relatively large viral proteins that are being made in the infected cell from being cut up and assembled into new viruses – so you don’t get as many viruses causing damage in the body. The R component stops the N medication being broken down in the liver so the N drug levels are boosted and do more work stopping the virus. If you take the medication too late, the damage has already occurred – that is why Paxlovid does not work if someone is already severely ill.
Paxlovid has a low incidence of side effects if recipients are chosen carefully, BUT it can cause problems if patients have weak kidneys or are taking drugs that interact with it. Many common drugs (like heart medication, blood thinners, pain killers e.g pethidine and feldene, diazepam, anti-epilepsy medication, and anti-cholesterol medications to name a few) dramatically increase the risk of side effects. There is more info here on the drug interactions: https://www.covid19-druginteractions.org/checker
Paxlovid was added to the Australian Pharmaceutical Benefits Scheme (PBS) on 1st May 2022. Drugs on the PBS are available to Australians for about $40. The cost for a private (non-PBS) prescription is reported to be about $1000 for a 5-day course. In Australia, there is a limited supply of Paxlovid, so it has been requested that doctors do not supply this medication “off the PBS” or there will not be enough to go around to the patients who most need it. Giving it “off the PBS” means, for example, giving it to patients who are fully vaccinated and only have mild immunosuppression, if any. We don’t know yet if Paxlovid is helpful in this group of “standard risk” individuals. We have no evidence that it helps this standard risk population to get less symptoms, avoid hospital, avoid LongCOVID, or even to be less contagious. (The data is being collected and we may get further information in the future.)
According to Australian guidelines, the following groups are currently the only ones who are recommended to takePaxlovid after they are diagnosed with COVID-19[1]:
- 70 years and older, regardless of risk factors and with or without symptoms
- 50 years or older with 2 additional risk factors
- Aboriginal or Torres Strait Islander, 30 years or older and with 2 additional risk factors.
- Any patient over the age of 18 who is moderately to severely immunocompromised.
Risk factors for severe COVID-19diseaseinclude those with some types of cancer, those on some immunosuppressive drugs, and those with organ failure (heart/lung /liver/kidney), HIV, untreated high blood pressure, obesity, diabetes requiring medication, Downs syndrome, or sickle cell disease.
So in summary, Paxlovid is currently not recommended and not necessary for healthy vaccinated travellers in case they get COVID-19 while overseas.
Dr Deb Mills MBBS MPHTM
[1]https://www.health.gov.au/health-alerts/covid-19/treatments/oral
But what about those of us at risk (eg over 70) that want to travel. Is Paxlovid in such short supply that we can’t take it with us to countries where it is not available. I’m over 70 and being asked to undertake a business trip to India. I am not sure I will risk it without Paxlovid in my bag. Is it a legal restriction or just a recommendation stopping it’s supply off PBS?
Hi Greg,
Yes you are right paxlovid is likely to be in even more short supply in some other countries.
I agree with you – it makes sense to have it if you will be somewhere where the drug is unavailable when you contract COVID-19
It is not a legal problem.
The Australian government has restricted supply by increasing the price for those who are NOT getting it on the PBS ( ie if you are sick you get it on the PBS)
Actually Paxlovid is under-utilized and the word is that there is a lot that is expiring.
If you have no contraindications, you can get a private script but it will cost $1000 to have it filled. Lately, some travellers are paying the money and taking paxlovid with them – just in case for peace of mind.
There have just been results released that Paxlovid is effective in vaccinated persons as well as in unvaccinated persons.
https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciac673/6672670
That is the best news, we are longing to travel and i am willing to pay $1,000, I am going to ask my Doctor as he has previously said I am able to take them
Hi Christine, just wondered if you were able to get the paxlovid (private script, Non-PBS) to take with you on your trip? I’m in the same situation now, need to travel overseas to some countries where I think it will be difficult to get paxlovid, but not sure if the GP will give me prescription for it (even as a private script) without a positive Covid test. Thanks 🙂
HI Nick, Doctors do not need a positive COVID test to write a private script, Aus Doctors only need a positive covid test to be able to write a PBS (cheap) script. Doctors need to be satisfied the person would benefit taking it if they get COVID (eg over 70 etc) and that it would be safe ( no kidney problems) and any drug interactions are clearly spelled out ( what drugs to stop and for how long )
May I get a Paxlovid prescription for travel abroad?
You can only get a private script
Hi there,
I was prescribed Paxlovid last year when I had COVID. I’m going to the USA in April. Will I be able to get it in the USA if I contract Covid while there?
Thanks
HI Brenton
You would need to interact with the US medical system – my colleagues in US tell me you many have to go to an urgent care centre or find a doctor. Likely travel insurance Hotlines may help.
Ideally you should have your doctor here run your medications through the Liverpool drug interaction checker
https://www.covid19-druginteractions.org/checker
to make sure there are no interactions with your existing medications, and so you know which medications you have to stop for how long – for example some meds need to be stopped while on paxlovid and for 3 days or 5 days after. The checker will do a nice print you can carry.
Best to be clear about while in australia
Paxlovid is available but the US authorities (FDA) have criteria for the practitioners and pharmacists to follow:
http://www.fda.gov/media/158165/download
Cost is approximately $10 to $20- so I am told
Carry some RAT tests so you can be ready if you get symptoms as the sooner you start after you get COVID the better
regards Dr Deb
Thank you, this is excellent information. If I suffered from long covid issues (myocarditis), would I be eligible to get paxlovid filled (PBS) before I left Australia for Bali? The Dr has given all clear to travel. Again just a precaution. Thank you,
Sadly you have to be Covid positive regardless of pre-existing conditions
Suppose you are in a risk category, age-wise.
Suppose you are traveling (for a month) to a country where you are not sure of Paxlovid availability.
Could you get PBS script for a pack due to expire, say, one week after your planned return … a pack that would otherwise likely be discarded?
… for use if medically diagnosed positive overseas, and returned unopened if not used?
[Complex issue, as there could be a surge here during such a period.]
Great idea but sadly no – it seems politicians have taken over making medical decisions
I asked my doc to prescribed me the paxlovid for travel to third world country
But my doc scolded me by saying he can report me to the board and this is illegal to do so . Please advise if this is a legal issue ?
HI Lay, Your doctors is partly correct – it would be illegal if the doctor wrote a script on the PBS for paxlovid when you were not sick and did not have COVID at that time, however it is perfectly legal to write a PRIVATE script for paxlovid. It would cost $1,100-$1,300 to get a private paxlovid script filled which is clearly a lot of money, so many doctors just discount the possibility that anyone would want to pay that. However for some persons at high risk who are travelling to areas where the medication is not available they feel that this is worth it for them to have the peace of mind.