Paxlovid is an oral antiviral medication prescribed to treat mild-to-moderate COVID-19 in individuals at high risk for severe illness. It is a five-day treatment taken twice daily to prevent the virus from multiplying. While it significantly reduces the risk of severe illness, knowing what to expect after the last dose is important.
The Immediate Post-Treatment Period
Following the five-day course, many individuals continue to see their COVID-19 symptoms improve. Side effects from Paxlovid, such as a metallic taste (dysgeusia) or diarrhea, usually disappear after completing the treatment. Common side effects experienced during treatment include a bitter taste, diarrhea, increased blood pressure, muscle aches, nausea, and headache. It's vital to finish the full five-day course, even if you feel better earlier.
Understanding COVID-19 Rebound
A key consideration after finishing Paxlovid is "COVID-19 rebound," where symptoms or a positive test return 2 to 8 days after initial recovery. Rebound can occur whether or not someone took antiviral medication.
While initial data suggested a low rebound rate, some studies indicate it could be higher, potentially 20% or more in those treated with Paxlovid. One theory is that the antiviral temporarily suppresses the virus, and upon stopping the medication, any remaining virus can replicate, causing symptoms to return.
Rebound symptoms are typically milder than the original illness, often including cough, fatigue, headache, and sore throat. Severe outcomes from rebound have not been reported.
What to Do If You Experience a Rebound
If symptoms return or you test positive after completing Paxlovid, the CDC advises re-isolating for at least 5 more days. Isolation can end after 5 days if fever-free for 24 hours without medication and symptoms improve. Masking is recommended for 10 days from the start of rebound symptoms. A second course of Paxlovid or other antivirals is not currently recommended for rebound; manage symptoms with supportive care as advised by your doctor. You can be contagious during a rebound.
Comparing Normal Recovery vs. Paxlovid Rebound
| Feature | Normal Post-Paxlovid Recovery | COVID-19 Rebound |
|---|---|---|
| Symptom Trajectory | Symptoms continue to improve or resolve completely. | After initial improvement, symptoms reappear 2-8 days after treatment ends. |
| Symptom Severity | Lingering mild symptoms like a cough may persist but gradually fade. | Rebound symptoms are typically milder than the initial infection. |
| COVID-19 Test | Should turn and remain negative. | May test positive again after a previous negative test. |
| Required Action | Follow standard CDC guidance for ending isolation once symptoms improve and you are fever-free. | Restart a 5-day isolation period and wear a mask for 10 days from rebound onset. |
| Contagiousness | Less likely to be contagious once fever-free and symptoms are improving. | Considered contagious; isolation is necessary to prevent spread. |
Long-Term Outlook and Conclusion
Paxlovid remains highly effective in preventing severe COVID-19 outcomes for high-risk individuals, significantly reducing hospitalization risk. The possibility of a mild rebound should not prevent eligible patients from taking it.
Studies on Paxlovid and Long COVID have had mixed results, with one indicating no significant reduction in Long COVID risk, while other research has suggested a potential reduction. If you experience rebound symptoms, they usually resolve within a few days. Contact your healthcare provider if symptoms persist or worsen. After recovering, whether from the initial illness or a rebound, continue to follow health guidelines and consult your doctor about any lasting concerns.
For more information from the manufacturer, you can report adverse events to Pfizer's safety portal. {Link: Pfizer https://www.pfizer.com/contact/safety}
