Everything About Paxlovid, the First Oral Tablet for COVID-19 Treatment That’s Now Approved in S’pore

Yes, there’s now a tablet that can treat COVID-19.

After all the talk about how vaccines are our main weapons against COVID-19, we understand that this tablet may sound a little sus. Here’s everything about Paxlovid simplified for you.

Treatment, Not Cure

If you’re thinking that someone can just pop a pill and be cured of COVID-19, I’m pretty sure that’s more of an act of divine intervention than the pill’s effect.

This isn’t a magic pill to cure COVID-19, but rather something that treats COVID-19 illnesses to reduce the risk of hospitalisation and death.

Given this pill’s intended purpose, it won’t be given out to everyone who gets infected. Instead, it’ll be prioritised for those at higher risks of developing severe illness, like the elderly or the unvaccinated.

Combination of 2 Medicines

Reader Bao: Er, actually I don’t really need to know what this is made of lah, I just need to know how efficient it is. Not like I’m making the tablet myself—

Anti-vaxxer, probably: We don’t know what’s truly in those vaccines! I will not inject mysterious substances into my bloodstream!

So before anyone starts screaming about how we’re ingesting mysterious substances, this tablet is a combination of two medicines: nirmatrelvir, the antiviral medicine, and ritonavir, which is to keep the concentration of nirmatrelvir high and active in the body for longer to fight the virus.

Nirmatrelvir was designed to block activity of the Sars-CoV-2 3CL enzyme, which the coronavirus replicates.

Now that that’s out of the way, I’ll answer Reader Bao’s query on how efficient this tablet is.

Reduce Hospitalisation or Death By Up To 88.9%

The tablet has to be taken twice daily for five days, and should be given within five days of the onset of symptoms.

Clinical data has shown that the drug can reduce COVID-19 related hospitalisation or death by 88.9% when given within three days, and 87.8% when given within five days of symptoms onset.

This data also included patients infected with the Delta variant, and lab studies revealed that this drug also works against Delta and Omicron.

Side Effects are Mild to Moderate, May Interact with Other Medicines

The Health Sciences Authority (HSA) noted that there were low numbers of cases with side effects in the clinical data. If there were side effects, they were only mild to moderate ones like diarrhoea, vomiting, muscle pain, chills, hypertension, and altered sense of taste.

I mean, isn’t one of the symptoms of COVID-19 the loss of your sense of taste? How would an altered sense of taste work in this scenario? 

But the side effects could be much more serious if you take Paxlovid while on other medications. Medicines for irregular heart rate, migraines and cholesterol levels could interact with Paxlovid.

Additionally, some drugs could interact with Paxlovid and lower the level of it in your body. This includes medicines for epileptic seizures.

Sounds serious, right? However, based on available clinical data, the HSA has determined that the benefits outweigh the risks of Paxlovid, thus approving it for interim use.

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HSA’s Conditions To Approve Use of Paxlovid in Singapore

The HSA has granted interim approval of the drug under the Pandemic Special Access Route (PSAR) on 31 January, but the approval can be revoked anytime.

The HSA will thus require Pfizer, the manufacturer of the tablet, to continue collecting safety data and monitor the use of the tablet.

They’ll also need to submit updated data from ongoing clinical studies, so that the HSA can ensure the safety and efficacy of Paxlovid. This is especially pertinent when it comes to ensuring the efficacy of Paxlovid against newer variants like Omicron.

Additionally, as PSAR only offers interim authorisation, Pfizer would have to submit the complete dataset based on international standards to obtain full approval.

But for now, the Ministry of Health is working with Pfizer to deliver the first batch of Paxlovid within this month.

Other Countries Have Approved Paxlovid Too

In fact, countries like South Korea, Britain, USA and Israel have started administering the drug to COVID-19 patients this month.

Pfizer has also agreed to allow other manufacturers to manufacture and supply versions of Paxlovid to low and middle-income countries.

This was done through a licensing agreement with international public health group Medicines Patent Pool. This agreement helps to ensure that poorer countries can use the drug too.

HSA Reviewing Another Tablet, But Vaccination Still Remains Key

The HSA is also reviewing another antiviral tablet, molnupiravir, for use in treating COVID-19. Clinical trials for this drug have shown that it can halve the risks of death or hospitalisation for those at risk of severe illness.

Reader Bao: Wah, so many tablets to treat COVID-19, that means no need for vaccinations already is it? 

Nope, Reader Bao, you still have to go take your vaccinations and booster shots. Vaccinations will still remain the key to Singapore’s response against the COVID-19 pandemic, even with the introduction of such antiviral pills.

The majority of Singaporeans, if infected, will be well protected by the vaccines and won’t require any specific treatment. These pills are just complementary measures to help the high-risk groups fight their infections better.

Think of vaccinations as a doughnut, and the pills are here to fill in the empty spaces with filling. But the doughnut is still the main thing here.

Reader Bao: …Weird analogy, but OK.

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