Lagevrio (molnupiravir) vs Paxlovid (nirmatrelvir and ritonavir)

Lagevrio (molnupiravir) vs Paxlovid (nirmatrelvir and ritonavir)

Lagevrio (molnupiravir) and Paxlovid (nirmatrelvir and ritonavir) are both oral antiviral medications used to treat mild to moderate COVID-19 in individuals at risk for developing severe illness. Lagevrio works by introducing errors into the viral RNA, thereby inhibiting replication, while Paxlovid works by blocking a protein the virus needs to replicate. When deciding between the two, it is important to consider factors such as potential drug interactions, especially since Paxlovid includes ritonavir, which can affect the metabolism of other drugs, and the patient's overall health status and medical history.

Difference between Lagevrio and Paxlovid

Metric Lagevrio (molnupiravir) Paxlovid (nirmatrelvir and ritonavir)
Generic name Molnupiravir Nirmatrelvir and ritonavir
Indications Treatment of mild-to-moderate COVID-19 in adults with positive results of direct SARS-CoV-2 viral testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death. Treatment of mild-to-moderate COVID-19 in patients who are at high risk for progression to severe COVID-19, including hospitalization or death, and for whom alternative COVID-19 treatment options authorized by the FDA are not accessible or clinically appropriate.
Mechanism of action Molnupiravir is an oral antiviral that inhibits SARS-CoV-2 replication by viral mutagenesis. Nirmatrelvir inhibits the SARS-CoV-2 main protease, which is necessary for viral replication. Ritonavir slows the breakdown of nirmatrelvir, increasing its effectiveness.
Brand names Lagevrio Paxlovid
Administrative route Oral Oral
Side effects Diarrhea, nausea, dizziness. Dysgeusia (taste disturbance), diarrhea, hypertension, and myalgia.
Contraindications Not recommended during pregnancy, breastfeeding, or in patients with severe renal impairment. Contraindicated with drugs highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening reactions.
Drug class Antiviral Protease inhibitor (nirmatrelvir) and CYP3A inhibitor (ritonavir)
Manufacturer Merck Sharp & Dohme (a subsidiary of Merck & Co., Inc.) Pfizer Inc.

Efficacy

Lagevrio (Molnupiravir) Efficacy

Lagevrio, known generically as molnupiravir, is an antiviral medication developed for the treatment of COVID-19. It is designed to introduce errors into the SARS-CoV-2 viral RNA, thereby inhibiting its replication. Clinical trials have demonstrated that molnupiravir is effective in reducing the risk of hospitalization or death in patients with mild to moderate COVID-19 who are at risk for progressing to severe disease. Specifically, the MOVe-OUT Phase 3 trial showed that treatment with molnupiravir resulted in a 30% reduction in the risk of hospitalization or death when administered within five days of symptom onset. However, it is important to note that the efficacy may vary based on the patient population and the prevalence of different variants of the virus.

Paxlovid (Nirmatrelvir and Ritonavir) Efficacy

Paxlovid is a combination of two antiviral drugs, nirmatrelvir and ritonavir, which is authorized for use in treating COVID-19. Nirmatrelvir inhibits a SARS-CoV-2 enzyme to prevent the virus from replicating, while ritonavir slows down nirmatrelvir's breakdown to help it remain in the body for a longer period at higher concentrations. The EPIC-HR trial has shown that Paxlovid is highly effective in reducing the risk of hospitalization or death in patients with COVID-19 who are at high risk for severe disease. In this study, Paxlovid reduced the risk of hospitalization or death by 89% when treatment was initiated within three days of symptom onset and by 85% when treatment was started within five days.

Comparative Efficacy

When comparing Lagevrio and Paxlovid, data suggests that Paxlovid may offer a higher efficacy in preventing severe outcomes from COVID-19, particularly in high-risk populations. However, the efficacy of both drugs can be influenced by factors such as the timing of administration after symptom onset, the presence of comorbid conditions, vaccination status, and the emergence of new viral variants. It is also crucial to consider the potential for drug interactions, especially with Paxlovid due to ritonavir's role as a potent inhibitor of cytochrome P450 3A4, which can affect the metabolism of many other drugs.

Conclusion

Both Lagevrio and Paxlovid have shown efficacy in the treatment of COVID-19 and are valuable tools in managing the disease, particularly for patients at increased risk of severe outcomes. The choice between these antiviral treatments should be made based on individual patient factors, potential drug interactions, and the latest evidence on variant susceptibility. Continuous monitoring and research are essential to ensure the optimal use of these medications as the pandemic evolves and new variants of the virus emerge.

Regulatory Agency Approvals

Lagevrio
  • European Medical Agency (EMA), European Union
  • Food and Drug Administration (FDA), USA
  • Therapeutic Goods Administration (TGA), Australia
  • Medicines & Healthcare products Regulatory Agency (MHRA), United Kingdom
Paxlovid
  • European Medical Agency (EMA), European Union
  • Food and Drug Administration (FDA), USA
  • Health Canada
  • Therapeutic Goods Administration (TGA), Australia
  • Medicines & Healthcare products Regulatory Agency (MHRA), United Kingdom

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If Lagevrio or Paxlovid are not approved or available in your country (e.g. due to supply issues), you can access them via Everyone.org.

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