Getting sick when you’re pregnant just sucks a little extra. You’re already feeling run down as it is trying to grow an entire person, and you have to be pickier than ever about which medications you can take with a baby on board. So, if you come down with Covid, can you take Paxlovid while pregnant? And what about when you’re breastfeeding? Here, experts answer all your questions about taking Paxlovid if you’re expecting.
Can you take Paxlovid while pregnant?
Yes, it’s safe to take Paxlovid when you’re expecting, and also when you’re breastfeeding, experts say. “We recommend taking it, in fact, particularly if people have additional risk factors for severe covid infection,” says Dr. Brenna Hughes, M.D., maternal-fetal medicine specialist at Duke Health. Pregnancy suppresses the immune system, which increases your risk of developing a more serious case of Covid, she notes.
While you might think of Paxlovid as a new drug (and you’re not wrong), there are actually decades of data behind some of its components that show they’re safe. “One of the medications in Paxlovid is one that we use routinely for people in pregnancy who have HIV infection. We have a very long history of using that medication in pregnancy, like decades of use in pregnancy. So we know that it is quite safe,” says Hughes. The other medications in Paxlovid come from a class of antiviral drugs known to be safe in pregnancy as well, she notes.
Covid is known to cause pregnancy complications in some patients, according to the American College of Obstetricians and Gynecologists (ACOG), like raising the risk of pre-term birth and blood pressure issues. So, taking Paxlovid to reduce its severity is important.
“If a patient who’s pregnant has a positive covid test and has symptoms, we talk to them about their risk factors for severe disease and whether or not they would like to start the medication,” says Hughes. “Pregnancy is one risk factor, but many pregnant people have additional risk factors. They may have underlying asthma, cardiac disease, high blood pressure, or diabetes. Certainly if they’re immunocompromised and pregnant, then we really strongly recommend taking Paxlovid.”
When you’re speaking with your OB-GYN about taking Paxlovid, be sure to tell them about every other medication you’re currently taking. Paxlovid interacts poorly with a long list of other drugs, Hughes says, and your provider needs to know about all your prescriptions to ensure Paxlovid will be safe and effective for you. If Paxlovid doesn’t play well with something you take, your doctor can work with you to either pause that other medication or find an alternative to treat your Covid, like Remdesivir, Hughes says.
When should you take Paxlovid?
Ideally, you’d take this medicine as early in your covid infection as possible. Of course, you’ll probably want to take a covid test to confirm that’s the virus causing you to feel ill, and getting a positive or negative test will determine whether you need to quarantine. But if you’re deciding when to take Paxlovid, think instead about when your symptoms started.
“Ideally, people should take it as early in the disease process as possible, but we generally say within five days of the start of symptoms. Because that’s really how it’s been studied in terms of when it’s been shown to decrease the risks of hospitalization and ICU admissions,” Hughes says.
Can anyone get Paxlovid now?
“Paxlovid is FDA-approved for individuals 12 years and older, who weigh at least 88 pounds, with mild-to-moderate Covid-19 who are at high risk of developing severe disease, including hospitalization,” says Dr. Alok Patel, M.D., pediatric hospitalist at Stanford Medicine Children’s Health. Anyone fitting this profile should have access to the medication, and the earlier you talk to your doctor about your symptoms, the more likely you are to get a prescription for Paxlovid in time for it to help.
Do you need Paxlovid if you’re vaccinated?
You should still talk to your doctor about whether Paxlovid would benefit you, whether you’re fully vaxxed or not. “While vaccination greatly reduces someone’s risk of becoming severely ill, getting hospitalized, or dying from Covid-19, there may still be situations in which Paxlovid is recommended,” Patel says.
What over-the-counter medications can you take while pregnant to ease your symptoms?
Aside from the usual routine of hydrating and resting, what can you pick up at the pharmacy to help you feel less awful while your covid runs its course?
“We generally say that Tylenol is OK to take in pregnancy, following the directions on the bottle, not an excessive amount,” Hughes says. “That’ll help keep their fever down, help with aches, pains, et cetera. Then if they want to take an over-the-counter cough suppressant, that’s probably fine as well.”
It’s a good idea to call your OB-GYN or birth provider and tell them specifically which medications you’re wanting to take, just to be safe. For example, some forms of Mucinex are OK to take during pregnancy to help with a cough and congestion, while some variations of it are not safe. Some decongestants are on the no-go list as well (those containing pseudoephedrine and phenylephrine specifically).
Just remember that taking Paxlovid is not a replacement for getting vaccinated against covid (and it has been proven that it’s safe to be vaccinated during pregnancy). Staying healthy yourself is “the most important safety thing you can do for your pregnancy,” Hughes says. “We know that severe covid infection is not good for the fetus, so keeping mom as healthy as possible is paramount. If you’re pregnant — even if you’re not pregnant — please get that 2023-2024 monovalent booster because that is the best way to keep yourself safe right now.”
Dr. Brenna Hughes, M.D., maternal-fetal medicine specialist at Duke Health
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