Joe Biden swallowed it, Olaf Scholz probably too, and Karl Lauterbach tweeted last summer: “To avoid complications, I take Paxlovid.” Middle was approved in early 2022 as the first home-use drug that inhibits the multiplication of the dangerous virus. It sounded like a miracle: you swallow a couple of pills and the risk of a severe course is practically eliminated. Finally, the world rejoiced, a cure for the virus! Nevertheless, Paxlovid now seems to have become a slow seller. Of the one million doses ordered by the Federal Ministry of Health, pharmacies have so far only called up 300,000 therapy units. Doctors rarely prescribe it, and it doesn’t currently play a major role in everyday clinical practice either. The reasons for this are surprising – and some have nothing to do with the drug itself.
With the onset of the pandemic, the search for an effective remedy against SARS-CoV-2, as well tolerated as possible and in tablet form. Initially, they relied on antibodies that can intercept the virus in the blood. But they must be infused into a vein under medical supervision, and they have little effect against the omicron variant. The drug remdesivir works in a different way, it prevents the virus from multiplying – but is only available as an infusion. The drugs in tablet form, Paxlovid, and the less effective molnupiravir were therefore considered breakthroughs. And in fact, Paxlovid brought in more than 17 billion US dollars worldwide for its manufacturer group in 2022 by last autumn, in the third quarter of 2022 it accounted for a third of sales. The drug consists of two active ingredients: Nirmatrelvir inhibits the enzyme 3-chymotrypsin-like protease, which the virus needs to multiply. Ritonavir, in turn, blocks another protein, causing nirmatrelvir to break down more slowly. An elegant solution. Infected people take two tablets of nirmatrelvir and one of ritonavir in the morning and evening, as precisely as possible every twelve hours, over a period of five days.