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Paxlovid mouth: The unpalatable truth about the COVID-19 antiviral
After almost three years of dodging COVID-19, it took me down over the holidays. When I called my doctor to report my positive test, he checked my age and preexisting conditions and immediately recommended I go on the antiviral Paxlovid.
Paxlovid is used to treat mild-to-moderate COVID-19 in adults and children ages 12 and older. The candidates for the antiviral must weigh at least 88 pounds, have a positive SARS-CoV-2 test and be at high risk of progressing to severe COVID-19 that could result in hospitalization or death.
Paxlovid is actually a combination of two medications, nirmatrelvir and ritonavir. Nirmatrelvir helps stop the SARS-CoV-2 virus from replicating itself. And since nirmatrelvir is rapidly broken down by the body, it’s combined with the anti-HIV drug ritonavir to slow that breakdown and allow nirmatrelvir to stay in the body longer.
The combination worked like magic on me. Within 24 hours my horrible cough was gone, and I was feeling pretty much 100 percent by the time I’d finished the five-day Paxlovid course.
Unfortunately, there was one extremely upsetting side effect I hadn’t counted on….
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The horror of “Paxlovid mouth”
Within minutes of taking my first Paxlovid dose, an absolutely disgusting taste spread through my mouth. If I had to describe it, I would say it tasted the way hot garbage on a metal roof smells. The taste was so foul that it nearly made me gag.
When I went to the internet to find out more about this unpleasant side effect, I discovered it had been given a name: “Paxlovid mouth”. Medically known as dysgeusia, it’s a condition where a person experiences a constant bad metallic, bitter, salty or rancid taste in their mouth. Dysgeusia can also affect the way food and beverages taste.
Dysgeusia has been reported to only affect about 6 percent of people taking Paxlovid, though from what I’ve seen in online forums and on social media that number is probably higher.
Medical experts have said this type of reaction could be related to an inflammatory response or receptor malfunction. Dysgeusia also is not limited to Paxlovid, though it’s not been as widely reported in other antivirals.
As unpleasant as it can be, Paxlovid mouth isn’t considered harmful and doesn’t affect your overall health. It usually resolves once you’ve finished the medication and it’s fully processed out of the body. I know that was the case for me; within a day or so of finishing my Paxlovid course, that awful taste in my mouth had disappeared.
The biggest danger associated with Paxlovid mouth is that it can prompt people to stop the medication before the full five days of prescribed therapy are up. If it wasn’t for the fact that my doctor recommended Paxlovid so strongly, I may have stopped taking the medication altogether. But my doctor had cautioned me that once I started taking an antiviral like Paxlovid, it’s the same as taking an antibiotic. He told me I needed to take all the medication, or I could risk the virus mutating into an even more problematic illness.
Despite this advice, it’s not known for certain what the impact of stopping Paxlovid early might be. Still, one family medicine physician, Dr. David Cutler, tells Medical News Today that it could leave that individual more vulnerable to hospitalization and death from COVID-19.
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Weighing Paxlovid’s pros and cons
Cutler calls the decision to initiate Paxlovid therapy complex and says a person must consider all the potential benefits, risks, and options before deciding on the best course of action.
“In addition to ‘Paxlovid mouth’ there are many other risks to taking Paxlovid,” he tells Medical News Today. “Diarrhea is common, as well as other gastrointestinal symptoms like nausea, vomiting, and liver toxicity.”
Cutler adds that many medications have adverse interactions with Paxlovid, so your doctor needs to carefully check which medications you’re on before recommending the antiviral. Also, people with significant kidney or liver dysfunction should not take Paxlovid.
Plus, there’s the issue of COVID-19 “rebound.” This happens when the SARS-CoV-2 infection initially resolves, then reappears a week or so later.
Interestingly, one group of researchers determined that early treatment with Paxlovid suppressed the natural development of antibodies against COVID-19. This could leave people with lower overall immune responses and possibly more vulnerable to subsequent SARS-CoV-2 infection.
On the more positive side, not only has Paxlovid been found to shorten the severity and duration of COVID-19, but it also may result in a roughly 25 percent lower risk of a post-COVID condition, the phenomenon also known as “long COVID.”
Getting rid of Paxlovid’s nasty taste
If you’re unlucky enough to experience Paxlovid mouth, you may be wondering if there’s any way to get rid of it. Thankfully, when I took Paxlovid, it did not affect the way my food and drink tasted. In fact, eating and drinking were the only things that helped temporarily relieve the awful taste, though it kicked up again as soon as I’d finished the food or beverage.
There were some food suggestions on social media that I found offered relief for up to 30 minutes after I’d consumed them. They included gum, mints, cinnamon candies, milk, cinnamon or mint teas and pineapple.
One doctor recommended to Medical News Today that people on Paxlovid take zinc as well. “It has a number of different immune benefits, and it also helps with sense of taste and smell,” says Dr. Raphael Kellman, physician of integrative and functional medicine at Kellman Wellness Center in New York.
“Whenever you’re taking an antiviral or an antibacterial medication, I would recommend taking a probiotic as well,” Kellman adds. A probiotic can help protect your gut flora from being destroyed by these powerful medicines.
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Sources:
Paxlovid mouth: What is it and how to get rid of it — Medical News Today
Paxlovid May Lower Long COVID Risk, VA Study Suggests — MedPage Today
Why subvariants of the SARS-CoV-2 virus accelerated the pandemic — ScienceDaily
What Does It Feel Like to Take Paxlovid for COVID? — GoodRx Health
Paxlovid mouth’: What it is—and how to treat it — Advisory Board
By Carolyn Gretton
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