COVID-19 antivirals – your questions answered

Antivirals are medicines that help stop a virus infecting healthy cells or multiplying in the body.

There are antivirals available that work against COVID-19 and they work best when taken as soon as possible.

COVID-19 antivirals do not work against other viruses like the flu. There are different antivirals for the flu.

Antiviral medicines target the virus (SARS-CoV-2) that causes COVID-19 to prevent it infecting healthy cells in your body and multiplying. This helps stop the spread of the virus inside your body and helps your immune system to fight off the infection.

By reducing how severe the illness is, you are less likely to:

• go to hospital
• develop breathing difficulties
• need assistance with oxygen or intensive care treatment, or
• die from COVID-19.

Antivirals are not a substitute for vaccination. Vaccination is still the best protection against COVID-19.

The Therapeutic Goods Administration (TGA) has approved 2 oral antiviral treatments for COVID-19 in Australia. Both are available in NSW.

They are:

• Paxlovid® (nirmatrelvir + ritonavir)
• Lagevrio® (molnupiravir).

COVID-19 antivirals work best when taken as soon as possible, usually within 5 days from when your symptoms start.

Most people who are eligible will be prescribed oral antivirals, which come in tablet or capsule form to be taken by the mouth. This means you can take these medicines at home and don’t need to go to hospital for treatment.

There are other treatment options available including antiviral injections. Your doctor will let you know the best treatment option for you.

You can only be prescribed antiviral medicines by a doctor if you test positive to COVID-19 through a PCR (nose and throat swab) or rapid antigen test (RAT) and meet the eligibility criteria.

You may be eligible to receive antiviral medicines if you are:

• 70 years of age or older
• 50 to 69 years of age with 1 additional risk factor for severe illness 
• an Aboriginal person, 30 years of age or older and with 1 additional risk factor for severe illness
• 18 years of age or older and are immunocompromised.

If you are 18 years of age or older and have been previously hospitalised with COVID-19, you are eligible for antiviral treatments if you test positive to COVID-19 again.

Risk factors include:

• living in residential aged care
• living with disability with multiple conditions and/or frailty (but not limited to living in supported accommodation)
• neurological conditions like stroke or dementia and demyelinating conditions e.g., multiple sclerosis, Guillain-Barre Syndrome
• chronic respiratory conditions including COPD, moderate or severe asthma
• obesity or diabetes (type I or II requiring medication)
• heart failure, coronary artery disease, cardiomyopathies
• kidney failure or cirrhosis
• living remotely with reduced access to higher level healthcare
• past COVID-19 infection episode resulting in hospitalisation.

Find out more about risk factors and your eligibility for antiviral medicines on the Department of Health website.

Some people who are at higher risk of severe illness who test positive to COVID-19 may still be able to obtain antiviral medicines even if they do not meet the Pharmaceutical Benefits Scheme (PBS) criteria. Speak to your doctor.

You can use the COVID-19 Symptom and Antiviral Eligibility Checker to check your eligibility for antiviral medication.

Talk to your doctor now so you know:

• which COVID-19 test you should do if you get sick
• if you need antiviral medicines.

Your doctor can fill out an action plan and you can discuss which treatment best suits you:

• Pre-assessment action plan for respiratory infections
• Pre-assessment action plan for respiratory infections in aged care facility resident

If you test positive for COVID-19, your doctor will still need to provide a prescription for antiviral medicines but knowing which antiviral medicine is right for you will help you access it more quickly and easily.

There are 2 avenues for accessing antivirals:

1. Call your doctor immediately to discuss antivirals (usually via telehealth). Antivirals work best when taken as soon as possible, usually within 5 days from when your symptoms start.

If your doctor says you are eligible for antivirals, they will send you a prescription (online or paper copy). It's recommended you ask your pharmacy to arrange home delivery for your medication or ask someone to collect it on your behalf.

2. Complete a survey via SMS. If you register a positive rapid antigen test with Service NSW, or test positive to COVID-19 on a PCR test, you'll receive a survey link from NSW Health via SMS. Although registration of a positive rapid antigen test is no longer mandatory, voluntarily doing this helps you access antiviral medicines if you are eligible.

If you're identified as higher risk after completing the survey, you will receive an SMS from Healthdirect Australia about discussing antivirals with your doctor.

You will only be sent an SMS from Healthdirect Australia if you have:

• received a positive COVID-19 PCR test result or registered a positive rapid antigen test result
• completed the survey you receive from NSW Health
• been identified as being at higher risk of severe illness.

If you believe you are at high risk of getting very sick from COVID-19 and have not received the NSW Health survey or cannot get in touch with your doctor, contact the National Coronavirus Helpline on 1800 020 080.

Why can't everyone access antivirals?

Antivirals can only be used in the early stages of infection and are not suitable for everyone. Most people can manage COVID-19 safely at home without needing antivirals. Antivirals may help people who are at higher risk of developing severe illness, depending on their circumstances.

All medicines can potentially have side effects but most will disappear with time or when you stop treatment.

You can have different side effects from antivirals based on which medicine your doctor has prescribed for you. The medicine information sheets discuss side effects:

• Lagevrio® (molnupiravir)
• Paxlovid® (nirmatrelvir + ritonavir)

Your doctor will tell you if they are safe for you to use.

Some people should not take any COVID-19 antiviral medicines. Some people can only take 1 type of antiviral medicine and not the other. Your doctor can tell you if antivirals are not suitable for you.

The medicine information sheets also provide further information:

• Lagevrio® (molnupiravir)
• Paxlovid® (nirmatrelvir + ritonavir)

Oral antivirals, Lagevrio® and Paxlovid® are available on the Pharmaceutical Benefits Scheme (PBS) in Australia and are subsidised for people with a Medicare card.  

Visit the Department of Health website for the latest information on costs.

You can still access antivirals if you do not have a Medicare card but the cost for treatment will vary depending on your circumstances. Visit COVID-19 oral treatments for people without a Medicare card for more information.

Please read more information on oral antivirals on NPS Medicinewise.