Clinician fact sheet for use of nirmatrelvir/ritonavir (Paxlovid™) and molnupiravir (Lagevrio®) for treatment of COVID-19, oseltamivir (Tamiflu®) for prophylaxis and treatment of influenza.
GPs and residential care facilities are encouraged to establish and document a pre-assessment for people at higher risk of severe disease to receive respiratory antivirals. This supports timely access and safe administration.
To support this, people who may be at higher risk for severe disease from influenza or COVID-19 should be pre-assessed for eligibility for these treatments using either:
Advice should be provided to people at higher risk of severe disease, and their treatment plan documented on the Antiviral Pre-Assessment Form.
Where there is concern regarding renal function, a recent creatinine and eGFR should be undertaken and the results recorded on the pre-assessment form.
Visit the Department of Health website for information about eligibility for oral COVID-19 treatments.
Nirmatrelvir/ritonavir (Paxlovid™) can be used in eligible people with confirmed COVID-19 in the community. The drug should be commenced as early as possible but no later than day 5 after symptom onset. It may also be used as soon as possible in asymptomatic people aged 70 years or over. This medicine requires dose adjustment in people with renal impairment and is contraindicated in people with severe renal or hepatic impairment.
Paxlovid interacts with many different medicines, including herbal supplements. These interactions may lead to clinically significant adverse reactions, and/or a loss of therapeutic effect of Paxlovid. The GP should review the person’s medications/supplements and potential for drug interactions. The Liverpool COVID-19 drug interactions checker can be used to assess this.
Molnupiravir (Lagevrio®) can be used in eligible people with confirmed COVID-19 in the community. The drug should be commenced as early as possible but no later than day 5 after symptom onset. It may also be used as soon as possible in asymptomatic people aged 70 years or over.
While nirmatrelvir/ritonavir (Paxlovid™) is considered first line for treatment of patients with mild to moderate COVID-19 at higher risk of progression to severe disease, in many common clinical circumstances Paxlovid™ will be contraindicated or unsuitable for use, and molnupiravir remains a suitable option in such patients.
Oseltamivir (Tamiflu®) can be used for treatment of people with suspected/confirmed influenza, or for prophylactic use in exposed people (primarily during influenza outbreaks in facilities and in people at higher risk of severe disease). Treatment with oseltamivir may shorten the duration and severity of disease in people that already have influenza.
The Australian Therapeutic Guidelines* recommends treatment with antivirals be offered for patients with influenza complications or severe disease. Clinicians can consider treatment for people at higher risk of severe disease from influenza.
People at higher risk of severe disease from influenza (from the Therapeutic Guidelines⃰):
⃰ Current as of 31 March 2023. Clinicians should refer to the Therapeutic Guidelines for further details and the most current clinical advice.
