Treatment Database

An oral antiviral approved for acute COVID-19: nirmatrelvir blocks the SARS-CoV-2 main protease, and ritonavir boosts its levels. It has been tested for established Long COVID on the theory that persistent virus drives symptoms, and three randomized placebo-controlled trials have found no benefit: STOP-PASC (JAMA Internal Medicine 2024; n=155, 15 days), PAX LC (Lancet Infectious Diseases 2025; n=100, 15 days), and the largest, RECOVER-VITAL (Lancet Infectious Diseases 2026; n=959 at 69 US sites, 15 or 25 days). Evidence for prevention is more encouraging but not settled: in PANORAMIC Norway (Lancet Infectious Diseases 2026), 5 days of treatment during acute infection lowered the rate of Long COVID at 3 months (26% vs. 43% on placebo), but the trial enrolled only 144 of a planned 2,000 participants and was stopped early, so the authors call for larger trials. Ritonavir causes significant drug interactions that carry a boxed warning, so every medication should be reviewed with a prescriber before use.