COVID-19 Antiviral Comparison Tool
Select an antiviral and risk profile, then click Compare to see detailed information.
Comparison Table
| Factor | Molnupiravir | Paxlovid | Remdesivir | Favipiravir |
|---|---|---|---|---|
| Efficacy | Reduces hospitalization by ~50% in high-risk patients | Reduces hospitalization by ~89% in high-risk patients | Reduces recovery time by ~30% in hospitalized patients | Reduces viral load in early-stage patients |
| Safety | Common: Diarrhea, nausea, mild headache | Common: Altered taste, diarrhea, hypertension | Common: Infusion-site reactions, elevated liver enzymes | Common: Nausea, diarrhea, elevated ALT |
| Convenience | Oral, 5-day course | Oral, 5-day course | IV administration, 3–5 days | Oral, 5-day course |
| Cost (UK) | £150–£200 | £300–£400 | £1000+ | £50–£100 |
| Regulatory Status | FDA, EMA, MHRA approved | FDA, EMA, MHRA approved | FDA, EMA, MHRA approved | EMA approved, FDA restricted |
When a COVID‑19 infection hits, the first question most people ask is: which antiviral will get me back on my feet fastest? Molnupiravir (sold under the brand name Movfor) has been in the news a lot, but it’s not the only option on the market. This guide walks you through the most common alternatives, weighs their pros and cons, and helps you decide which drug matches your health profile, budget, and access needs.
What is Molnupiravir (Movfor)?
Molnupiravir is a small‑molecule antiviral that works by inducing errors in the viral RNA of SARS‑CoV‑2. It was originally developed by Ridgeback Biotherapeutics and Merck and received emergency use authorization in the UK and USA in 2022. The drug is taken as a 5‑day course of 800mg capsules taken twice daily.
Molnupiravir’s key selling point is that it can be prescribed to adults with mild‑to‑moderate COVID‑19 who are at risk of severe disease, without requiring any special dosing adjustments for kidney or liver function.
Other Front‑line Antivirals
In 2025 the therapeutic landscape includes three other major oral or IV options that have amassed large real‑world data sets:
- Paxlovid (nirmatrelvir+ritonavir) - an oral protease inhibitor combo that blocks the main viral protease, preventing the virus from maturing. It’s taken for five days, 300mg nirmatrelvir + 100mg ritonavir twice daily.
- Remdesivir - a nucleotide analogue administered intravenously over three days (or five days in hospital settings). It inhibits the viral RNA‑dependent RNA polymerase.
- Favipiravir (commercially known as Avigan) - an oral polymerase inhibitor first used for influenza, later repurposed for COVID‑19 in several Asian countries.
All of these drugs target SARS‑CoV‑2, the virus that causes COVID‑19, but they differ in mechanism, administration route, efficacy data, and regulatory status.
How We Compare Antivirals
To keep the comparison useful, we focus on five practical criteria that patients and clinicians actually care about:
- Efficacy - reduction in hospitalization or death in high‑risk patients.
- Safety profile - common side‑effects and contraindications.
- Convenience - oral vs IV, dosing frequency, and need for monitoring.
- Access & cost - how easy it is to obtain the drug and its approximate price in the UK and US markets.
- Regulatory endorsement - approval status by the FDA, EMA, and MHRA.
Side‑Effect and Safety Snapshot
| Antiviral | Common side‑effects | Key contraindications |
|---|---|---|
| Molnupiravir | Diarrhoea, nausea, mild headache | Pregnancy (category not recommended), severe renal impairment |
| Paxlovid | Altered taste, diarrhoea, hypertension | Strong CYP3A4 inhibitors, severe liver disease |
| Remdesivir | Infusion‑site reactions, elevated liver enzymes | Severe renal dysfunction (eGFR <30ml/min), hypersensitivity |
| Favipiravir | Hyperuricaemia, elevated triglycerides, GI upset | Pregnancy (foetal toxicity), severe hepatic disease |
Effectiveness in Real‑World Studies
Data up to mid‑2025 show the following approximate relative risk reductions (RRR) for hospitalization or death among high‑risk adults when treatment starts within five days of symptom onset:
- Molnupiravir: 30% RRR (based on the PANORAMIC trial data).
- Paxlovid: 89% RRR (EPIC‑HR trial and subsequent observational studies).
- Remdesivir: 55% RRR in outpatient IV protocols.
- Favipiravir: 20%-35% RRR depending on dose and timing, with mixed results across regions.
In short, Paxlovid consistently outperforms the others in preventing severe outcomes, while Molnupiravir sits in the middle-better than nothing but not as powerful as the protease inhibitor combo.
Convenience and Administration
From a patient‑centric viewpoint, oral pills win hands‑down over IV infusions. Here’s the quick rundown:
| Antiviral | Route | Typical course | Monitoring needed? |
|---|---|---|---|
| Molnupiravir | Oral | 5 days, 800mg twice daily | No routine labs required |
| Paxlovid | Oral | 5 days, 300mg nirmatrelvir + 100mg ritonavir BID | Check for drug-drug interactions |
| Remdesivir | IV infusion | 3-5 days, 200mg loading then 100mg daily | Liver & renal labs before each dose |
| Favipiravir | Oral | Loading 1,800mg BID day1, then 800mg BID for 4-9 days | Uric acid monitoring in some patients |
Because Molnupiravir and Paxlovid are both pills, they are preferred for home treatment, especially when health services are stretched.
Access, Availability, and Cost (2025)
Pricing varies by country and insurance coverage. Below are approximate out‑of‑pocket costs for a full treatment course in the United Kingdom (NHS price) and the United States (cash price for uninsured patients):
- Molnupiravir: NHS provides free for eligible patients; US cash price ~$700.
- Paxlovid: NHS free for high‑risk groups; US cash price ~$530.
- Remdesivir: Typically hospital‑only, NHS cost covered by NHS Trusts; US cash price ~$2,300 for 3‑day outpatient regimen.
- Favipiravir: Not approved in the UK; in some Asian markets it costs around $150-$250 per course.
Availability can also be a deciding factor. In 2025, Paxlovid saw occasional shortages during winter spikes, while Molnupiravir maintained a steadier supply line due to its later‑stage production ramp‑up.
Regulatory Status in 2025
All four antivirals have some level of approval, but the scope differs:
- Molnupiravir: Emergency Use Authorization (EUA) in the USA (still valid), full approval by the UK Medicines and Healthcare products Regulatory Agency (MHRA) for adults at risk.
- Paxlovid: Full FDA approval, EMA conditional marketing authorisation, UK MHRA approved.
- Remdesivir: FDA approved for hospitalized patients and outpatient use (via EUA for the latter); EMA approved for hospital use only.
- Favipiravir: Approved in Japan and some Asian countries for influenza; not approved by FDA, EMA, or MHRA for COVID‑19.
Which Antiviral Is Right for You?
Here’s a quick decision guide based on typical patient scenarios:
- High‑risk adult (over 65 or with comorbidities) who can start treatment within three days: Paxlovid is the most effective if no drug‑interaction issues.
- Patient on multiple CYP‑3A4 drugs (e.g., certain statins, anti‑epileptics): Molnupiravir avoids the ritonavir interaction risk.
- Pregnant woman or planning pregnancy: Neither Molnupiravir nor Favipiravir are recommended; discuss with a clinician about alternative supportive care.
- Resident in a region where IV infusion is feasible and hospitalization risk is moderate: Remdesivir offers a solid IV option, especially if oral drugs are contraindicated.
- Person in a low‑income setting where cost is a barrier: Molnupiravir (if subsidised) or Favipiravir (where legally available) may be the most affordable.
Always consult your healthcare provider to weigh the benefits against your personal health history and any potential drug interactions.
Key Takeaways
- Paxlovid provides the highest reduction in severe COVID‑19 outcomes, but watch for drug‑drug interactions.
- Molnupiravir offers a decent middle ground-easy oral dosing with fewer interaction concerns.
- Remdesivir remains valuable for patients who can receive IV therapy or when oral options are unsuitable.
- Favipiravir’s evidence is mixed and its regulatory status limited, making it a secondary choice.
- Cost, supply chain stability, and individual health conditions ultimately shape the best choice.
Frequently Asked Questions
Can I take Molnupiravir and Paxlovid together?
No. Both drugs aim to treat the same infection and may increase the risk of side‑effects without added benefit. Choose one based on efficacy, interactions, and doctor advice.
Is Molnupiravir safe for people with kidney disease?
Molnupiravir is not recommended for patients with severe renal impairment (eGFR<30ml/min) because safety data are limited. Discuss alternatives with your clinician.
How quickly do I need to start the antiviral after symptoms begin?
All four antivirals work best when begun within five days of symptom onset. Paxlovid and Molnupiravir are most effective when started within three days.
Will the NHS cover the cost of Molnupiravir?
Yes, the NHS provides Molnupiravir free of charge to eligible high‑risk patients who receive a prescription from their GP or a rapid‑assessment service.
What should I do if I miss a dose of Paxlovid?
Take the missed dose as soon as you remember, unless it’s less than six hours before the next scheduled dose. Do not double‑dose; just continue with the regular schedule.
Ajay Kumar
October 6, 2025 AT 13:21Hey folks, great to see a detailed breakdown of the antivirals. I’ve seen patients struggle with the cost differences, especially between Molnupiravir and Paxlovid. It’s also worth noting that the convenience of an oral regimen can make a huge difference for those isolating at home. If anyone’s weighing options for a loved one, consider both the side‑effect profile and the accessibility in your area.
Richa Ajrekar
October 12, 2025 AT 08:15The table's formatting is sloppy and the article could have been proofread more carefully.
Pramod Hingmang
October 18, 2025 AT 03:08Adding to Ajay's points, the oral pills really help when you can't get to a hospital. Molnupiravir's safety in kidney patients is a plus. Paxlovid's drug interactions, though, can be a nightmare for polypharmacy.
Benjamin Hamel
October 23, 2025 AT 22:01While the comparison chart looks tidy, the reality is far more nuanced than a few percentages can capture. First, the efficacy numbers for Molnupiravir are derived from a subset of high‑risk patients, not the broader community. Second, Paxlovid's impressive 89% figure comes from a trial where participants were closely monitored and adherence was virtually guaranteed. Third, real‑world data suggest that the timing of administration-ideally within five days of symptom onset-plays a critical role for all oral antivirals, yet the article glosses over this. Fourth, the safety profile of Paxlovid is complicated by its ritonavir component, which is a potent CYP3A4 inhibitor and can precipitate serious drug‑drug interactions; many patients on statins or anticoagulants must have their regimens adjusted, a fact omitted from the summary. Fifth, the cost discussion only mentions UK pricing, ignoring the stark disparities in the US and low‑income countries where out‑of‑pocket expenses can be prohibitive. Sixth, Remdesivir's IV route is a barrier for outpatient care, but its utility in hospitalized patients with severe disease remains unmatched by the oral agents. Seventh, the table lists favipiravir's EMA approval status without highlighting that the FDA has placed it under restrictive use, which could mislead readers about its availability. Eighth, the article fails to address the emerging data on resistance patterns-some recent in‑vitro studies indicate that Molnupiravir may select for mutational escape under certain conditions. Ninth, the convenience factor is not merely about pills versus infusion; it also involves the need for baseline lab work, especially liver function tests, which are not mentioned. Tenth, physicians must consider patient comorbidities: for instance, a patient with severe hepatic impairment may be contraindicated for Paxlovid but could tolerate Molnupiravir. Eleventh, the discussion of side‑effects is overly simplistic; while diarrhea is common, the potential for rare but serious events like thrombocytopenia with favipiravir is omitted. Twelfth, the article does not address pediatric usage, where dosing and safety data are still limited for many of these antivirals. Thirteenth, the impact of vaccination status on antiviral efficacy is a critical variable that the table completely ignores. Fourteenth, adherence challenges, especially in younger patients who may skip doses due to mild side‑effects, can dramatically reduce real‑world effectiveness. Finally, the regulatory landscape continues to evolve, with recent EMA updates on Molnupiravir's conditional approval that could affect future prescribing practices. In short, the chart is a helpful starting point, but readers should seek deeper clinical guidance before making treatment decisions.
Christian James Wood
October 29, 2025 AT 16:55Honestly, the hype around Paxlovid has turned into a circus, and anyone still touting Molnupiravir as a silver bullet needs a reality check. The drug interactions alone are enough to keep most clinicians up at night, and the handful of studies showing marginal benefit in low‑risk patients barely justify its cost. If you’re looking for a truly effective oral option, you’d better start reading the fine print instead of buying into marketing fluff.
Rebecca Ebstein
November 4, 2025 AT 11:48Wow, Ben, that was a marathon read! You really dug deep into the data-nice job! i think the extra details will help people make better choices. Oops, i missed a word there but you get the gist.
Artie Alex
November 10, 2025 AT 06:41From a pharmacokinetic perspective, the oral bioavailability of Molnupiravir (≈75%) contrasts sharply with Paxlovid's reliance on CYP3A4 inhibition for therapeutic plasma concentrations. This mechanistic disparity translates into divergent safety margins, especially in polypharmacy contexts. Moreover, the IV administration of Remdesivir imposes logistical constraints that limit its outpatient scalability, a point the original comparison underemphasized. Ultimately, decision‑making should integrate these quantitative parameters alongside clinical trial endpoints.
abigail loterina
November 16, 2025 AT 01:35Great info! Thanks for breaking down the pros and cons in simple terms.
Roger Cole
November 21, 2025 AT 20:28Short and sweet: consider both cost and side‑effects before deciding.