Molnupiravir vs Alternatives: A Practical Comparison of COVID‑19 Antivirals

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:

1. Efficacy - reduction in hospitalization or death in high‑risk patients.
2. Safety profile - common side‑effects and contraindications.
3. Convenience - oral vs IV, dosing frequency, and need for monitoring.
4. Access & cost - how easy it is to obtain the drug and its approximate price in the UK and US markets.
5. Regulatory endorsement - approval status by the FDA, EMA, and MHRA.

Side‑Effect and Safety Snapshot

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:

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.