In Canada, oral nirmatrelvir/ritonavir (Paxlovid™) and intravenous remdesivir (Veklury®) are Health Canada-approved treatments for COVID-19.
Antiviral treatments should be strongly considered for individuals with COVID-19 symptoms and a positive test for SARS-CoV-2 based on positive PCR, rapid molecular, or rapid antigen test result who are at high risk of severe outcomes.
For these patients, nirmatrelvir/ritonavir is the preferred first-line therapy when safe and feasible. Remdesivir is indicated where nirmatrelvir/ritonavir is contraindicated (e.g., drug-drug interaction that cannot be safely managed, medical contraindication) or when patients are beyond the treatment window for nirmatrelvir/ritonavir initiation (i.e., symptom onset > 5 days).
Individuals who may be at high risk of severe outcomes include those who are:
- 60 years of age or older;
- 18 years of age or older and immunocompromised;
- Adults who have one or more comorbidity that puts them at high risk of severe COVID-19 disease; or
- Adults with inadequate immunity, i.e., unvaccinated or under-vaccinated - review the most recent immunization guidance from National Advisory Committee on Immunization to determine if your patient is under-vaccinated
Learn how primary care providers and other health care providers can access COVID-19 treatments for patients in the community:
- Access to antiviral treatments for COVID-19 in the community (September 15, 2023)
Review additional recommendations and resources on the use of COVID-19 treatments below.
- Ontario Health Recommendation on the Use of Nirmatrelvir/Ritonavir (Paxlovid) (December 8, 2022)
- Patient handout – Paxlovid (available in 29 languages)
- Nirmatrelvir/ritonavir (Paxlovid) use in patients with advanced chronic kidney disease and patients on dialysis with COVID-19 (April 13, 2022)
- Paxlovid Prescribing & Drug Interaction Information (University Health Network)
- Memo to primary care providers: Paxlovid prescribing in primary care: Testing and tools (August 30, 2022)
- Ontario Health Recommendations for Outpatient Use of Intravenous Remdesivir (Veklury) in Adults (September 15, 2023)
- Ontario Health Recommendation on the Use of Evusheld (December 12, 2022)
- Patient handout – Evusheld (December 12, 2022)
- Information about Evusheld (Tixagevimab and Cilgavimab): Reference for health care providers who may be prescribing or administering Evusheld (archived December 12, 2022)