Each week, OMRF Chief Medical Officer Dr. Judith James opens “Adam’s Journal” to answer a medical question from Adam Cohen, OMRF’s senior vice president & general counsel.
Adam’s Journal
I was extremely grateful to my physician when he gave me a prescription for Paxlovid to treat a recent case of Covid. But as soon as I began taking the drugs, I was overwhelmed by a side effect: My mouth constantly tasted as if I was simultaneously sucking on a penny and an aspirin (and not the pleasant baby kind).
The sensation was so bad and persistent that I nearly quit taking the medicine. What was going on?
Dr. James Prescribes
I am sorry to hear you suffered from an altered sense of taste, technically called dysgeusia (duhs-GOO-zuh). This is a known side effect of Paxlovid, and the good news is that it is harmless and temporary and that in most patients it disappears shortly after they complete their five-day course of the drug.
Indeed, I can say this with some confidence, as I recently regained my normal sense of taste following a bout of “Paxlovid mouth”!
In clinical trials, 6% of people taking Paxlovid reported that they experienced an unpleasant taste most commonly described as bitter or metallic. In practice, reports I’ve received from patients suggest the phenomenon may be considerably more prevalent than that 6% figure.
We lack conclusive evidence as to what’s going on at a biological level. It could be any of a number of factors, including direct stimulation of particular bitter taste bud receptors, changes in the saliva, changes in the flow of saliva, some combination of these, or something else altogether. And don’t forget: Covid also can cause changes in smell and taste, which can further contribute to a metallic taste in the mouth.
Regardless of how it is happening, experts suspect the primary culprit is a drug called ritonavir, which is one of the two drugs that make up the treatment marketed as Paxlovid.
In clinical trials for that drug alone,16% of subjects reported having an altered sense of taste. And a new study suggests that the other part of Paxlovid, nirmatrelvir, may also stimulate bitter taste receptors.
For some, gargling with salt water, taking zinc, or using lozenges or gum can help with the bad taste. For you, it sounds like the phenomenon ended when you finished your prescription, and that makes sense. Once the drug leaves the body (which can take up to a few days following the final dose), taste should return to normal.
Although dysgeusia could cause you to eat and drink too little at a time your body needs food and drink to help fight a virus, the most dangerous potential side effect is the one I’m glad you avoided: stopping the medication altogether.
Paxlovid has been shown to significantly decrease severe Covid infections, which can result in hospitalization or death. And as bothersome as Paxlovid mouth may be, I think you’ll agree it’s vastly preferable to the alternative.
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Dr. Judith James is OMRF’s executive vice president & chief medical officer, and Adam Cohen is OMRF’s senior vice president & general counsel. Send your health questions to contact@omrf.org.
