• See Section 6 regarding identifying patients at moderate risk.
• Because their risk of hospitalization is sufficiently high such that they will receive an appreciable reduction in hospitalization with the drug, the GDG concluded that a majority of well-informed moderate-risk patients would choose to use nirmatrelvir-ritonavir.
• Clinicians should not consider nirmatrelvir-ritonavir in patients with possible dangerous drug interactions (note: many commonly used drugs interact with nirmatrelvir-ritonavir).
• The GDG concluded that nirmatrelvir-ritonavir in general represents a superior choice to molnupiravir (due to greater reduction in hospitalization, and safety concerns with molnupiravir) and also a superior choice to remdesivir (due to practical issues with intravenous administration) provided that the intended recipient is not using other drugs that interact with nirmatrelvir-ritonavir.
• Given possible benefit and residual uncertainty regarding potential undesirable effects, clinicians should engage pregnant or breastfeeding individuals in fully informed shared decision-making regarding the use of nirmatrelvir-ritonavir

Practical info Route, dosage and duration: Additional considerations are available in three summaries of practical issues (nirmatrelvir-ritonavir for COVID-19, administration of nirmatrelvir-ritonavir for COVID-19, safety and monitoring for patients receiving nirmatrelvir-ritonavir for COVID-19), briefly summarized here:

• The recommended dose for nirmatrelvir-ritonavir is 300 mg (two 150 mg tablets) of nirmatrelvir and 100 mg of ritonavir every 12 hours daily for 5 days, as per the regimen evaluated in large trials informing the recommendation.
• In renal insufficiency (glomerular filtration rate [GFR] 30–59 mL/min) the dose should be reduced to 150 mg of nirmatrelvir and 100 mg of ritonavir every 12 hours daily for 5 days.
• Administration should be as early as possible in the course of disease. In the included studies, nirmatrelvir-ritonavir was administered within 5 days of symptom disease onset. In any patient being considered for nirmatrelvir-ritonavir use, clinicians need to give serious consideration to drug interactions. The Liverpool COVID-19 drug interaction checker may be useful in this regard [20].