Compare Movfor (Molnupiravir) with Other COVID-19 Antiviral Options

When you’re diagnosed with COVID-19 and your doctor suggests an antiviral, you might hear the name Movfor - that’s the brand for molnupiravir. But you’re not alone if you’re wondering: Is this the best option? What else is out there? And does it even work like they say?

Movfor isn’t the only antiviral approved for early-stage COVID-19. In fact, since 2021, several drugs have entered the market, each with different strengths, risks, and use cases. By late 2024, real-world data from over 1.2 million patients showed that while molnupiravir reduces hospitalization risk by about 30%, other options like Paxlovid cut it by nearly 60%. That’s a big difference. And it matters - especially if you’re over 60, diabetic, or have heart disease.

What Is Movfor (Molnupiravir)?

Movfor is the branded version of molnupiravir, an oral antiviral made by Merck and Ridgeback Biotherapeutics. It’s approved for adults with mild to moderate COVID-19 who are at high risk for severe illness. You take it as four capsules every 12 hours for five days - that’s 40 pills total. It works by scrambling the virus’s genetic code so it can’t replicate properly.

The FDA approved it in December 2021 under emergency use, and it’s been used globally since then. But it’s not a magic bullet. Clinical trials showed it reduced hospitalizations and deaths by about 30% compared to placebo in unvaccinated adults. In vaccinated people, the benefit shrinks - sometimes to just 10-15%. And it’s not recommended for pregnant people or those under 18 because of potential effects on DNA.

Paxlovid: The Gold Standard

If you’re looking for the most effective oral antiviral, Paxlovid (nirmatrelvir/ritonavir) is still the top choice. Made by Pfizer, it’s taken as three pills twice a day for five days. It works differently than Movfor - it blocks a key enzyme the virus needs to copy itself.

In clinical trials, Paxlovid cut hospitalization and death risk by 88% in high-risk, unvaccinated patients. Real-world studies from the CDC and UK Health Security Agency confirmed it still works well in vaccinated people - about a 60-70% reduction. That’s why most doctors prescribe it first.

But Paxlovid has downsides. It interacts with a lot of common medications: statins, blood thinners, anti-seizure drugs, even some heart medications. If you’re on any of these, your doctor might not be able to prescribe it. Also, some people get a rebound - symptoms come back after finishing the course. That happens in about 10-20% of cases, but it’s usually mild.

Remdesivir: The Injection Option

Remdesivir (Veklury) was the first antiviral approved for COVID-19, back in 2020. Unlike Movfor and Paxlovid, it’s given by IV infusion - usually over three days in a clinic or hospital. It’s not something you take at home.

It’s most often used for people who can’t take oral meds - maybe they’re vomiting, have trouble swallowing, or have kidney issues. Studies show it reduces hospital stays by about 30% and lowers death risk in high-risk outpatients. But because it requires medical visits, it’s not practical for most people unless they’re already in a care setting.

It’s also more expensive than pills. A full course can cost over $3,000 without insurance. That’s why it’s usually reserved for those who can’t use oral drugs.

Other Alternatives: What’s on the Horizon?

While Movfor and Paxlovid dominate the market, other options exist or are being studied. Ensitrelvir (Xocova), approved in Japan and South Korea, is an oral antiviral similar to Paxlovid but without ritonavir boosting. Early data suggests it’s as effective as Paxlovid with fewer drug interactions - but it’s not available in the U.S. yet.

There’s also bebtelovimab, a monoclonal antibody that was used in 2022, but it lost effectiveness against newer variants and was withdrawn in 2023. No new monoclonals have replaced it since.

For now, the only widely available alternatives are Movfor, Paxlovid, and Remdesivir.

Side Effects: What to Expect

All these drugs are generally safe, but side effects vary.

Movfor: Nausea, diarrhea, dizziness. Rarely, people report headaches or trouble sleeping. No major safety red flags in over 100,000 users, but long-term effects aren’t fully known.

Paxlovid: Metallic taste (very common), diarrhea, high blood pressure, muscle aches. The ritonavir component causes most drug interactions. Some people say the taste is so strong they can’t finish the course.

Remdesivir: Liver enzyme spikes, low blood pressure during infusion, nausea. Rarely, allergic reactions.

If you’ve had liver problems, kidney disease, or are on multiple meds, talk to your pharmacist before starting any of these. They can check for dangerous interactions.

Who Gets Which Drug?

There’s no one-size-fits-all. Your choice depends on your health, meds, and access.

• Best for most people: Paxlovid - if you’re not on conflicting meds and can take pills at home.
• Best if Paxlovid won’t work: Movfor - if you’re on statins, blood thinners, or have liver issues that block Paxlovid.
• Best if you can’t swallow pills: Remdesivir - if you’re vomiting, have swallowing issues, or are already in a clinic.

Age matters too. For people over 70, Paxlovid reduces death risk by 70%. Movfor only cuts it by 25%. For someone under 50 with no risk factors, antivirals may not be needed at all - the body usually handles it fine.

Cost and Access

In the U.S., all three drugs are free for patients through federal programs - no out-of-pocket cost. But you still need a prescription, and not all pharmacies carry them.

Paxlovid is the most widely stocked. Movfor is harder to find - many pharmacies order it only on request. Remdesivir is usually only available in hospitals or infusion centers.

If your local pharmacy doesn’t have it, call a nearby hospital or clinic. Some telehealth providers can get it shipped directly to your home in 24-48 hours.

Timing Is Everything

None of these drugs work well if you wait too long. They’re only effective when taken within five days of symptom start. That means:

• Get tested as soon as you feel sick.
• Call your doctor the same day you test positive.
• Don’t wait for symptoms to get worse.

Delaying by even 24 hours can cut the drug’s effectiveness in half. Many people miss the window because they think, “I’ll wait and see.” But by day six, the virus has already done most of its damage.

What About Vaccines?

Antivirals aren’t a substitute for vaccines. They’re a backup. People who are up to date on their COVID vaccines have much lower risk of severe illness - so antivirals are less likely to be needed.

But if you’re immunocompromised, over 65, or have chronic lung or heart disease, even vaccinated people benefit from early antiviral treatment. Vaccines reduce your risk. Antivirals reduce your risk further if you still get infected.

Final Thoughts

Movfor (molnupiravir) has its place. It’s better than nothing - especially if Paxlovid isn’t an option. But it’s not the best. If you can take Paxlovid, it’s the clear winner. If you can’t, Movfor is a reasonable second choice. Remdesivir is for special cases.

Don’t wait. Test early. Call your doctor fast. And ask: “Is Paxlovid right for me?” If the answer is no, then ask about Movfor. Don’t settle for the first option your doctor mentions - ask for the best one for your body.