Paxlovid Mouth Is Bitter, Metallic Taste From COVID Medication

The "gross" side effect is suspected to be short-lived.

Rich Scherr is an updates strategist and fact checker for Dotdash Meredith brands, including Health and Verywell. He is a seasoned financial and technology journalist who served as editor-in-chief of the Potomac Tech Wire for nearly two decades, and is a regular contributor to the sports pages of The Baltimore Sun. He has also been a news editor for America Online and has contributed to the Associated Press and The Washington Post.

Paxlovid, the antiviral COVID-19 medication, is a life-saving treatment. The drug has been shown to cut the risk of hospitalization or death in high-risk people by nearly 90% if it's taken within the first few days of infection—said Pfizer in 2021—but those benefits may come with a bad taste many are dubbing "Paxlovid mouth."

A Pfizer representative told Health that most cases of Paxlovid mouth were "mild" and "nonserious," and only two participants ended the drug trial early because of it. But as more people begin taking the drug for COVID-19, they're taking their stories to social media.

"It has been only hours since my [first] dose of Paxlovid, but it's doing something," Twitter user @AlisaValdesRod1 wrote. "Strong weird metallic grapefruit taste in mouth, but tightness in my chest is GONE and I can take a deep breath." Others also chimed in to call the taste of Paxlovid mouth "gross" or to ask for food suggestions that would cover up the "horrible bitter metallic" flavor.

That bad taste in the mouth—technically called dysgeusia—isn't necessarily a common side effect of Paxlovid, but it does happen: In data from Pfizer's clinical trials of the drug reported in 2022, about 6% of participants in the Paxlovid group experienced the altered taste, compared to less than 1% of those in the placebo group.

Here's what to know about what Paxlovid mouth is, how it happens, and why it shouldn't deter you from the treatment if it's recommended by a healthcare provider.

Paxlovid is a combination of two drugs—nirmatrelvir and ritonavir—that are co-packaged to be used together to treat mild-to-moderate COVID-19. The medication is authorized for emergency use in people ages 12 or older who weigh at least 88 pounds, have tested positive for COVID-19, and are at high risk for severe illness.

The medication is prescription-only and is meant to be used as soon as possible after COVID-19 diagnosis—within five days of symptom onset.

The bad taste that can accompany Paxlovid may be the result of two things at work. First: "Both of the drugs in Paxlovid are bitter," Jamie Alan, PharmD, PhD, associate professor of pharmacology and toxicology at Michigan State University, told Health. As a result, it can taste bitter when you take it.

As for the lingering bad taste the drug can leave in the mouth, that may be because the drug is excreted in the salivary glands, said Alan—that's a process that happens with other medications too, including IV saline solutions, and isn't unique to Paxlovid.

Another theory, according to Omid Mehdizadeh, MD, an otolaryngologist, and laryngologist at Providence Saint John's Health Center in Santa Monica, California, is that the medication is lingering in the body, and thus still providing a stimulus. "Many times, it's just the medication in the system stimulating the taste buds," he told Health. This could be especially true with Paxlovid, since one of the medications, ritonavir, helps slow the breakdown of the other (nirmatrelvir), so it can stay in the body for longer periods of time at higher concentrations.

According to Dr. Mehdizadeh, Paxlovid mouth should be a short-lived annoyance. "This is a new medication and we don't know for sure, but it's not suspected that the taste should stay too long," he said. If you feel the need to try to mask the taste, Dr. Mehdizadeh said saltwater gurgles or lozenges may be able to help.

In addition to Paxlovid mouth, the other side effects of the medication "have been relatively minor and transient," Thomas Russo, MD, professor and chief of infectious disease at the University at Buffalo in New York, told Health.

The most common adverse events behind dysgeusia include diarrhea, high blood pressure (hypertension), and muscle aches (myalgia). In data collected after Paxlovid's EUA had been granted, some instances of hypersensitivity or allergic reactions were also reported.

Paxlovid may also interact with certain drugs, and it's not recommended for people with severe kidney or liver impairment.

That said, if a health care provider prescribes a course of Paxlovid for you, it means they believe the benefits outweigh any potential risks. That's especially true for Paxlovid mouth, which is "a small price to pay for possibly avoiding severe disease and bad outcomes," said Dr. Russo.

"If it were me," said Alan, "I would go with the bad taste and decrease my likelihood of being on a ventilator and lifelong complications."

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.

The Atlantic. Paxlovid mouth is real—and gross.

Pfizer. Pfizer announces additional phase 2/3 study results confirming robust efficacy of novel COVID-19 oral antiviral treatment candidate in reducing risk of hospitalization or death.

Pfizer. Pfizer shares top-line results from phase 2/3 EPIC-PEP study of Paxlovid for post-exposure prophylactic use.

U.S. Food & Drug Administration. Coronavirus (COVID-19) update: FDA authorizes first oral antiviral for treatment of COVID-19.

McGill University. Why can I taste saline and medications when they're inserted into my IV?