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

When you’re told you have COVID-19 and are at risk for severe illness, your doctor might mention Movfor - the brand name for molnupiravir. But you’ve probably heard of other options too, like Paxlovid. So which one actually works better? And does it even matter? The truth is, not all antivirals are created equal. Some work faster. Some have fewer side effects. Some are easier to take. And some aren’t even available in every country.

What is Movfor (Molnupiravir)?

Movfor is the brand name for molnupiravir, an oral antiviral medication designed to stop the SARS-CoV-2 virus from replicating in the body. It was first authorized for emergency use in late 2021 and is approved in over 40 countries, including New Zealand, the UK, and Australia.

It comes as a capsule you take twice a day for five days. You start it as soon as possible after symptoms begin - ideally within five days. The goal isn’t to cure you overnight. It’s to reduce the chance you’ll end up in the hospital. Clinical trials showed it cut hospitalizations by about 30% in high-risk adults. That’s not perfect, but it’s something.

How it works is unique. Molnupiravir tricks the virus into making copying errors as it tries to reproduce. Think of it like giving the virus a faulty blueprint. Eventually, it builds so many broken copies that it can’t keep spreading. This mechanism is why it’s been studied for other RNA viruses too, like influenza and Ebola.

Paxlovid: The Current Gold Standard

If you’ve been following COVID-19 treatments, you’ve likely heard of Paxlovid, a combination of nirmatrelvir and ritonavir, approved for high-risk patients with mild to moderate COVID-19.

Paxlovid is taken as three pills twice a day for five days. It’s more effective than molnupiravir - reducing hospitalizations by around 89% in clinical trials when taken early. That’s a huge difference. It’s also the most widely recommended antiviral in the U.S., the UK, and New Zealand for people over 60 or those with chronic conditions like diabetes or heart disease.

But Paxlovid has a catch: it interacts with a lot of common medications. If you’re on blood thinners, statins, or certain heart or mental health drugs, Paxlovid can be dangerous. Your pharmacist or doctor needs to check your full medication list before prescribing it. That’s why some people get molnupiravir instead - not because it’s better, but because it’s safer for their existing regimen.

Remdesivir: The IV Option

Not everyone can take pills. If you’re too sick to swallow or can’t manage oral meds at home, remdesivir, an intravenous antiviral given over three days in a clinic or hospital. It’s not a first-line choice for outpatient care, but it’s the only antiviral approved for use in hospitalized patients.

Remdesivir is also used off-label for high-risk outpatients who can’t take oral drugs. You get it via IV drip, usually over 60 minutes. That means you need to travel to a medical center. For people in rural areas or with mobility issues, that’s a big barrier. But it’s still a solid option when oral antivirals aren’t possible.

Studies show remdesivir reduces hospital stay length by about 30% and lowers death risk in early-stage patients. It’s not as convenient as pills, but it’s more potent. It’s also one of the few antivirals approved for children under 12.

Other Alternatives: What’s Out There?

Outside of these three, options are limited. In some countries, you might find:

• Ensitrelvir - approved in Japan and South Korea. It’s a newer pill taken once daily for five days. Early data suggests it’s as effective as Paxlovid with fewer drug interactions.
• Favipiravir - used in Russia and India. Less proven, with mixed trial results and higher side effect rates. Not recommended by WHO or CDC.
• Fluvoxamine - an antidepressant studied for COVID-19. Some small trials showed reduced hospitalizations, but it’s not approved for this use anywhere. Don’t self-medicate.

For most people in New Zealand, Australia, or the U.S., the real choices are Movfor, Paxlovid, or Remdesivir. Everything else is either unavailable, unproven, or not recommended.

Side Effects: Which One Is Easier to Tolerate?

Side effects matter. If you feel worse taking the medicine than you did with the virus, you might skip it. Here’s how they compare:

Movfor has the most concerning long-term safety flags. Animal studies showed it could cause mutations in DNA. That’s why it’s not given to pregnant people or anyone under 18. Paxlovid doesn’t carry that risk, but its drug interactions are a minefield. Remdesivir is safest in that regard - no known interactions - but you have to sit through an IV.

Who Gets Which Treatment?

There’s no one-size-fits-all. Your doctor picks based on your health, meds, age, and access.

• Paxlovid is first choice for healthy adults over 60 or with chronic illness - if your other meds don’t clash.
• Movfor is used when Paxlovid isn’t safe due to drug interactions, or if Paxlovid isn’t available.
• Remdesivir is for people who can’t take oral meds, or when both pills are contraindicated.

In New Zealand, the Ministry of Health prioritizes Paxlovid for those at highest risk. But if you’re on warfarin or a beta-blocker, Movfor becomes the default. Pharmac (the country’s drug subsidy agency) covers both, so cost isn’t usually a barrier.

Real-World Experience: What Patients Say

One 72-year-old man in Auckland with type 2 diabetes and high blood pressure started Paxlovid after testing positive. He had to stop his cholesterol pill for two weeks. He said the metallic taste was awful, but he didn’t get sick enough to go to the hospital.

A 58-year-old woman on antidepressants couldn’t take Paxlovid. Her doctor gave her Movfor. She had mild nausea but finished the course. She says she felt better faster than her husband, who didn’t take any antiviral.

Another patient, a 45-year-old nurse with asthma, got Remdesivir because she was vomiting and couldn’t keep pills down. She spent three hours in a clinic but didn’t need oxygen. She’s glad she got it.

These stories aren’t rare. They show that the best treatment isn’t always the most effective - it’s the one you can actually take.

When Not to Take Any Antiviral

Antivirals aren’t magic bullets. They don’t help if:

• You’re more than five days into symptoms
• You’re not at high risk for severe disease (young, healthy, fully vaccinated)
• You’re already hospitalized and on oxygen
• You’re pregnant or under 18 (for molnupiravir)

For most healthy people, rest, hydration, and paracetamol are enough. Antivirals are for those who need extra help to avoid the ER.

What’s Next?

New antivirals are in the pipeline. Ensitrelvir is coming to more countries. Long-acting injectables are being tested. But for now, the choices are limited.

If you’re at risk, get tested early. Don’t wait until you’re gasping for air. Call your doctor the moment you test positive. Ask: "Is Paxlovid safe for me? If not, is Movfor an option?" That’s how you make the right call.

Final Thoughts

Movfor isn’t the best antiviral. But it’s one of the few options when Paxlovid isn’t safe. It’s not perfect - it has limitations, side effects, and safety concerns. But in the right hands, at the right time, it can keep someone out of the hospital. The key is acting fast and knowing your options. Don’t wait. Don’t guess. Talk to your doctor the moment you test positive. Your next steps matter more than you think.