Cardiovascular Drug Interactions With Nirmatrelvir/Ritonavir in Patients With COVID-19

Nirmatrelvir-ritonavir (NMVr) is used to treat symptomatic, nonhospitalized patients with coronavirus disease-2019 (COVID-19) who are at high risk of progression to severe disease. Patients with cardiovascular risk factors and cardiovascular disease are at a high risk of developing adverse events fr...

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Published in:Journal of the American College of Cardiology 2022-11, Vol.80 (20), p.1912-1924
Main Authors: Abraham, Sonu, Nohria, Anju, Neilan, Tomas G., Asnani, Aarti, Saji, Anu Mariam, Shah, Jui, Lech, Tara, Grossman, Jason, Abraham, George M., McQuillen, Daniel P., Martin, David T., Sax, Paul E., Dani, Sourbha S., Ganatra, Sarju
Format: Article
Language:English
Subjects:
cardiovascular medications
COVID-19
drug-drug interactions
nirmatrelvir-ritonavir
SARS-CoV-2
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Summary:Nirmatrelvir-ritonavir (NMVr) is used to treat symptomatic, nonhospitalized patients with coronavirus disease-2019 (COVID-19) who are at high risk of progression to severe disease. Patients with cardiovascular risk factors and cardiovascular disease are at a high risk of developing adverse events from COVID-19 and as a result have a higher likelihood of receiving NMVr. Ritonavir, the pharmaceutical enhancer used in NMVr, is an inhibitor of the enzymes of CYP450 pathway, particularly CYP3A4 and to a lesser degree CYP2D6, and affects the P-glycoprotein pump. Co-administration of NMVr with medications commonly used to manage cardiovascular conditions can potentially cause significant drug-drug interactions and may lead to severe adverse effects. It is crucial to be aware of such interactions and take appropriate measures to avoid them. In this review, we discuss potential drug-drug interactions between NMVr and commonly used cardiovascular medications based on their pharmacokinetics and pharmacodynamic properties. [Display omitted] •Concomitant administration of NMVr with several commonly prescribed cardiovascular medications can be associated with clinically relevant DDIs.•Given the frequency of DDI with NMVr, dose adjustment or temporary interruption of these medications may be required when prescribing NMVr.•NMVr should be avoided when potentially interacting cardiovascular medications cannot be safely interrupted.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2022.08.800