ACCEL Lite: Cardiovascular Drug Interactions with Paxlovid (Nirmatrelvir/Ritonavir) in Patients with COVID-19

Millions of people are being prescribed Paxlovid for COVID-19 treatment; many of them are on cardiovascular medications. Paxlovid can have potentially harmful interactions with commonly prescribed cardiovascular medications and hence it is crucial to be aware of them and build a strategy to avoid them while providing effective treatment for COVID -19.   In this interview, Sarju Ganatra MD, FACC, and Joseph E. Marine MD, MBA, FACC, discuss Cardiovascular Drug Interactions with Nirmatrelvir/Ritonavir in Patients with COVID-19.  Nirmatrelvir-ritonavir (NMVr) is used to treat symptomatic, non-hospitalized 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.  Read Dr, Ganatra's review of Paxlovid drug interactions with common cardiovascular medications here: https://www.jacc.org/doi/10.1016/j.jacc.2022.08.800    Download a useful chart on those interactions and potential adjustments here: https://www.acc.org/education-and-meetings/image-and-slide-gallery/media-detail?id=10877633723b4a10b8a450922c42bad3  Subscribe on Apple Podcasts | Subscribe on Google Play | Subscribe to ACCEL