A new study published today reveals the potential drug-drug interactions (DDIs) between Paxlovid and commonly used medications.
People with heart disease who have symptoms of COVID-19 are often given nirmatrelvir-ritonavir (Paxlovid) to stop the disease from getting worse. However, it can interact with some medicines that have already been prescribed.
A review article that was just released in the Journal of the American College of Cardiology looks into potential Paxlovid drug-drug interactions (DDIs) with other regularly prescribed cardiovascular drugs as well as potential solutions to reduce serious negative effects.
It’s important to be aware of Paxlovid’s potential pharmacological interactions with popular cardiovascular medications as it could help avoid related adverse events like blood clots.
“The prescription of Paxlovid could be incorporated into an order set, which allows physicians, whether it be primary care physicians or cardiology providers, to consciously rule out any contraindications to the co-administration of Paxlovid,” adds senior author Sarju Ganatra.
“Consultation with other members of the health care team, particularly pharmacists, can prove to be extremely valuable. However, a health care provider’s fundamental understanding of the drug-drug interactions with cardiovascular medications is key.”
For the treatment of symptomatic, non-hospitalized people with mild to moderate COVID-19 infection who are at high risk of progression to severe disease, the U.S. Food and Drug Administration granted emergency use clearance for the oral antiviral drug Paxlovid in December 2021.
People with heart disease and other risk factors, such as diabetes, high blood pressure, chronic renal disease, and smoking, make up a significant component of the high-risk group that can benefit from Paxlovid.
The authors note that although Paxlovid has been demonstrated to be highly successful in patients with pre-existing heart disease, it has significant drug-drug interactions (DDIs) with widely prescribed cardiovascular drugs, emphasizing the significance of all practitioners being aware of these DDIs.
The authors used existing knowledge and data regarding how treatments like Paxlovid typically interact with other medications to provide guidance regarding potential interactions and the associated likely outcomes based on the degree of interaction because there is little clinical information available regarding DDI-related adverse events.
The following are the top five paxlovid and cardiovascular medication interactions to be aware of:
Anti-rhythmic agents
Antiarrhythmic medications are used to treat irregular heartbeat. When combined with Paxlovid, many of these medicines are processed in a way that raises plasma levels.
Even though it may be possible to start Paxlovid after temporarily stopping the antiarrhythmic drugs for 2-2.5 days, this may not be possible in real life.
Clinicians are urged to avoid co-administering these medications with Paxlovid and to think about other COVID-19 therapy. Sotalol is another drug used to treat abnormal heart rhythms. It is cleared by the kidneys and doesn’t interact with Paxlovid.
Antiplatelet and anticoagulant agents
Antiplatelet medicines are used to treat coronary artery disease, especially when a stent has been implanted. It’s okay to take prasugrel and aspirin at the same time as Paxlovid.
When Paxlovid is administered with clopidogrel, there is an increased chance of blood clots, and when administered with ticagrelor, there is an increased risk of bleeding. When it is possible to do so, these drugs should be changed to prasugrel.
If patients have contraindications to taking prasugrel, Paxlovid coadministration should be avoided, and alternative COVID-19 therapy should be investigated.
Paxlovid may be co-administered with anticoagulants, or blood thinners, used to treat or prevent blood clots, such as warfarin, however close monitoring of clotting factors in bloodwork is necessary.
When Paxlovid is given with other direct oral anticoagulants, the plasma levels of all of them go up. This means that the dose may need to be changed or the anticoagulants may need to be stopped temporarily and replaced with others.
Statins
Co-administering simvastatin or lovastatin with Paxlovid can lead to higher plasma levels, which can cause muscle weakness (myopathy) and rhabdomyolysis, a condition in which the breakdown of muscle tissue releases a harmful protein into the bloodstream.
Before starting Paxlovid, these medications need to be stopped. When given with Paxlovid, it makes sense to lower the dose of atorvastatin and rosuvastatin.
When given with Paxlovid, the other statins are thought to be safe.
Ranolazine
In the presence of CPY450 inhibitors like Paxlovid, the plasma concentration of ranolazine, a medication used to treat angina and other heart-related chest discomforts, exponentially rises, raising the risk of clinically significant QT prolongation and torsade de pointes (a type of arrhythmia).
Paxlovid should not be administered in combination. If you are recommending Paxlovid, you should temporarily stop taking ranolazine.
Immunosuppressive medications
When co-administered with Paxlovid, the plasma levels of immunosuppressive drugs given for individuals who have had heart transplants grow exponentially to toxic levels.
Reducing immunosuppressive drugs temporarily would require frequent monitoring and be logistically challenging. Alternative COVID-19 therapy should therefore be considered in these patients.
The authors come to the conclusion that knowing about and having access to other COVID-19 therapies lets clinicians offer other treatment options to patients who can’t take Paxlovid because of DDIs.
Source: 10.1016/j.jacc.2022.08.800
Image Credit: Getty
You were reading: Be Aware Of The Five Most Important Paxlovid Drug Interactions, Study Finds
