Cardiovascular Drug Interactions With Nirmatrelvir/Ritonavir: Key Points

Abraham S, Nohria A, Neilan TG, et al.
Cardiovascular Drug Interactions With Nirmatrelvir/Ritonavir in Patients With COVID-19: JACC Review Topic of the Week. J Am Coll Cardiol 2022;Oct 12:[Epub ahead of print].

The following are key points to remember about co-administration of nirmatrelvir-ritonavir (NMVr) with cardiovascular medications:

  1. NMVr is used to treat symptomatic, high-risk coronavirus disease 2019 (COVID-19) patients in the outpatient setting.
  2. Patients with cardiovascular disease are a high-risk group that are likely to receive NMVr.
  3. Ritonavir, the pharmacological enhancer used in NMVr, is a known CYP450 inhibitor, which affects the metabolism of other medications.
  4. Co-administration of NMVr with selected cardiovascular medication may lead to drug-drug interactions.
  5. A comprehensive medication reconciliation is required to avoid drug-drug interactions.
  6. Since all cardiovascular medications’ metabolism are not affected by NMVr, each medication should be reviewed to determine potential for drug-drug interaction.
  7. If NMVr is prescribed, dose adjustment or temporary discontinuation of commonly used cardiovascular medications may be required.
  8. Patients who are receiving antiarrhythmic drugs or immunosuppressive agents should not receive NMVr due to the risk of severe drug-drug interactions that may result in adverse outcomes.
  9. Tables included in this review article are available to prescribers for quick reference to avoid unsafe drug-drug interactions.
  10. Other treatments should be considered to treat COVID-19 in patients who are at high risk for hospitalization or death from COVID-19.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, COVID-19 Hub, Prevention, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Anti-Arrhythmia Agents, Anticoagulants, Arrhythmias, Cardiac, Cardiovascular Diseases, COVID-19, Cytochrome P-450 Enzyme System, Drug Interactions, Immunosuppressive Agents, Medication Reconciliation, Metabolism, Outpatients, Patient Care Team, Primary Prevention, Risk Assessment, Ritonavir

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