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Using nirmatrelvir/ritonavir in patients with epilepsy: An update from the Israeli chapter of the International
Iris Noyman1,2, Dana Ekstein3,4, Firas Fahoum5,6
1Pediatric Neurology Unit, Soroka University Medical Center, Beer Sheva, Israel.
Abstract:
Presented herein are recommendations for use of nirmatrelvir/ritonavir in patients with epilepsy, as issued by the Steering Committee of the Israeli chapter of the International League Against Epilepsy. The recommendations suggest that patients on moderate-to-strong enzyme-inducing antiseizure medications (ASMs) and everolimus should not be treated with nirmatrelvir/ritonavir; rectal diazepam may be used as an alternative to buccal midazolam; doses of ASMs that are cytochrome P450 (CYP3A4) substrates might be adjusted; and patients treated with combinations of nirmatrelvir/ritonavir and ASMs that are CYP3A4 substrates or lamotrigine should be monitored for drug efficacy and adverse drug reactions.
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