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Cardiovascular Drug Interactions With Nirmatrelvir/Ritonavir in Patients With COVID-19: JACC Review Topic of the Week

Sonu Abraham1, Anju Nohria2, Tomas G Neilan3

  • 1Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA.

Journal of the American College of Cardiology
|October 15, 2022
PubMed

Insights

Nirmatrelvir-ritonavir (NMVr) treats high-risk COVID-19 patients. Co-administration with cardiovascular drugs may cause dangerous interactions due to ritonavir

Area of Science:

  • Pharmacology
  • Cardiology
  • Infectious Diseases

Background:

  • Nirmatrelvir-ritonavir (NMVr) is a key treatment for nonhospitalized, high-risk COVID-19 patients.
  • Patients with cardiovascular disease (CVD) are at higher risk for severe COVID-19 and more likely to receive NMVr.
  • Ritonavir, a component of NMVr, inhibits CYP3A4, CYP2D6, and P-glycoprotein, impacting drug metabolism.

Purpose of the Study:

  • To review potential drug-drug interactions (DDIs) between NMVr and common cardiovascular medications.
  • To highlight the clinical significance of these interactions for patient safety.
  • To inform healthcare providers on managing concurrent NMVr and cardiovascular therapy.

Main Methods:

  • Review of pharmacokinetic and pharmacodynamic properties of NMVr and cardiovascular drugs.
  • Analysis of known interactions involving ritonavir as a CYP3A4 and P-glycoprotein inhibitor.
  • Identification of cardiovascular medications frequently co-prescribed with NMVr.

Main Results:

  • Significant potential for DDIs exists between NMVr and various cardiovascular medications.
  • Inhibition of CYP3A4 and P-glycoprotein by ritonavir can alter the efficacy and toxicity of cardiovascular drugs.
  • Specific examples of high-risk cardiovascular drug classes requiring careful consideration are discussed.

Conclusions:

  • Awareness of NMVr-cardiovascular drug interactions is critical for preventing adverse events.
  • Close monitoring and potential dose adjustments of cardiovascular medications are necessary during NMVr treatment.
  • Proactive management strategies are essential to ensure patient safety in this vulnerable population.

Keywords:
COVID-19SARS-CoV-2cardiovascular medicationsdrug-drug interactionsnirmatrelvir-ritonavir

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