Collaboration and Decision-Support Tools to Mitigate Nirmatrelvir/Ritonavir Drug Interactions

Nirmatrelvir/ritonavir (Paxlovid) is used to treat mild to moderate COVID-19 for patients at high risk for disease progression. However, its use presents challenges due to drug-to-drug interactions that affect its effectiveness and the safety of coadministered medications. In response, a nurse-initiated protocol and interprofessional prescribing guidance were developed at a large nonprofit academic medical center to expedite proactive treatment for at-risk, ambulatory patients with COVID-19. The guidance was based on a standardized risk score.

Decision-support tools were developed collaboratively with the pharmacy team and built into the electronic health record to provide just-in-time directives for prescribers. Patients who would otherwise have been excluded were prescribed nirmatrelvir/ritonavir using evidence-based, drug-to-drug interaction management strategies coupled with patient education and supported by the team infrastructure.

Between November 1, 2020, and February 1, 2023, 3802 patients at high risk for disease progression who had a documented drug-to-drug interaction with nirmatrelvir/ritonavir were evaluated for treatment. Of these patients, 2351 (61.8%) were treated.

Our management strategies efficiently and safely provided treatment to more than 60% of patients at high risk of disease progression who would otherwise have been excluded from receiving this medication option due to drug-to-drug interactions with nirmatrelvir/ritonavir.