According to a study issued in the "Journal of the American College of Cardiology", although Nirmatrelvir-ritonavir (Paxlovid) is very efficacious in individuals with existing heart disorders, it has substantial drug-drug interactions with commonly used cardiovascular drugs.

Paxlovid is frequently used to treat people with heart disease and symptomatic COVID-19 to stop the development of a severe illness. However, Paxlovid can interact with a number of previously given drugs. This study looked into potential Paxlovid drug-drug interactions with popular cardiovascular drugs and also explored potential remedies to lessen serious adverse effects.

The clinicians must be aware of Paxlovid's possible interactions with cardiovascular medications. Drug-drug interactions can be included in electronic medical records as system-level treatments to assist in the prevention of adverse events. Paxlovid's prescription might be included in an order set, enabling medical professionals—whether they are cardiologists or general practitioners—to intentionally rule out any contraindications that would prevent Paxlovid from being administered with another medication.

It may be beneficial to consult with other healthcare professionals, especially pharmacists. The fundamental knowledge of drug-drug interactions with cardiovascular drugs is crucial. In December 2021, the Food and Drug Administration (FDA) granted Paxlovid emergency use authorization (EUA) to manage non-hospitalized, symptomatic people infected with mild-moderate SARS-CoV-2 who have a high chance of developing a serious illness.

A considerable percentage of the elevated-risk group for whom Paxlovid is advantageous includes individuals with heart disorders and various risk factors like smoking, chronic renal disease, high blood pressure, and diabetes. Existing data and awareness of interactions between Paxlovid and other drugs were used to offer guidance on possible interactions and the linked outcomes on the basis of the degree of interaction.

 

Five most important interactions between Paxlovid and cardiovascular medications are as follows:

(a) Immunosuppressive agents

When taken concurrently with Paxlovid, the plasma levels of immunosuppressive medications indicated for individuals who had heart transplantation rapidly increase to hazardous levels.

Temporarily reducing the dosage of immunosuppressive medications needs frequent monitoring and would be logistically challenging. Alternative COVID-19 therapeutic options must be taken into account for these individuals.

(b) Ranolazine

In the presence of Paxlovid (CPY450 inhibitors), Ranolazine's (a medication for mitigating angina and other heart-linked chest pain) plasma concentration elevates exponentially, magnifying torsade de pointes (a type of arrhythmia) and QT prolongation risk. Paxlovid must not be given in combination. If Paxlovid is recommended to a patient, administration of Ranolazine must be stopped temporarily.

(c) Certain statins

Lovastatin or Simvastatin co-administration with Paxlovid can trigger elevated plasma levels. This can cause rhabdomyolysis (a disorder in which a harmful protein is released into the circulation due to the breakdown of muscle tissue) and muscular weakness/myopathy. Prior to the initiation of Paxlovid, these medications should be discontinued. When used alongside Paxlovid, Atorvastatin and Rosuvastatin dosages should be decreased. When coadministered with Paxlovid, the other statins are regarded as safe.

(d) Anticoagulants and antiplatelet agents

Paxlovid might be co-administered with blood thinners or anticoagulants (like warfarin) utilized to prevent or manage blood clots. It is important to strictly monitor clotting factors in bloodwork. When provided concurrently with Paxlovid, the plasma levels of all the direct oral anticoagulant drugs rise, necessitating utilization of alternative anticoagulant drugs, temporary cessation, or dose modification.

When a patient has received a stent, antiplatelet medications are often utilized to manage coronary artery disease. It is safe to consume Aspirin and Prasugrel with Paxlovid at the same time. There is an elevated risk of bleeding when Paxlovid is administered along with Ticagrelor, and there is a raised chance of blood clots when administered along with Clopidogrel. These medications must be changed to Prasugrel whenever feasible. If patients have a contraindication to taking prasugrel, alternative COVID-19 therapy should be taken into consideration and Paxlovid's co-administration must be avoided.

(e) Antiarrhythmics

Antiarrhythmics are utilized to combat abnormal rhythms of the heart. Several of these medications are processed in a way that boosts their plasma levels when utilized with Paxlovid. Paxlovid can potentially be commenced after a temporary 2- to 2.5-day cessation of antiarrhythmics. However, this may not be feasible. Doctors are urged for thinking about other COVID-19 therapy and for avoiding co-administration of these medications with Paxlovid. Paxlovid and the second antiarrhythmic drug Sotalol do not interact since sotalol is renally eliminated.

These outcomes emphasized the importance for all doctors to be familiar with these interactions. To sum up, the availability and knowledge of additional COVID-19 medicines allow doctors to provide individuals with alternative therapy options who are not able to use Paxlovid due to drug-drug interactions.