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J Am Coll Cardiol . Cardiovascular Drug Interactions With Nirmatrelvir/Ritonavir in Patients With COVID-19: JACC Review Topic of the Week

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  • J Am Coll Cardiol . Cardiovascular Drug Interactions With Nirmatrelvir/Ritonavir in Patients With COVID-19: JACC Review Topic of the Week


    J Am Coll Cardiol


    . 2022 Oct 6;S0735-1097(22)06825-5.
    doi: 10.1016/j.jacc.2022.08.800. Online ahead of print.
    Cardiovascular Drug Interactions With Nirmatrelvir/Ritonavir in Patients With COVID-19: JACC Review Topic of the Week


    Sonu Abraham 1 , Anju Nohria 2 , Tomas G Neilan 3 , Aarti Asnani 4 , Anu Mariam Saji 1 , Jui Shah 1 , Tara Lech 1 , Jason Grossman 1 , George M Abraham 5 , Daniel P McQuillen 6 , David T Martin 2 , Paul E Sax 7 , Sourbha S Dani 1 , Sarju Ganatra 8



    Affiliations

    Abstract

    Nirmatrelvir-ritonavir (NMVr) is used to treat symptomatic, nonhospitalized patients with coronavirus disease-2019 (COVID-19) who are at high risk of progression to severe disease. Patients with cardiovascular risk factors and cardiovascular disease are at a high risk of developing adverse events from COVID-19 and as a result have a higher likelihood of receiving NMVr. Ritonavir, the pharmaceutical enhancer used in NMVr, is an inhibitor of the enzymes of CYP450 pathway, particularly CYP3A4 and to a lesser degree CYP2D6, and affects the P-glycoprotein pump. Co-administration of NMVr with medications commonly used to manage cardiovascular conditions can potentially cause significant drug-drug interactions and may lead to severe adverse effects. It is crucial to be aware of such interactions and take appropriate measures to avoid them. In this review, we discuss potential drug-drug interactions between NMVr and commonly used cardiovascular medications based on their pharmacokinetics and pharmacodynamic properties.

    Keywords: COVID-19; SARS-CoV-2; cardiovascular medications; drug-drug interactions; nirmatrelvir-ritonavir.

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