Oral Drugs Against COVID-19: Management of Drug Interactions With the Use of Nirmatrelvir/Ritonavir.
Background: Five-day oral therapies against early COVID-19 infection have recently been conditionally approved in Europe. In the drug combination nirmatrelvir + ritonavir (nirmatrelvir/r), the active agent, nirmatrelvir, is made bioavailable in clinically adequate amounts by the additional administr...
| Publicado en: | Deutsches Ärzteblatt International Vol. 119; no. 15; pp. 263 - 273 |
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| Autores principales: | , , , , , , |
| Formato: | Journal Article |
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Deutscher Aerzte-Verlag GmbH
4/15/2022
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=158071563&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 158071563 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 18660452 5F0N jtl: Deutsches Ärzteblatt International issn: 18660452 maglogo: N pubinfo: dt: 4/15/2022 vid: 119 iid: 15 pid: 25312 pub: Deutscher Aerzte-Verlag GmbH artinfo: ui: 158071563 10.3238/arztebl.m2022.0152 158071563 ppf: 263 ppct: 10 formats: fmt: @attributes: type: P tig: atl: Oral Drugs Against COVID-19: Management of Drug Interactions With the Use of Nirmatrelvir/Ritonavir. aug: au: Mikus, Gerd Foerster, Kathrin I. Terstegen, Theresa Vogt, Cathrin Said, André Schulz, Martin Haefeli, Walter E. affil: Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany sug: ab: Background: Five-day oral therapies against early COVID-19 infection have recently been conditionally approved in Europe. In the drug combination nirmatrelvir + ritonavir (nirmatrelvir/r), the active agent, nirmatrelvir, is made bioavailable in clinically adequate amounts by the additional administration of a potent inhibitor of its first-pass metabolism by way of cytochrome P450 [CYP] 3A in the gut and liver. In view of the central role of CYP3A in the clearance of many different kinds of drugs, and the fact that many patients with COVID-19 are taking multiple drugs to treat other conditions, it is important to assess the potential for drug interactions when nirmatrelvir/r is given, and to minimize the risks associated with such interactions. Methods: We defined the interaction profile of ritonavir on the basis of information derived from two databases (Medline, GoogleScholar), three standard electronic texts on drug interactions, and manufacturer-supplied drug information. We compiled a list of drugs and their potentially relevant interactions, developed a risk minimization algorithm, and applied it to the substances in question. We also compiled a list of commonly prescribed drugs for which there is no risk of interaction with nirmatrelvir/r. Results: Out of 190 drugs and drug combinations, 57 do not need any special measures when given in combination with brief, low-dose ritonavir treatment, while 15 require dose modification or a therapeutic alternative, 8 can be temporarily discontinued, 9 contraindicate ritonavir use, and 102 should preferably be combined with a different treatment. Conclusion: We have proposed measures that are simple to carry out for the main types of drug that can interact with ritonavir. These measures can be implemented under quarantine conditions before starting a 5-day treatment with nirmatrelvir/r. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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