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Safely Prescribing Nirmatrelvir and Ritonavir—Avoiding Drug-Drug Interactions

To identify the key insights or developments described in this article
1 Credit CME

A 72-year-old man called his primary care physician (PCP) after 2 days of throat pain, myalgia, mild shortness of breath, and fever. A home COVID-19 antigen test result was positive. He had received 3 doses of the BNT162b2 vaccine (Pfizer-BioNTech COVID-19 vaccine); the most recent dose was 6 months prior. Considering a history of recent coronary artery bypass graft, hypertension, diabetes, and the patient’s age, his PCP prescribed nirmatrelvir and ritonavir (Paxlovid) for 5 days. The patient called his PCP after 2 days with active complaints of worsening myalgia. On medication review, the patient’s active medications included atorvastatin, 80 mg daily; metformin, 1000 mg twice a day; aspirin, 81 mg daily; and dapagliflozin, 10 mg daily.

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Article Information

Corresponding Author: Roshni Culas, MD, Fellow, Division of Infectious Diseases, Department of Medicine, Memorial Sloan Kettering Cancer Center, 417 E 68th St, New York, NY 10065 (roshnif@mskcc.org).

Published Online: February 20, 2023. doi:10.1001/jamainternmed.2022.6834

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
1.
Hammond  J , Leister-Tebbe  H , Gardner  A ,  et al; EPIC-HR Investigators.  Oral nirmatrelvir for high-risk, nonhospitalized adults with Covid-19.   N Engl J Med. 2022;386(15):1397-1408. doi:10.1056/NEJMoa2118542PubMedGoogle ScholarCrossref
2.
US Department of Health & Human Services, Administration for Strategic Preparedness and Response. COVID-19 therapeutics thresholds, orders, and replenishment by jurisdiction. Accessed September 20, 2022. https://aspr.hhs.gov/COVID-19/Therapeutics/orders/Pages/default.aspx
3.
McQuade  BM , Campbell  A .  Drug prescribing: drug-drug interactions.   FP Essent. 2021;508:25-32.PubMedGoogle Scholar
4.
Zanger  UM , Schwab  M .  Cytochrome P450 enzymes in drug metabolism: regulation of gene expression, enzyme activities, and impact of genetic variation.   Pharmacol Ther. 2013;138(1):103-141. doi:10.1016/j.pharmthera.2012.12.007PubMedGoogle ScholarCrossref
5.
Kashani  A , Phillips  CO , Foody  JM ,  et al.  Risks associated with statin therapy: a systematic overview of randomized clinical trials.   Circulation. 2006;114(25):2788-2797. doi:10.1161/CIRCULATIONAHA.106.624890PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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