Covid antiviral drugs interact with CV drugs • The Medical Republic

A new in-depth review article provides guidance and warnings when prescribing paxlobid to patients on cardiovascular medications.

Clinicians prescribing the novel coronavirus drugs nilmatrelvir/ritonavir are cautioned to be aware of potentially serious drug interactions with a range of commonly used cardiovascular drugs.

write in of Journal of the American College of Cardiology (JACC), The authors said many patients with heart disease and symptomatic covid are often treated with nilmatrelvir/ritonavir (Paxlovid, Pfizer Australia) to prevent progression to severe disease.

However, paxlovid is available in a wide variety of prescriptions, including several antiplatelet/anticoagulant drugs, certain statins, antianginal drugs, antihypertensive drugs, antiarrhythmic drugs, heart failure treatment, pulmonary hypertension treatment, and immunosuppressive anti-inflammatory drugs. May interact with drugs. Not all drugs in these classes interact with antiviral agents, researchers report.

of Jack A review paper describes potential drug-drug interactions (DDIs) between paxlobid and approximately 80 commonly used cardiovascular drugs and the potential for temporary adjustment or adjustment of drugs prior to the use of antiviral therapy. We are scrutinizing potential options to mitigate severe side effects, including discontinuation. , or whether to avoid.

Dr. Sarju Ganatra, a US-based senior author of the paper, said it is essential to recognize the potential of DDI.

“We described many known and potential DDIs between various cardiovascular drugs and NMVr [Paxlovid],” He said.

“The importance of adjusting medication prior to initiation of NMVr to avoid severe DDI cannot be overemphasized. Dose adjustment or discontinuation of cardiovascular medications may be necessary.”

Dr. Ganatra, director of the Cardiac Oncology Program at Lahey Hospital and Medical Center in Burlington, Massachusetts, said that combining Paxlovid with certain cardiovascular medications is undesirable or discontinuing them temporarily is practical. If not, Paxlovid should be avoided and other treatments should be pursued, he said. Already used.

“The awareness and availability of other covid-19 therapies such as remdesivir, molnupiravir and anti-SARS-COV-2 monoclonal antibodies will allow clinicians to offer alternative treatment options to patients who cannot take NMVr due to DDI. ” he said.

Statins were among the drug interactions they reviewed. The authors found that simvastatin or lovastatin in combination with nilmatrelvir/ritonavir increased plasma levels, followed by muscle weakness (myopathy) and rhabdomyolysis (breakdown of muscle tissue releasing toxic proteins into the bloodstream). states that it may lead to

“These drugs should be discontinued prior to initiation of paxlovid,” the authors wrote.

“Dose reductions for atorvastatin and rosuvastatin are reasonable when coadministered with paxlobid. Other statins are believed to be safe when given with paxlobid.”

The use of immunosuppressants in combination with paxlovid was also a red flag.

“Plasma concentrations of immunosuppressants prescribed to heart transplant patients rise exponentially to toxic levels when co-administered with paxlovid,” the authors wrote.

“Temporarily reducing the dose of immunosuppressants requires frequent monitoring and is logistically challenging. Therefore, alternative covid-19 treatments should be considered for these patients.”

Although this detailed paper focuses on drugs used to treat cardiovascular disease, there are other potential drug-drug interactions that clinicians should be aware of before prescribing paxlobid. in australia, NPS MedicineWise provides a list of potential drug interactions.

Journal of the American College of Cardiology 2022, online October 12