Paxlovid Drug Interactions To Know

By
Aanchal Rao
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Paxlovid Drug Interactions To Know - DATOS

Paxlovid Drug Interactions: If you are experiencing mild to moderate symptoms of COVID-19, you could potentially qualify for a prescription of Paxlovid (nirmatrelvir/ritonavir). Paxlovid is an oral antiviral drug that aims to reduce the chances of hospitalization or fatal outcomes from COVID-19. Its availability has increased considerably in the United States as time has passed.

Despite the increased availability of Paxlovid, safety measures continue to be a top concern. Your healthcare provider or pharmacist will conduct necessary routine assessments to ensure that Paxlovid is suitable and safe for your use.

As part of these precautions, they will probably inquire about the medications and supplements you currently take at home. Screening for Paxlovid Drug Interactions is a crucial step in prescribing Paxlovid and can help prevent any undesirable side effects.

If you are experiencing mild to moderate COVID-19 symptoms, you might qualify for a prescription of Paxlovid (nirmatrelvir/ritonavir). Paxlovid is an oral antiviral drug that aims to reduce the likelihood of hospitalization or death caused by COVID-19. Its availability has increased significantly in the United States as time has passed.

Even though Paxlovid is more readily available now, safety remains a top priority. To ensure your well-being, your healthcare provider or pharmacist will conduct routine checks to confirm that Paxlovid is safe for you to use.

As part of these measures, they will probably inquire about the medications and supplements you currently use at home. Screening for Paxlovid Drug Interactions is one of the essential steps in prescribing Paxlovid, as it can assist in preventing any undesirable side effects.

Common Paxlovid Drug Interactions 

paxlovid drug interactions- datos
Paxlovid drug interactions

Paxlovid consists of two antiviral medications, namely nirmatrelvir and ritonavir. Both components are essential for the treatment’s effectiveness, but it appears that ritonavir is primarily responsible for the majority of Paxlovid Drug Interactions with other substances.

Paxlovid interferes with specific enzymes (proteins) that play a role in metabolizing medications. As a result, these medications can remain in your system for an extended period, potentially leading to intensified side effects. Similarly, certain medications may also reduce the effectiveness of Paxlovid.

Before visiting the pharmacy to obtain Paxlovid, ensure you have an up-to-date list of all the medications you are currently taking. This list should encompass both prescription and over-the-counter medications, as well as any supplements and vitamins you use. Providing this information to your care team will aid them in preventing and managing any Paxlovid Drug Interactions effectively.

While not comprehensive, here are some typical Paxlovid Drug Interactions to keep in mind. 

Statins

Statins are widely used medications for reducing high cholesterol levels. Atorvastatin (Lipitor), a specific type of statin, has gained popularity and is noted as one of the most frequently prescribed drugs in the United States.

Despite their popularity in pharmacies, statins can be problematic when interacting with other medications, and Paxlovid is no exception. Paxlovid can hinder the enzyme responsible for breaking down statins, leading to their prolonged presence in your body.

As a consequence, the risk of side effects, such as muscle pain, can be exacerbated. In rare instances, there is also a possibility of rhabdomyolysis, a severe condition characterized by intense muscle breakdown.

While on Paxlovid treatment, it is crucial to avoid taking atorvastatin or rosuvastatin (Crestor).

If you are currently on lovastatin or simvastatin (Zocor, FloLipid), there is a more stringent guideline to follow. You must discontinue these medications 12 hours prior to your first Paxlovid dose. Furthermore, you should refrain from taking them until 5 days have elapsed since your last Paxlovid dose.

Heart and blood pressure medications

Numerous heart and blood pressure medications are accessible in the U.S., including commonly used ones like angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and beta blockers. Fortunately, Paxlovid does not interact with these particular medications. However, it’s essential to be aware that many other heart and blood pressure medications may have Paxlovid Drug Interactions.

Heart Medications

Digoxin (Lanoxin) is prescribed for heart failure and irregular heart rhythms. While combining digoxin and Paxlovid is not necessary to avoid, be aware that taking them together can elevate digoxin levels in your system.

For the following medications, it is strongly advised to avoid their use with Paxlovid due to a significant risk of serious heart changes or other adverse effects: 

  • Amiodarone (Pacerone)
  • Disopyramide (Norpace, Norpace CR)
  • Dofetilide (Tikosyn)
  • Dronedarone (Multaq)
  • Eplerenone (Inspra)
  • Flecainide
  • Ivabradine (Corlanor)
  • Propafenone
  • Quinidine
  • Ranolazine (Ranexa)
  • Blood thinners

If you are currently on blood thinners or antiplatelet medications to manage blood clots, it is essential to be aware of additional Paxlovid Drug Interactions. In such cases, your healthcare provider or pharmacist might exercise caution when considering the prescription of Paxlovid.

  • Warfarin (Coumadin, Jantoven)
  • Rivaroxaban (Xarelto)
  • Apixaban (Eliquis)
  • Dabigatran (Pradaxa)
  • Clopidogrel (Plavix)
  • Ticagrelor (Brilinta)
  • Vorapaxar (Zontivity)

Blood pressure medications

You should avoid certain blood pressure medications, including aliskiren (Tekturna), when taking Paxlovid.

Regarding other blood pressure medications, it may be possible to use them alongside Paxlovid, but your healthcare provider might recommend a lower dosage. This is especially relevant for calcium channel blockers.

Certain mental health medications:
  • Amlodipine (Norvasc)
  • Diltiazem (Cardizem)
  • Felodipine
  • Nicardipine
  • Nifedipine (Procardia)
  • Verapamil

Some medications used for anxiety and depression have known Paxlovid Drug Interactions.

Antidepressants such as bupropion (Wellbutrin XL, Wellbutrin SR), bupropion/dextromethorphan (Auvelity), and trazodone are three examples to be mindful of. Paxlovid has the potential to reduce bupropion levels, which could diminish its effectiveness.

On the other hand, the interaction with trazodone has the opposite effect. Paxlovid can elevate trazodone levels, leading to increased side effects like dizziness and low blood pressure.

It is important to be aware of these Paxlovid Drug Interactions, but it is essential to consult your healthcare provider to understand the specific implications for your medication regimen.

Antipsychotic medications are also affected by Paxlovid Drug Interactions. For instance, Paxlovid can elevate the levels of quetiapine (Seroquel) in your system, increasing the likelihood of experiencing side effects. In such cases, your healthcare provider may recommend a lower quetiapine dose while you are on Paxlovid.

Furthermore, Paxlovid can lead to severe reactions when combined with clozapine (Clozaril), lurasidone (Latuda), and pimozide. It is crucial to avoid taking Paxlovid alongside these medications to prevent potential complications.

Seizure medications

Antiepileptic medications, commonly known as seizure medications, interact differently with Paxlovid. Many of these medications can reduce the effectiveness of Paxlovid.

As a result, this may lead to an insufficiently treated infection and potentially promote medication resistance.

To ensure optimal efficacy of Paxlovid, it is crucial to avoid combining it with the following seizure medications: 

  • Phenobarbital 
  • Carbamazepine (Tegretol) 
  • Primidone (Mysoline)
  • Phenytoin (Dilantin, Phenytek)

Certain migraine medications

Over time, numerous medications and medical devices have been approved and cleared to address migraine symptoms and prevent migraines. These treatments operate in distinct ways to alleviate symptoms. However, it’s important to note that some of these migraine medications can have hazardous Paxlovid Drug Interactions.

An illustration of this is eletriptan (Relpax). When used in conjunction with Paxlovid, it can result in severe side effects related to the heart or brain. To avoid such risks, it is recommended to space out Paxlovid and eletriptan doses by at least three days (72 hours). However, other triptan migraine medications seem to be safe to use alongside Paxlovid.

Ubrogepant (Ubrelvy), rimegepant (Nurtec ODT), and ergot derivatives (dihydroergotamine, ergotamine, and methylergonovine) are other migraine medications that require attention. It is essential to avoid combining Paxlovid with these medications due to potential side effects.

Hormonal birth control

Contraception offers a wide array of choices to suit individual needs. Options such as birth control pills, intrauterine devices (IUDs), arm implants, and various others are accessible to cater to different preferences.

If you are using an oral contraceptive pill, it’s essential to examine the label for the presence of ethinyl estradiol. This type of estrogen is commonly found in both generic and brand-name birth control pills, including Sprintec, Apri, Junel, and others. Additionally, ethinyl estradiol is a component of vaginal rings and birth control patches.

While taking ethinyl estradiol, Paxlovid can still be used; however, it is advisable to use an additional form of contraception, such as condoms, while on Paxlovid. This precaution is recommended to reduce the risk of unintended pregnancies. It may also be prudent to continue using backup contraception until after your first period following the completion of Paxlovid treatment.

In theory, Paxlovid could potentially reduce the effectiveness of ethinyl estradiol, increasing the chance of unintended pregnancies. However, since Paxlovid is administered for only 5 days at a time, the impact on ethinyl estradiol’s efficacy may not be significant.

Erectile dysfunction medications

PDE-5 inhibitors are commonly prescribed medications for erectile dysfunction, used before sexual activity when needed. However, if you receive a prescription for Paxlovid, it is advisable to avoid using these medications concurrently.

One of these medications is Avanafil (Stendra). When taking Paxlovid, it can increase the levels of avanafil in your system, although the exact extent is not yet known. As a precautionary measure, it is best to avoid combining these two medications.

Sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) are also PDE-5 inhibitors, and they are more commonly used than avanafil. While it may be acceptable to take them with Paxlovid, it is crucial to consult your healthcare provider about possibly reducing your dose. Paxlovid has the potential to elevate the levels of these medications as well.

Here are some other Paxlovid Drug Interactions that you should avoid:

  • Alfuzosin (Uroxatral)
  • Bosentan (Tracleer)
  • Colchicine (Colcrys)
  • Cyclosporine (Sandimmune)
  • Erythromycin (Ery-Tab)
  • Everolimus (Afinitor)
  • Finerenone (Kerendia)
  • Flibanserin (Addyi)
  • Glecaprevir/pibrentasvir (Mavyret)
  • Lomitapide (Juxtapid)
  • Lumacaftor/ivacaftor (Orkambi)
  • Midazolam
  • Naloxegol (Movantik)
  • Fentanyl
  • Rifampin
  • Silodosin (Rapaflo)
  • St. John’s wort
  • Salmeterol-containing inhalers, such as Wixela Inhub
  • Sirolimus (Rapamune)
  • Suvorexant (Belsomra)
  • Tamsulosin (Flomax)
  • Tacrolimus (Prograf)
  • Tolvaptan (Samsca)
  • Voclosporin (Lupkynis)
  • Triazolam (Halcion)

Apart from the frequently prescribed medications mentioned earlier, there are other medications with which Paxlovid should not be taken, or you may need to adjust the dosage.

Can you take OTC cold and flu medicines like NyQuil with Paxlovid?

Yes, it is generally safe to take over-the-counter (OTC) cold and flu medicines while on Paxlovid. OTC cold and flu medicines typically contain one or more of the following ingredients:

  • A cough suppressant, Dextromethorphan
  • An expectorant, Guaifenesin
  • An antihistamine like diphenhydramine or doxylamine
  • A pain reliever like ibuprofen or acetaminophen 
  • A decongestant like phenylephrine or pseudoephedrine

Among these medications, there is a minor interaction that may only impact certain individuals taking dextromethorphan. Dextromethorphan is available both as a standalone medication and in combination with products such as Mucinex DM, NyQuil, and Theraflu Multi-Symptom Severe Cold.

When taking Paxlovid and dextromethorphan simultaneously, there is a possibility of experiencing slightly increased dextromethorphan side effects. However, you do not need to avoid this combination. It is advisable to inform your healthcare provider if you encounter any new or worsening side effects for appropriate monitoring and management.

When should I reach out to my healthcare provider regarding a Paxlovid interaction?

Generally, contacting your healthcare provider about a Paxlovid interaction should not be necessary, as Paxlovid follows recommended prescribing guidelines. However, if you notice side effects that you suspect might be related to interaction, it’s essential to get in touch with your healthcare provider promptly.

They can provide guidance and support in addressing the situation. If your symptoms are severe, do not hesitate to seek immediate medical attention.

Summary

Paxlovid is an approved antiviral medication for treating specific individuals with COVID-19. However, it’s crucial to be aware that Paxlovid can exacerbate the side effects of statins, heart medications, and erectile dysfunction medications. Additionally, it may reduce the effectiveness of certain medications. To ensure your safety, it is essential for your healthcare provider or pharmacist to screen for Paxlovid Drug Interactions before prescribing Paxlovid.

Read More: Paxlovid Drug Interactions To Know

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