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Paxlovid Disease Interactions

There are 7 disease interactions with Paxlovid (nirmatrelvir / ritonavir).

Moderate

Nirmatrelvir (applies to Paxlovid) liver dysfunction

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Liver Disease

No pharmacokinetic or safety data are available regarding the use of nirmatrelvir (or ritonavir) in patients with severe liver dysfunction (Child-Pugh C); nirmatrelvir-ritonavir is not recommended for use in these patients. No dosage adjustment of nirmatrelvir-ritonavir is recommended for patients with mild or moderate liver dysfunction (Child-Pugh A or B).

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Moderate

Nirmatrelvir (applies to Paxlovid) renal dysfunction

Moderate Potential Hazard, Moderate plausibility.

Renal dysfunction increases nirmatrelvir exposure, which may increase the risk of nirmatrelvir-ritonavir adverse reactions. Nirmatrelvir-ritonavir is not recommended for use in patients with severe renal dysfunction (estimated GFR [eGFR] less than 30 mL/min) or patients with ESRD (eGFR less than 15 mL/min) receiving dialysis until more data are available; the appropriate dosage has not been established for patients with severe renal dysfunction. The dosage of nirmatrelvir-ritonavir should be reduced in patients with moderate renal dysfunction (eGFR 30 to less than 60 mL/min); patients should be counseled about renal dosing instructions. No dosage adjustment is recommended in patients with mild renal dysfunction (eGFR 60 to less than 90 mL/min). Prescriptions should specify the numeric dose of each active ingredient within nirmatrelvir-ritonavir.

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Moderate

PIs (applies to Paxlovid) hemophilia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Coagulation Defect

There have been reports of increased bleeding, including spontaneous skin hematomas and hemarthrosis, in patients with hemophilia type A and B treated with protease inhibitors; however, a causal relationship has not been established. In some patients, additional factor VIII was given. In more than half of the reported cases, protease inhibitor therapy was continued or reintroduced. Patients with hemophilia or other coagulation defects should be monitored closely for bleeding during protease inhibitor therapy.

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Moderate

PIs (applies to Paxlovid) hyperglycemia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Abnormal Glucose Tolerance, Diabetes Mellitus

New onset diabetes mellitus, exacerbation of preexisting diabetes mellitus, hyperglycemia, and some cases of diabetic ketoacidosis have been reported during postmarketing surveillance in HIV-infected patients treated with protease inhibitors. Some patients required either initiation or dosage adjustments of insulin or oral hypoglycemic agents for treatment of these events. In some cases, hyperglycemia persisted despite discontinuation of protease inhibitor therapy. A causal relationship has not been established between protease inhibitor therapy and these events. Monitoring patients for hyperglycemia, new onset diabetes mellitus, or exacerbation of diabetes mellitus should be considered during protease inhibitor therapy.

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Moderate

PIs (applies to Paxlovid) hyperlipidemia

Moderate Potential Hazard, Moderate plausibility.

Treatment with ritonavir alone or in combination with other protease inhibitors (e.g., lopinavir, saquinavir, tipranavir, fosamprenavir) has resulted in substantial increases in the concentration of total cholesterol and triglycerides. These effects have also been reported with other protease inhibitors but may be the most dramatic with ritonavir. The clinical significance of these elevations is unclear. Marked elevation in triglyceride levels is a risk factor for development of pancreatitis. Triglyceride and cholesterol testing is recommended before starting ritonavir (with or without other protease inhibitors) and periodically during therapy. Lipid disorders should be managed as clinically appropriate.

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Moderate

Ritonavir (applies to Paxlovid) heart block

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Heart Disease

Ritonavir may prolong the PR interval in some patients. Postmarketing cases of second or third degree atrioventricular block have been reported. Ritonavir should be administered with caution in patients with underlying structural heart disease, preexisting conduction abnormalities, ischemic heart disease, and cardiomyopathies as these patients might be at increased risk for developing cardiac conduction abnormalities.

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Moderate

Ritonavir (applies to Paxlovid) hepatotoxicity

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Liver Disease

Hepatotoxicity (including jaundice, clinical hepatitis, and hepatic transaminase elevations exceeding 5 times the upper limit of normal) has been reported in patients receiving ritonavir alone or in combination with other antiretroviral drugs. Ritonavir should be administered with caution in patients with preexisting liver diseases, liver enzyme abnormalities, or hepatitis; increased monitoring of AST/ALT should be considered in these patients, especially during the first 3 months of ritonavir therapy. Ritonavir is not recommended for use in patients with severe liver dysfunction.

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Paxlovid drug interactions

There are 679 drug interactions with Paxlovid (nirmatrelvir / ritonavir).

Paxlovid alcohol/food interactions

There are 2 alcohol/food interactions with Paxlovid (nirmatrelvir / ritonavir).


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.