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Paxlovid and Alcohol/Food Interactions

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


ritonavir food

Moderate Food Interaction

Consumer information for this interaction is not currently available.

ADJUST DOSING INTERVAL: Administration with food may modestly affect the bioavailability of ritonavir from the various available formulations. When the oral solution was given under nonfasting conditions, peak ritonavir concentrations decreased 23% and the extent of absorption decreased 7% relative to fasting conditions. Dilution of the oral solution (within one hour of dosing) with 240 mL of chocolate milk or a nutritional supplement (Advera or Ensure) did not significantly affect the extent and rate of ritonavir absorption. When a single 100 mg dose of the tablet was administered with a high-fat meal (907 kcal; 52% fat, 15% protein, 33% carbohydrates), approximately 20% decreases in mean peak concentration (Cmax) and systemic exposure (AUC) were observed relative to administration after fasting. Similar decreases in Cmax and AUC were reported when the tablet was administered with a moderate-fat meal. In contrast, the extent of absorption of ritonavir from the soft gelatin capsule formulation was 13% higher when administered with a meal (615 KCal; 14.5% fat, 9% protein, and 76% carbohydrate) relative to fasting.

MANAGEMENT: Ritonavir should be taken with meals to enhance gastrointestinal tolerability.


  1. "Product Information. Norvir (ritonavir)." Abbott Pharmaceutical (2001):

High Cholesterol (Hyperlipoproteinemia, Hypertriglyceridemia, Sitosterolemia)

Moderate Potential Hazard, Moderate plausibility

PIs - hyperlipidemia

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.


  1. "Product Information. Norvir (ritonavir)." AbbVie US LLC (2022):
  2. "Product Information. Reyataz (atazanavir)." Bristol-Myers Squibb (2020):
  3. "Product Information. Lexiva (fosamprenavir)." ViiV Healthcare (2019):
  4. "Product Information. Kaletra (lopinavir-ritonavir)." AbbVie US LLC (2020):
  5. "Product Information. Invirase (saquinavir)." Roche Laboratories (2020):
  6. "Product Information. Aptivus (tipranavir)." Boehringer Ingelheim (2020):
View all 6 references

Paxlovid drug interactions

There are 650 drug interactions with Paxlovid (nirmatrelvir / ritonavir).

Paxlovid disease interactions

There are 7 disease interactions with Paxlovid (nirmatrelvir / ritonavir) which include:

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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.