IDSA offers guidance on managing drug interactions with nirmatrelvir/ritonavir

The Infectious Diseases Society of America (IDSA) listed six steps to help clinicians prescribe the COVID-19 medication while minimizing interaction risks. Other recent research looked at neuropsychiatric conditions after COVID-19 and hospital profits during the pandemic.

The Infectious Diseases Society of America issued guidance on managing drug interactions with nirmatrelvir/ritonavir (Paxlovid) on May 6.

The resource recommends clinicians take six steps to minimize the risk of drug interactions for patients with COVID-19 who are eligible for nirmatrelvir/ritonavir:

  1. 1. Obtain a complete list of the patient's current medications, including over-the-counter agents and herbal supplements.
  2. 2. Confirm that the patient is taking each medication as prescribed. If the patient is not taking a medication, remove the medication from their medication profile.
  3. 3. Review the FDA fact sheet on nirmatrelvir/ritonavir to identify any medications that the patient is currently taking that are contraindicated. If the patient is taking a contraindicated medication, prescribe an alternative treatment for mild to moderate COVID-19.
  4. 4. Review potential drug interactions between nirmatrelvir/ritonavir and the patient's current medications using any of several available resources listed in the guidance.
  5. 5. Advise the patient on dose adjustments, temporary cessation of medication, or clinical monitoring that is needed during and after the five-day nirmatrelvir/ritonavir treatment.
  6. 6. If relapse occurs after initial treatment and a second course of nirmatrelvir/ritonavir treatment is warranted, the duration of therapy should be used to guide adjustments to concomitant medications.

The guidance notes that among the top 100 prescribed drugs, only two have interactions so severe that nirmatrelvir/ritonavir should be avoided altogether: rivaroxaban and salmeterol. It goes on to list recommended dose changes for a number of other medications.

In other COVID-19 news, a study published by JAMA Psychiatry on May 11 compared the rate of new-onset neuropsychiatric conditions and new neuropsychiatric medication prescriptions in patients who had been hospitalized for COVID-19 or another severe acute respiratory infection. It found that both groups had similar, significantly increased rates of anxiety, dementia, and new antidepressant prescriptions compared to the general population. A study published by JAMA Health Forum on May 13 found that U.S. hospitals had a similar overall profit margin in 2020 compared to prior years, which the authors attributed to the government's COVID-19 relief fund. Government, rural, and smaller hospitals had higher profit margins in 2020 than in 2019.