From the Research
Paxlovid (nirmatrelvir/ritonavir) has significant drug interactions with metformin, lanreotide, and Imodium (loperamide) that can increase the risk of serious side effects, including respiratory depression and lactic acidosis. The interactions occur because ritonavir, a component of Paxlovid, is a strong CYP3A4 inhibitor, which can substantially increase the blood levels of these medications, leading to their accumulation in the body 1. Some key points to consider:
- Temporary discontinuation of Imodium during the 5-day Paxlovid course is recommended to avoid respiratory depression.
- For metformin, consider reducing the dose during Paxlovid treatment and monitor blood glucose closely to minimize the risk of lactic acidosis.
- Regarding lanreotide, while direct evidence is limited, it's metabolized by CYP3A4, suggesting Paxlovid could increase its concentration, potentially affecting blood sugar control. Patients taking these medications together should be closely monitored for side effects, with potential dose adjustments needed 1, 2. It's essential to weigh the benefits of Paxlovid treatment against the potential risks of drug interactions, considering the patient's individual risk factors and medical history 3. In clinical practice, drug interactions are common and can have a direct impact on patients' morbidity and mortality, but with appropriate knowledge, they can be avoided or managed effectively 4.