From the Guidelines
Paxlovid (nirmatrelvir/ritonavir) should not be taken concurrently with rosuvastatin due to significant drug interactions, and rosuvastatin should be temporarily discontinued during the 5-day Paxlovid treatment course and for 1 day after completion. This recommendation is based on the potential for ritonavir, a component of Paxlovid, to inhibit the CYP3A4 enzyme and the OATP1B1/1B3 transporters, which can dramatically increase rosuvastatin blood levels, potentially leading to serious adverse effects such as myopathy and rhabdomyolysis 1. Although the provided evidence does not directly address the interaction between Paxlovid and rosuvastatin, it does discuss the effects of protease inhibitors, including ritonavir, on statins, highlighting the need for caution and appropriate dosing and monitoring when co-administering these medications.
Key Considerations
- The interaction between Paxlovid and rosuvastatin can lead to elevated rosuvastatin concentrations, increasing the risk of adverse effects such as muscle pain, tenderness, and weakness.
- Temporarily discontinuing rosuvastatin during Paxlovid treatment poses minimal cardiovascular risk compared to the dangers of the interaction.
- Patients should inform all healthcare providers about all medications they are taking to prevent potentially harmful drug interactions.
Management Strategy
- If a patient needs both Paxlovid and rosuvastatin, consider alternative statins that are less likely to interact with Paxlovid.
- Monitor patients for signs of myopathy and rhabdomyolysis, such as muscle pain, tenderness, and weakness, during and after Paxlovid treatment.
- Restart rosuvastatin after completing Paxlovid treatment, with close monitoring of liver enzymes and muscle symptoms.
From the Research
Potential Interactions between Paxlovid and Rosuvastatin
The potential interactions between Paxlovid (nirmatrelvir/ritonavir) and rosuvastatin are a concern due to the risk of drug-drug interactions (DDIs).
- Paxlovid is a promising antiviral oral medication for patients at high risk of severe COVID-19, but its concomitant use with statins like rosuvastatin may result in significant DDIs 2.
- Ritonavir, a component of Paxlovid, is a potent inhibitor of cytochrome P450 3A4 (CYP3A4), which can increase the levels of rosuvastatin, a substrate of CYP3A4, and lead to increased risk of toxicity 3, 4.
- A reduction of the dose of rosuvastatin is recommended during Paxlovid treatment to minimize the risk of DDIs 2.
- The management of DDIs between Paxlovid and rosuvastatin requires careful assessment and knowledge of the clinical pharmacology of both drugs, as well as consideration of the patient's individual risk factors and comorbidities 5, 6.
- Healthcare providers should be aware of the potential DDIs between Paxlovid and rosuvastatin and take steps to mitigate these risks, such as adjusting the dose of rosuvastatin or monitoring the patient closely for signs of toxicity 4, 6.