From the FDA Drug Label
• Strong cytochrome P450 3A4 inhibitors (e.g., ritonavir): Risk of increased systemic corticosteroid effects. Exercise caution when used with budesonide and formoterol fumarate dihydrate. (5.9) • Strong cytochrome P450 3A4 inhibitors (e.g., ritonavir): Use with caution. May cause increased systemic corticosteroid effects. (7. 1)
The patient should exercise caution when taking Symbicort (budesonide/formoterol) with Paxlovid (nirmatrelvir/ritonavir) due to the risk of increased systemic corticosteroid effects. However, the label does not explicitly state that the patient should discontinue Symbicort. It is recommended to use with caution and monitor for signs of increased drug exposure 1.
From the Research
Patients should not discontinue Symbicort (budesonide/formoterol) while taking Paxlovid (nirmatrelvir/ritonavir) without consulting their healthcare provider, as this decision requires individual medical assessment. Paxlovid can potentially increase blood levels of budesonide due to inhibition of the CYP3A4 enzyme system, which could theoretically increase the risk of corticosteroid-related side effects such as immunosuppression, elevated blood sugar, or adrenal suppression 2. However, completely stopping Symbicort could lead to worsening of asthma or COPD symptoms, which might be particularly dangerous during a COVID-19 infection.
Some key points to consider:
- The interaction between Paxlovid and Symbicort may increase the risk of corticosteroid-related side effects, but the severity of this interaction is not well established 3.
- Stopping Symbicort could lead to worsening of respiratory symptoms, which could be dangerous during a COVID-19 infection 4.
- Healthcare providers may recommend temporarily reducing the Symbicort dose rather than stopping it completely, or they may determine that the short-term use of Paxlovid poses an acceptable risk when weighed against respiratory disease control 5.
- The decision to discontinue Symbicort should be based on the severity of the patient's respiratory condition, the specific COVID-19 situation, and individual risk factors 6.
In general, the benefits of continuing Symbicort during Paxlovid treatment likely outweigh the risks, especially considering the potential for worsening respiratory symptoms during a COVID-19 infection. However, each patient's situation should be evaluated individually by their healthcare provider.