Jayk Bernal A, Gomes da Silva MM, Musungaie DB, et al. The product labels for apixaban do not recommend the concomitant use with strong dual CYP3A4 and P-gp inhibitors, although the US label for apixaban gives the option to use apixaban at a reduced dose (i.e., 2.5 mg) if needed. Includes Paxlovid side effects, uses, interactions, and dosage. Refer to the quetiapine prescribing information for recommendations. PharmaCare previously paid a fee (PAX-F) to pharmacists for following up and monitoring patients for adverse drug events. 5,19. Find patient medical information for Paxlovid (EUA) oral on WebMD including its uses, side effects and safety, interactions, pictures, warnings and user ratings. a Reduced effectiveness of clopidogrel is likely. If coadministration is necessary, reduce quetiapine dose and monitor for quetiapine-associated adverse reactions. COVID-19 supplemental clinical guidance #4: nirmatrelvir/ritonavir (Paxlovid) use in patients with advanced chronic kidney disease and patients on dialysis with COVID-19. No dosage adjustment is needed in patients with mild renal impairment. Sufficient information is available, such as through access to health records, patient reporting of medical history, or consultation with a health care provider in an established provider-patient relationship with the individual patient, to obtain a comprehensive list of medications (prescribed and non-prescribed) that the patient is taking to assess for potential drug interaction. Pfizer had said that in the clinical trial for Paxlovid, several participants appeared to have a rebound in virus levels, although this also occurred in some people who were given a placebo. If a drug's potential interaction with Paxlovid poses too much of a risk, Anderson said, a safe and effective alternative Covid-19 therapy would be GlaxoSmithKline's sotrovimab the sole . If signs and symptoms of a clinically significant hypersensitivity reaction or anaphylaxis occur, immediately discontinue PAXLOVID and initiate appropriate medications and/or supportive care.Hepatotoxicity: Hepatic transaminase elevations, clinical hepatitis, and jaundice have occurred in patients receiving ritonavir. 4 3CL PRO is responsible for cleaving polyproteins 1a and 1ab of SARS-CoV-2. Alternate antimycobacterial drugs such as rifabutin should be considered [see Contraindications (4)]. But because many children reach 88 poundsconsidered to be an adult weightthe FDA has allowed extensions of EUAs for medications such as monoclonal antibodies and remdesivir in younger age groups, adds Dr. Topal. There are 5 disease interactions with Paxlovid (nirmatrelvir / ritonavir) which include: Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. The use of Paxlovid is further complicated by the large number of clinically important drug-to-drug interactions. One of our biggest public health challenges is to decrease the rate of severe COVID-19 disease in the face of pandemic fatigue, dried up funding, misinformation, and a changing virus. atorvastatin, rosuvastatin. In some cases, the recommendation is to avoid co-administration. Avoid concomitant use with PAXLOVID. Reply falcongsr . Drugs listed in this section are a guide and not considered a comprehensive list of all drugs that may be contraindicated with PAXLOVID. Coadministration contraindicated due to serious and/or life-threatening reactions such as cardiac arrhythmias [see Contraindications (4)]. Centers for Disease Control and Prevention. Ritonavir-boosted nirmatrelvir has not been studied in patients who were hospitalized for mild to moderate COVID-19. 2022. Paxlovid is the latest COVID-19 treatment thats been all over the news. Home testing is a huge part of the way to really operationalize these medications, he says, adding that while home tests may not be as highly sensitive as the laboratory-based polymerase chain reaction (PCR) tests, they are still very helpful in making a diagnosis. As a COVID-19 treatment, ritonavir essentially shuts down nirmatrelvirs metabolism in the liver, so that it doesnt move out of your body as quickly, which means itcan work longergiving it a boost to help fight the infection. From 1 April 2023, the patient eligibility criteria for Paxlovid on the PBS have been expanded to include people aged 60 to 69 years with mild to moderate COVID-19 and one risk factor for severe disease. Breastfeeding individuals with COVID-19 should follow practices according to clinical guidelines to avoid exposing the infant to COVID-19., Use of ritonavir may reduce the efficacy of combined hormonal contraceptives. 2.4 Important Drug Interactions with PAXLOVID Refer to other sections of the Fact Sheet for important drug interactions with PAXLOVID. So, if you test positive for the coronavirus and you are eligible to take the pills,you can take them at home and lower your risk of going to the hospital. Rebound of SARS-CoV-2 infection after nirmatrelvir-ritonavir treatment. oxycodone, methylprednisolone, Deo R, Choudhary MC, Moser C, et al. For Medical Information visit www.pfizermedicalinformation.com or call 18004381985 The proportions of subjects who discontinued treatment due to an adverse event were 2% in the PAXLOVID group and 4% in the placebo group.The following adverse reactions have been identified during post-authorization use of PAXLOVID. Cases of Toxic Epidermal Necrolysis and Stevens-Johnson syndrome have been reported with ritonavir, a component of PAXLOVID (refer to NORVIR prescribing information). The CDC says a rebound does not mean a person was resistant to Paxlovid, nor does it mean they were reinfected with the virus. Some chemotherapeutic agents may decrease the effectiveness of ritonavir-boosted nirmatrelvir. Fish Oil (omega-3 polyunsaturated fatty acids), Email this report to a friend, doctor, or patient. Minimally clinically significant. PAXLOVID IS NOT approved for any of the following: To treat patients who are hospitalized due to severe or critical COVID-19. 360bbb-3 (b) (1), unless the declaration is terminated or authorization . Nirmatrelvir and ritonavir are CYP3A4 substrates. tenofovir. Limited published data reports that ritonavir is present in human milk. 1 . No pharmacokinetic or safety data are available regarding the use of nirmatrelvir or ritonavir in subjects with severe hepatic impairment (Child-Pugh Class C); therefore, PAXLOVID is not recommended for use in patients with severe hepatic impairment.Please see Fact Sheet for Healthcare Providers and Fact Sheet for Patients, Parents, and Caregivers. Param Patel is a pharmacist. PP-PAX-USA-0562, PAXLOVID is not authorized for initiation of treatment in patients requiring hospitalization due to severe or critical COVID-19, PAXLOVID is not authorized for use as pre-exposure or post-exposure prophylaxis for prevention of, PAXLOVID is not authorized for use for longer than 5 consecutive days. (See also Liverpool's Quick Guide on Interactions with Outpatient Medicines and Paxlovid ) Refer to rifabutin product label for further information on rifabutin dose reduction. Ritonavir, a strong cytochrome P450 (CYP) 3A4 inhibitor and a P-glycoprotein inhibitor, is coadministered with nirmatrelvir to increase the blood concentration of nirmatrelvir, thereby making it effective against SARS-CoV-2. a This list is primarily based on the most common medication searches by U.S. users on the Liverpool COVID-19 Drug Interactions website between January 1 and December 31, 2022 (internal communication, January 2023). If withholding is not clinically appropriate, use an alternative concomitant medication or COVID-19 therapy. 2022. Please refer to the FDA EUA fact sheet for ritonavir-boosted nirmatrelvir and the prescribing information for the chemotherapeutic agent and consult the patients specialist provider. 2022. Coadministration of eletriptan within at least 72 hours of PAXLOVID is contraindicated due to potential for serious adverse reactions including cardiovascular and cerebrovascular events [see Contraindications (4)]. Submit adverse event and medication error reports to FDA MedWatch using one of the following methods: In addition, please provide a copy of all FDA MedWatch forms to: and may increase plasma concentrations of drugs that are primarily metabolized by CYP3A. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. The role of combination antiviral therapy or a longer treatment duration in treating patients who are severely immunocompromised is not yet known. It goes away at the end. PDE5 inhibitors can be coadministered with ritonavir-boosted nirmatrelvir in patients with erectile dysfunction, though the dose of the PDE5 inhibitor should be adjusted. cariprazine, Ritonavir may also increase blood concentrations of certain concomitant medications. Reference: PAXLOVID Fact Sheet for Healthcare Providers. See Pregnancy, Lactation, and COVID-19 Therapeutics for the Panels guidance regarding the use of ritonavir-boosted nirmatrelvir during pregnancy and lactation. Reduce dosage when coadministered with PAXLOVID. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for PAXLOVID and any potential adverse effects on the breastfed infant from PAXLOVID or from the underlying maternal condition. Ritonavir-boosted nirmatrelvir has significant drug-drug interactions, primarily due to the ritonavir component of the combination. The EPIC-HR trial enrolled nonhospitalized adults with mild to moderate COVID-19 who were not vaccinated and who were at high risk of progressing to severe disease. j For medications that are not included on the Liverpool COVID-19 Drug Interactions website or in the University of Waterloo/University of Toronto drug interaction guide, refer to the FDA labels for information on coadministering these medications with ritonavir or other strong CYP3A4 and/or P-gp inhibitors (e.g., ketoconazole). Usually avoid combinations; use it only under special circumstances. The following adverse reactions have been identified during post-authorization use of PAXLOVID. nifedipine, 2022. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Modification of other medications is needed due to a potential drug interaction. Copyright 2023 The University of Liverpool. that have not been previously reported with PAXLOVID use. Download . Its cheaper than many other COVID-19 drugs (its provided for free by the U.S. government while there is a public health emergency), and, perhaps most reassuring, it is expected to work against the Omicron variant. reference. Caution should be exercised when coadministeringPAXLOVID with digoxin, with appropriate monitoring of serum digoxin levels. triamcinolone. For information on treatment considerations for vaccinated individuals, see Therapeutic Management of Nonhospitalized Adults With COVID-19. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Because of the potential for significant drug-drug interactions with concomitant medications, this regimen may not be the optimal choice for all patients. The U.S. Food and Drug Administration (FDA) has issued an Emergency Use Authorization (EUA) for the emergency use of the unapproved product PAXLOVID for the treatment of adults and pediatric patients (12 years of age and older weighing at least 40 kg) with a current diagnosis of mild-to-moderate coronavirus disease 2019 (, ) and who are at high risk for progression to severe, To find COVID-19 treatments, please use the U.S. Dept. The FDA granted the EUA in December, just as a staggering number of people were infected with Omicron and the need for care skyrocketed, leading to supply issues. Published studies with ritonavir are insufficient to identify a drug-associated risk of miscarriage. Paxlovid's primary side effect is a metallic taste in the mouth during the five days of treatment. brexpiprazole You can use the site to search for the places near you where you can fill a COVID-19 prescription, or identify sites that provide testing, medical care, and COVID-19 medications. fentanyl, diltiazem, When it applied for FDA authorization, Pfizer presented data from a clinical trial conducted between mid-July and early Decemberin 2021. Providers should counsel patients about renal dosing instructions. In cases where the risks of the drug interaction outweigh the potential benefits, alternative COVID-19 therapy must be prescribed. Dosage adjustment of saxagliptin is recommended. The information provided is for educational purposes only. The hypothesis is that the immune system didnt have a chance to see the full extent of the virus, since Paxlovid suppressed replication early in disease, Dr. Roberts says. Using an alternative to the concomitant medication. Paxlovid gets in the way of certain enzymes (proteins) that are responsible for breaking down . g Withhold lovastatin and simvastatin for at least 12 hours before initiating ritonavir-boosted nirmatrelvir, during treatment, and for 5 days after treatment completion. , ombitasvir/paritaprevir/ Drugs listed in Table 1 are a guide and not considered a comprehensive list of all possible drugs that may interact with PAXLOVID. If signs and symptoms of a clinically significant hypersensitivity reaction or anaphylaxis occur, immediately discontinue PAXLOVID and initiate appropriate medications and/or supportive care. For patients with a lower risk of arterial or venous thrombosis, clinicians may consider administering low-dose aspirin while rivaroxaban is being withheld. While Paxlovid is authorized for use in adolescents and teenagers ages 12 and up, and weighing at least 88 pounds, that age group wasnt tested in the original clinical trial. Therefore, caution should be exercised when administering PAXLOVID to patients with, Because nirmatrelvir is co-administered with ritonavir, there may be a. in individuals with uncontrolled or undiagnosed HIV-1 infection. Drug interactions. Published studies with ritonavir are insufficient to identify a drug-associated risk of miscarriage. As always, patients should speak with their providers when starting new medications and follow their providers directions regarding the stopping or holding of any medications, Dr. Topal says. fluticasone, Dosage adjustment of tofacitinib is recommended. PAXLOVID is not authorized for use in pediatric patients younger than 12 years of age or weighing less than 40 kg. by clicking here. I think it's a good comparison, says Dr. Roberts. Forty-seven percent of the patients tested negative for SARS-CoV-2 antibodies, and 66% started study treatment within 3 days of symptom onset. Serotonin receptor 1A agonist/ serotonin receptor 2A antagonist. Paxlovid (nirmatrelvir and ritonavir) is an oral antiviral combination used to treat COVID-19. Katzenmaier S, Markert C, Riedel KD, et al. Food and Drug Administration. Paxlovid associated with decreased hospitalization rate among adults with COVID-19United States, AprilSeptember 2022. Find everything you need to know about Paxlovid, including what it is used for, warnings, reviews, side effects, and interactions. Drug class Recommendation (inhibition resolves approximately 3 days after PAXLOVID is . Potential clinically significant interaction that is likely to require additional monitoring, alteration of drug dosage or timing of administration. Paxlovid Summary of Product Characteristics, Pfizer Ltd, August 2022. The most common side effects of Paxlovid treatment tend to be mild and include diarrhea, muscle aches, high blood pressure, and an altered sense of taste, Roberts says. It is relatively new to the market, and information about its safety and effectiveness is limited. The hypothesis is that the immune system didnt have a chance to see the full extent of the virus, since Paxlovid suppressed replication early in disease, Dr. Roberts says. Drug-drug interactions are an important when considering whether to prescribe Paxlovid. Drug Interactions. Pfizer Inc.; September 26, 2022. Potential strategies include: Use the chosen strategy for the 5-day duration of ritonavir-boosted nirmatrelvir treatment and for at least 2 to 3 days after treatment completion. Available at: BC COVID Therapeutics Committee (CTC) COVID Therapy Review and Advisory Working Group (CTRAWG). Coadministration contraindicated due to potential for myopathy including rhabdomyolysis [see Contraindications (4)]. The healthcare provider should consult other appropriate Careful monitoring of therapeutic and adverse effects (including potentially fatal respiratory depression) is recommended when fentanyl, hydrocodone, oxycodone, or meperidine is concomitantly administered with PAXLOVID. If you are experiencingsymptoms of COVID-19and think you are eligible for a treatment, you can visit the governmentTest-to-Treat Locater. Efficacy of antiviral agents against the SARS-CoV-2 Omicron subvariant BA.2. Most people who take Paxlovid should not experience serious side effects, explains Dr. Roberts. To prevent COVID-19. Refer to apixaban Summary of Product Characteristics for further information. And as far as convenience, this medication is considered an improvement over treatments like remdesivir (approved by the FDAin October 2020), which is administered by intravenous (IV) injection. Available at: Charness ME, Gupta K, Stack G, et al. The following resources provide information on identifying and managing drug-drug interactions. Authentic PAXLOVID, from Pfizer Inc., may include the Pfizer name on the label and will be packaged in 5 aluminum push-through blister cards. Pfizer launched a clinical trial in March to study the safety and efficacy of Paxlovid in children and teenagers ages 6 to 17 who have COVID-19 symptoms and test positive for the virus, and who are neither hospitalized nor at risk for severe disease. . PAXLOVID is contraindicated in patients with a history of clinically significant hypersensitivity reactions (eg, toxic epidermal necrolysis [TEN] or Stevens-Johnson syndrome) to its active ingredients (nirmatrelvir or ritonavir) or any other components of the product. Taking PAXLOVID with these medicines may cause serious or life . An additional, nonhormonal method of contraception should be considered during the 5 days of PAXLOVID treatment and until one menstrual cycle after stopping PAXLOVID. [Originally published: March 10, 2022. Emergency Use Authorization (EUA) for Paxlovid (nirmatrelvir tablets co-packaged with ritonavir tablets): Center for Drug Evaluation and Research (CDER) review. Interactions between Paxlovid and common heart medications are well known, said Dr. Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in . . Withhold atorvastatin and rosuvastatin at the beginning of treatment with ritonavir-boosted nirmatrelvir and resume after completion of the 5-day course. The recommended treatment course of ritonavir-boosted nirmatrelvir for COVID-19 is 5 days. The list of drugs that Paxlovid interacts with includes some organ anti-rejection drugs that transplant patients take, as well as more common drugs like some used to . Other resources regarding management of drugs with potentially significant drug interactions with Paxlovid include: NIH COVID-19 Treatment Guidelines University of Liverpool COVID-19 Drug Interactions At the same time, nirmatrelvir and ritonavir are CYP3A substrates; therefore . Will some people still be hospitalized? Stopping lopinavir/ritonavir in COVID-19 patients: duration of the drug interacting effect. An official website of the United States government. There were no deaths in the ritonavir-boosted nirmatrelvir arm and 13 deaths in the placebo arm. Paxlovid update: Effectiveness, rebounding, drug interactions. We asked Yale Medicine infectious diseases experts common questions about Paxlovid. The more underlying medical conditions a person has, the higher their risk for developing a severe case of COVID-19, according to the CDC. We comply with the HONcode standard for trustworthy health information. d Ritonavir-boosted nirmatrelvir may increase concentrations of some chemotherapeutic agents, leading to an increased potential for drug toxicities. Drugs listed in Table 1 are a guide and not considered a comprehensive list of all possible drugs that may interact with PAXLOVID. Increased grazoprevir concentrations can result in ALT elevations. Paxlovid (nirmatrelvir and ritonavir) is a combination antiviral agent that has been shown to significantly reduce the risk of hospitalization or death from COVID in high-risk adults when administered within 5 days of symptom onset. After nirmatrelvir treatment, the COVID virus that is released from the cells is no longer able to enter uninfected cells in the body, which, in turn, stops the infection. iloperidone Avoid concomitant use of suvorexant with PAXLOVID. . PAXLOVID Fact Sheet for Healthcare Providers. c Some PDE5 inhibitors are used to treat both PAH and erectile dysfunction; however, the doses used to treat PAH are higher than those used for erectile dysfunction. midazolam amlodipine, Share sensitive information only on official, secure websites. Initiation of PAXLOVID, a CYP3A inhibitor, in patients receiving medications metabolized by CYP3A or initiation of medications metabolized by CYP3A in patients already receiving PAXLOVID, may increase plasma concentrations of medications metabolized by CYP3A. Avoid concomitant use with PAXLOVID. Cases of Toxic Epidermal Necrolysis and Stevens-Johnson syndrome have been reported with ritonavir, a component of PAXLOVID (refer to NORVIR prescribing information). The Food and Drug Administration's fact sheet on Paxlovid notes an extensive list of drug-drug interactions for health care providers, noting "caution is warranted" with Amlodipine, that "clinical . of glecaprevir/pibrentasvir with PAXLOVID. vorapaxar An oral SARS-CoV-2 M. Food and Drug Administration. Oral nirmatrelvir and ritonavir in nonhospitalized vaccinated patients with coronavirus disease 2019. High doses of ketoconazole or itraconazole (>200 mg/day) are not recommended. Dosage adjustment is recommended for use of sildenafil, tadalafil, or vardenafil with PAXLOVID. Nirmatrelvir is an oral protease inhibitor with emergency use authorization for the treatment of mild-to-moderate COVID-19. But there are also differences between the two, starting with the way they were studied, Dr. Topal adds. For patients with renal and/or hepatic impairment. . Its always been the Achilles heel of these antiviral drugs that most people dont get testedor they dont have access to testing.. Molnupiravir for oral treatment of COVID-19 in nonhospitalized patients. For the Panels recommendations on preferred and alternative antiviral therapies for outpatients with COVID-19, see Therapeutic Management of Nonhospitalized Adults With COVID-19. molnupiravir, remdesivir, Actemra, Lagevrio, Olumiant, nirmatrelvir / ritonavir. To view PAXLOVID dispensing information for patients with moderate renal impairment, see theFact Sheet for Healthcare Providers. The list of drugs that Paxlovid interacts with includes some organ anti-rejection drugs that transplant patients take, as well as more common drugs like some used to treat heart arrhythmias. Coadministration of ritonavir is required to increase nirmatrelvir concentrations to the target therapeutic range. Apixaban is a substrate of P-gp and is metabolized by CYP3A4. Dosing recommendations for co-administration of apixaban with Paxlovid depend on the apixaban dose. U Michigan and U Alabama Public Health websites said, Trazodone dosage should be reduced by 50% because Paxlovid can worsen the side . For treatment of atrial fibrillation with low dose apixaban (i.e., 2.5 mg twice daily), continue low dose on a case-by-case basis. Pfizer is committed to patient safety and ensuring that people have accurate information about the investigationaldrug PAXLOVID, including how it is accessed and administered. COVID-19 drug interactions: prescribing resources. For anyone who experiences a rebound, the CDC advises people restart isolation for five days, following its isolation guidance. lovastatin simvastatin. Of interest, no adverse outcomes were reported in six HIV infected patients treated with a reduced dose of apixaban (2.5 mg twice daily) while on ritonavir boosted regimens suggesting that a reduced dose of apixaban could be used with nirmatrelvir/ritonavir. IDSA recently published updated guidance on potential interactions between Paxlovid and the top 100 drugs, and important considerations for prescribing. No dosage adjustment of PAXLOVID is needed for patients with either mild (Child-Pugh Class A) or moderate (Child-Pugh Class B) hepatic impairment. Pillaiyar T, Manickam M, Namasivayam V, Hayashi Y, Jung SH. Patients on ritonavir-containing HCV regimens should continue their treatment as indicated. Image credit: Shutterstock.com The strategy may need to continue for a longer duration if ritonavir-boosted nirmatrelvir is initiated in an adult of advanced age or if the interacting medication has a long half-life. Structural basis for the in vitro efficacy of nirmatrelvir against SARS-CoV-2 variants. Atorvastatin and rosuvastatin do not need to be held prior to or after completing PAXLOVID. However, when ritonavir is used for 5 days, its induction properties are less likely to be clinically relevant than when the drug is used chronically (e.g., in people who take HIV protease inhibitors).3 The guidance in this document is based on the drug-drug interaction potential of the Food and Drug Administration (FDA)-authorized 5-day course of ritonavir-boosted nirmatrelvir. MMWR Morb Mortal Wkly Rep . These interactions may lead to: Clinically significant adverse reactions, potentially leading to severe, life-threatening, or fatal events from greaterexposures of concomitant medications, Clinically significant adverse reactions from greater exposures of PAXLOVID, Loss of therapeutic effect of PAXLOVID and possible development of viral resistance. In particular, the results of these studies may be affected by residual confounding. of Health and Human Services (HHS), 1: Established and Other Potentially Significant Drug Interactions, Copyright 2023 Pfizer Inc. All rights reserved. Coadministration has not been studied. clopidogrel, aliskiren They're both necessary parts of treatment. 239 are major, 364 are moderate, and 40 are minor. It's really our first efficacious oral antiviral pill for this virus. Coadministration with ivabradine is contraindicated due to potential for bradycardia or conduction disturbances [see Contraindications (4)]. Below are their responses. Refer to the saxagliptin product label for more information.. Three laboratory-based studies claim to back this uptwo of those studies were conducted by Pfizer, while the third was done by Pfizer in partnership with the Icahn School of Medicine at Mount Sinai. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Management of drug-drug interactions with nirmatrelvir and ritonavir can be complex. Ritonavir, a strong cytochrome P450 (CYP) 3A4 inhibitor and a P-glycoprotein inhibitor, is coadministered with nirmatrelvir to increase the blood concentration of nirmatrelvir, thereby making it effective against SARS-CoV-2. 2020. Withhold these medications during ritonavir-boosted nirmatrelvir treatment and for at least 23 days after treatment completion. This guide to COVID-19 medications and drug-drug interactions contains a helpful interaction checker, which provides a recommendation for management of DDIs in addition to a description of the primary data. ritonavir is the boosting agent in Paxlovid. Nirmatrelvir/ritonavir (5 days) [Please read the interaction details as management of these interactions may be complex.]. Share sensitive information only on official, secure websites. Surveillance for the emergence of significant resistance to nirmatrelvir is critical. View interaction reports for Paxlovid (nirmatrelvir / ritonavir) and the medicines listed below. Early remdesivir to prevent progression to severe COVID-19 in outpatients. Consider consulting with an expert (e.g., a pharmacist or the patients specialist providers) when treating patients who are receiving highly specialized therapies or drugs that are prone to concentration-dependent toxicities, such as certain anticonvulsant, anticoagulant, antiarrhythmic, chemotherapeutic, neuropsychiatric, and immunosuppressant drugs. ticagrelor Refer to the bosentan product label for further information. tadalafil If you could become pregnant, its recommended that you use effective barrier contraception or do not have sexual activity while taking Paxlovid.
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paxlovid interactions