COVID-19 Drug May Interact with Common Heart Medications

Burlington, Mass. – The anti-viral combination drug nirmatrevlvir-ritonavir, also known by the brand name Paxlovid, received emergency use authorization from the U.S. Food & Drug Administration in December 2021 for treatment of COVID-19 non-hospitalized adults with mild to moderate COVID-19 infection who are at high risk for progression to severe disease. Considered a game-changer, the oral antiviral demonstrated an 89 percent reduction in hospitalizations and deaths among unvaccinated patients at high-risk of severe disease. Patients with heart disease and other risk factors including diabetes, high blood pressure, chronic kidney disease and smoking make up a large portion of the high-risk population for whom Paxlovid is beneficial; however, it can interact with some previously prescribed medications.

In a review paper published in the Journal of the American College of Cardiology, physician-researchers examine the potential drug-drug interactions between nirmatrevlvir-ritonavir and commonly used cardiovascular medications, as well as potential options to mitigate severe adverse effects.

“Awareness of nirmatrevlvir-ritonavir potential drug-drug interactions with common cardiovascular medications is key,” said senior author Sarju Ganatra, MD, director of the cardio-oncology program at Lahey Hospital and Medical Center (LHMC). “Integrating the medication’s drug-drug interactions into electronic medical records could help avoid adverse events.”

Ganatra and colleagues previously reported in Clinical Infectious Diseases that nirmatrevlvir-ritonavir can be very effective in patients with existing heart disease, but significant drug-drug interactions with commonly used cardiovascular medications have been reported. Given the limited clinical information regarding these related adverse events, the authors used existing knowledge and data about how similar therapies typically react with cardiovascular medications to provide in-depth guidance for use of a variety of cardiovascular medications used to treat many forms of heart disease.

Five of the most important cardiovascular drug interactions with nirmatrevlvir-ritonavir to be aware of include; antiarrhythmic agents, used to manage abnormal heart rhythms; antiplatelet agents and anticoagulants or blood thinners, used for the treatment of coronary artery disease or used to treat or prevent blood clots; certain statins, which should be stopped prior to initiation of nirmatrevlvir-ritonavir; ranolazine, used to treat angina and other heart-related chest pain, which should not be used in conjunction with Paxlovid; and immunosuppressive agents prescribed for patients who have undergone heart transplantation, which should be reduced in the context of nirmatrevlvir-ritonavir.

The authors conclude awareness and availability of other COVID-19 therapies enable clinicians to offer alternative treatment options to patients who are unable to take Paxlovid due to potential drug-drug interactions.

“Incorporating a nirmatrevlvir-ritonavir prescription into an order set would allow physicians, whether primary care physicians or cardiology providers, to consciously rule out any contraindications,” said Ganatra. “Consultation with other members of the health care team — particularly pharmacists — can prove to be extremely valuable; however, a healthcare provider’s fundamental understanding of the drug-drug interactions with the cardiovascular medication is the most critical part of the equation.”

Co-authors included Sonu Abraham, MD, Anu Mariam Saji, MD, Jui Shah, MBBS, Tara Lech, PHARMD, BCPS, Jason Grossman, MD, Sourbha S. Dani, MD, MSc, and Daniel P. McQuillen, MD, of LHMC; Anju Nohria, MD, David T. Martin, MD, and Paul E. Sax, MD, of Brigham and Women’s Hospital; Tomas G. Neilan, MD, of Massachusetts General Hospital; Aarti Asnani, MD, of Beth Israel Deaconess Medical Center; and George M. Abraham, MD, MPH of Saint Vincent Hospital.

The authors report they have no relationships relevant to the contents of this paper to report.

Adapted from a press release from the American College of Cardiology