Evaluating Drug Interaction Risks: Nirmatrelvir & Ritonavir Combination (PAXLOVID®) with Concomitant Medications in Real-World Clinical Settings

Purpose This research article delves into the battle against the COVID-19 pandemic, focusing on the efficacy and safety of the combination of nirmatrelvir with ritonavir, found in the pharmaceutical product Paxlovid®. The study aims to analyze the potential interactions of commonly prescribed medicinal products with Paxlovid®, shedding light on its utilization in specific medical fields. Methods The analysis draws data from the registers of the Institute of Health Information and Statistics of the Czech Republic (IHIS CR) covering 4,078,065 patients diagnosed with COVID-19. The study focuses on 70 ATC groups, identified based on the most commonly prescribed substances and medical specialties. Pharmacological assessments were conducted using the Liverpool checker (LC) and the Summary of Product Characteristics (SPC) for Paxlovid®. Results The combination of nirmatrelvir and ritonavir in the treatment of COVID-19 significantly suppresses the progression to severe illness and reduces the viral load of SARS-CoV-2. An interim analysis showed a lower incidence of COVID-19-related hospitalization or death by day 28 in patients receiving the treatment compared to placebo (6.32% difference, p < 0.001). Conclusion The study highlights the promising efficacy of nirmatrelvir with ritonavir in early-stage COVID-19 treatment, emphasizing its potential to manage the disease effectively. Although concerns exist about potential drug interactions, particularly due to ritonavir's impact on cytochrome P450, these interactions are manageable. The analysis of concurrent therapies provides valuable insights into the rational use of Paxlovid® in clinical practice, contributing to ongoing efforts to find safe and effective treatments for COVID-19 amidst emerging variants of the virus.