Paxlovid: Covid-19 treatment may interact with common heart medications, doctors warn


Covid-19 patients with a history of cardiovascular disease are at increased risk of developing severe disease and could benefit the most from Covid-19 Paxlovid treatment – ​​but there is a catch.

Paxlovid may have dangerous interactions with some of the most common drugs for cardiovascular disease, including some statins and heart failure treatments, a new article warns.

The review article, published Wednesday in the Journal of the American College of Cardiology, lists dozens of cardiovascular medications and whether they can be safely taken with Paxlovid or whether they may have interactions.

According to the article, some medications such as aspirin can be taken safely with Paxlovid, but other medications may have interactions and therefore their dosage should be adjusted or temporarily interrupted while a patient is taking Paxlovid. .

When President Joe Biden tested positive for Covid-19 and started Paxlovid in July, his doctor, Dr Kevin O’Connor temporarily removed it Crestor and Eliquis, two heart medications the President takes for his pre-existing conditions. Doctors say there is no short-term risk in stopping these drugs.

The position paper states that interactions between Paxlovid and certain blood thinners may lead to an increased risk of bleeding. Interactions between Paxlovid and certain cholesterol medications such as statins can be toxic to the liver, and interactions between Paxlovid and certain blood pressure medications can cause low blood pressure, flushing, and swelling.

“There are some medications that you just won’t be able to stop, and a doctor will have to make a decision. It’s a risk-benefit analysis,” said Dr. Jayne Morgan, cardiologist and clinical director of the Covid task force at Piedmont Hospital/Healthcare in Atlanta, who was not involved in the new paper.

For cardiovascular drugs that patients might discontinue in order to take Paxlovid, Morgan noted that the Covid-19 treatment is a five-day regimen.

“You need to make the diagnosis and then stop your medications and do all of that in time to meet that five-day window,” Morgan said, adding that people will need to see their doctor to find out what’s best for them. .

The authors of the new paper – from Lahey Hospital and Medical Center, Harvard Medical School and other US institutions – wrote that Paxlovid should be avoided when potentially interacting cardiovascular drugs cannot be “safely discontinued”.

Paxlovid, an oral antiviral drug, was authorized in December for the treatment of mild to moderate Covid-19 in people aged 12 and over who are at high risk of serious illness, hospitalization or death.

“Awareness of the presence of drug interactions between Paxlovid and common cardiovascular drugs is essential. System-level interventions by integrating drug interactions into electronic medical records could help avoid associated adverse events,” said the paper’s lead author, Dr. Sarju Ganatra, Cardio-Oncology Program Director at Lahey Hospital and Medical Center in Massachusetts. A press release.

“The Paxlovid prescription could be integrated into a prescription package, which allows doctors, whether general practitioners or cardiologists, to consciously exclude any contraindications to the co-administration of Paxlovid. Consultation with other members of the healthcare team, especially pharmacists, can be extremely valuable,” Ganatra said. “However, a healthcare provider’s basic understanding of drug interactions with cardiovascular drugs is essential.”

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 Boston, who was not involved in the new article.

“Drug interactions have been reported, but I think Paxlovid has been prescribed so widely that some doctors and patients may not be as observant as they should be,” Barouch said.

Paxlovid is made up of two antivirals, nirmatrelvir and ritonavir.

“The second drug, ritonavir, is a nonspecific drug that inhibits metabolism and increases the dose of the other drug. But the ritonavir in Paxlovid can also inhibit the metabolism of other medicines. So you have to be very careful when prescribing Paxlovid to people who are taking certain blood thinners, heart medications, statins and other medications,” Barouch said. “So it’s not just a free pass.”

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