Table 4.
Summary of key pharmacist interventions on nirmatrelvir/ritonavir (Paxlovid) prescriptions *.
| Medication-Related Problem | Number of Prescriptions ** | Pharmacist Intervention(s) |
|---|---|---|
| DDI—Statins | 28 | Pharmacists recommended statins be held for the duration of nirmatrelvir/ritonavir therapy and 3 days post-treatment ***. |
| DDI—Calcium Channel Blockers (CCB) | 10 | Pharmacists recommended a 50% dose reduction of certain CCBs, such as amlodipine, and counseled patients to closely monitor blood pressure and heart rate for the duration of nirmatrelvir/ritonavir therapy. |
| DDI—Fluticasone Nasal Spray | 10 | Pharmacists recommended the patient hold fluticasone for the duration of nirmatrelvir/ritonavir therapy. |
| DDI—Benzodiazepines | 6 | Pharmacists recommended reducing as-needed alprazolam dosing by 50% and to monitor for increased drowsiness and sedation for duration of nirmatrelvir/ritonavir therapy. |
| DDI—Glucocorticoids | 6 | Pharmacists contacted providers to discuss the benefits and risks of using a glucocorticoid (dexamethasone, prednisone) outpatient for COVID-19, as current guidelines recommend against this. |
| DDI—Antiplatelets | 4 | Pharmacists called the provider/cardiologist to discuss the benefits and risks associated with decreased or increased antiplatelet efficacy when used together with nirmatrelvir/ritonavir. |
| Dose too high—Dose Adjustment for eGFR ≥ 30 to <60 |
4 | Pharmacist contacted the provider and had prescription directions changed to 150 mg nirmatrelvir (one 150 mg tablet) with 100 mg ritonavir (one 100 mg tablet) twice daily for 5 days. |
| Other | 4 | PDE-5 inhibitors—pharmacists counseled patients to hold as-needed PDE5 for the duration of nirmatrelvir/ritonavir therapy. Opioids—Pharmacists counseled patients to limit the use of as-needed opioids for the duration of nirmatrelvir/ritonavir therapy and to monitor for increased drowsiness and sedation. |
| DDI—Alpha-Blockers | 3 | Pharmacists recommended holding tamsulosin and alfuzosin for the duration of nirmatrelvir/ritonavir therapy. |
* Recommendations were made based on available evidence and resources during the timeframe analyzed in the study. Recommendations may have changed since the completion of this study. ** While 42 of the 54 prescriptions had interventions, some of the prescriptions had multiple interventions. DDI = Drug–drug interaction. *** After this study concluded nirmatrelvir/ritonavir product labeling updated to recommend holding simvastatin 12 hours before and 5 days after treatment.