Table 1.

Common drug interactions with Paxlovid

Drug	Affect with Paxlovid	Action needed	Interaction category
Inhaled Beta agonists
Salmeterol	Risk for arrhythmia	Avoid this combination	X
Oral Anticoagulants
Rivaroxaban	Increased bleeding risk	Avoid this combination	X
Apixaban	Increased bleeding risk	Decrease dose of apixaban by 50%¶	D
Warfarin	Unpredictable INR effects	Close monitoring of INR*	C
Alpha and Calcium channel blockers
Tamsulosin	Risk for orthostatic hypotension	Dose reduction/temporarily hold dose	X
Calcium channel blockers	Increased risk for hypotension and bradycardia	Consider reduced dose for duration of Paxlovid therapy.	C
Steroids and hormones
Hormonal contraceptive	Contraceptive failure	Use alternate contraception	D
Steroids (inhaled and systemic)	Increased drug levels	Monitor for increased steroid-related adverse effects	C
Benzodiazepines and Atypical antipsychotics
Quetiapine	Increased drug levels	Reduce Quetiapine dose to 1/6th for duration of Paxlovid therapy	D
Alprazolam, Clonazepam, Diazepam	Risk for sedation, respiratory depression	Dose reduction.	D

C = Monitor therapy X = Avoid combination D = Consider therapy modification

^*INR= International normalized ratio

^¶-Hold apixaban if dose is 2.5 mg twice a day