Figure 1.

Interaction between antiviral agents and antiplatelet drugs on CYP3A4 metabolism. In red, antiviral agents are depicted. Lopinavir and ritonavir exert an inhibitory action on the cytochrome. This increases the exposure of ticagrelor leading to a dysregulation of hemostasis (highlighted in the picture being it the only depicted potential effect). Remdesivir is instead an inducer of CYP3A4 function. Differently from ticagrelor, prasugrel is metabolized by several cytochromes (2C19, 2C9, 3A4/3A5, 2B6, 2D6), thus its effects seem to be unmodified by ritonavir or lopinavir interaction. CYP3A4: Cytochrome P450 3A4, ADP P2Y12 receptor: adenosine 5′diphosphate P2Y12 receptor.