Oral drugs against COVID-19
Background: Five-day oral therapies against early COVID-19 infection have recently been conditionally approved in Europe. In the drug combination nirmatrelvir + ritonavir (nirmatrelvir/r), the active agent, nirmatrelvir, is made bioavailable in clinically adequate amounts by the additional administr...
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| Main Authors: | , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
APR 15 2022
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| In: |
Deutsches Ärzteblatt
Year: 2022, Volume: 119, Issue: 15, Pages: 263-272 |
| ISSN: | 1866-0452 |
| DOI: | 10.3238/arztebl.m2022.0152 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.3238/arztebl.m2022.0152 Verlag, lizenzpflichtig, Volltext: https://www.webofscience.com/api/gateway?GWVersion=2&SrcAuth=DOISource&SrcApp=WOS&KeyAID=10.3238%2Farztebl.m2022.0152&DestApp=DOI&SrcAppSID=EUW1ED0DBFBCHlGCUiZBp1AoM9kvE&SrcJTitle=DEUTSCHES+ARZTEBLATT+INTERNATIONAL&DestDOIRegistrantName=Deutscher+Arzte-Verlag+GmbH 
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| Author Notes: | Gerd Mikus, Kathrin I. Foerster, Theresa Terstegen, Cathrin Vogt, Andre Said, Martin Schulz, Walter E. Haefeli |
| Summary: | Background: Five-day oral therapies against early COVID-19 infection have recently been conditionally approved in Europe. In the drug combination nirmatrelvir + ritonavir (nirmatrelvir/r), the active agent, nirmatrelvir, is made bioavailable in clinically adequate amounts by the additional administration of a potent inhibitor of its first-pass metabolism by way of cytochrome P450 [CYP] 3A in the gut and liver. In view of the central role of CYP3A in the clearance of many different kinds of drugs, and the fact that many patients with COVID-19 are taking multiple drugs to treat other conditions, it is important to assess the potential for drug interactions when nirmatrelvir/r is given, and to minimize the risks associated with such interac-tions. Methods: We defined the interaction profile of ritonavir on the basis of information derived from two databases (Medline, GoogleScholar), three standard electronic texts on drug interactions, and manufacturer-supplied drug information. We com-piled a list of drugs and their potentially relevant interactions, developed a risk min -imization algorithm, and applied it to the substances in question. We also compiled a list of commonly prescribed drugs for which there is no risk of interaction with nirmatrelvir/r. Results: Out of 190 drugs and drug combinations, 57 do not need any special measures when given in combination with brief, low-dose ritonavir treatment, while 15 require dose modification or a therapeutic alternative, 8 can be temporarily dis-continued, 9 contraindicate ritonavir use, and 102 should preferably be combined with a different treatment. Conclusion: We have proposed measures that are simple to carry out for the main types of drug that can interact with ritonavir. These measures can be implemented under quarantine conditions before starting a 5-day treatment with nirmatrelvir/r. |
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| Item Description: | Gesehen am 09.11.2022 |
| Physical Description: | Online Resource |
| ISSN: | 1866-0452 |
| DOI: | 10.3238/arztebl.m2022.0152 |