- drug information
- Drug-drug interactions
drug information
Last updated: March 6, 2023
Ritonavir, a potent inhibitor of cytochrome P450 (CYP) 3A4 and a P-glycoprotein inhibitor, is co-administered with nirmatrelvir to increase the blood concentration of nirmatrelvir, making it effective against SARS-CoV-2. Ritonavir may also increase the blood concentrations of certain concomitant medications.
Before prescribing ritonavir-boosted nirmatrelvir (Paxlovid) to treat patients with mild to moderate COVID-19, carefully review the patient's concomitant medications, including over-the-counter medications, herbal supplements, and recreational drugs. Because ritonavir-boosted nirmatrelvir is the only highly effective oral antiviral for the treatment of COVID-19, drug-drug interactions that can be safely managed should not preclude the use of this drug.
Clinicians should be aware that many commonly used medications can be safely co-administered with ritonavir-boosted nirmatrelvir despite its potential for drug interactions. Box 1 includes commonly prescribed drugs that are not expected to have clinically relevant interactions with ritonavir-boosted nirmatrelvir.
Box 1. Selected Outpatient Drugs Not Expected to Have Clinically Relevant Interactions with Ritonavir-Boosted Nirmatrelvir (Paxlovid)
This is not a complete list of all drugs that are not expected to have clinically relevant interactions with ritonavir-boosted nirmatrelvir.a
| Medications without clinically relevant interactions | ||
|---|---|---|
| These drugs can be co-administered without dose adjustment and without further monitoring.aThis list does not include all non-interacting drugs within each drug category. | ||
acid reducers
| immunosuppressants
| Pain
|
aThis list is primarily based on the most common drug searches performed by US users on the Liverpool COVID-19 Drug Interactions website between January 1 and December 31, 2022 (internal communication, January 2023) . bCo-administration of ethinyl estradiol-containing contraceptive products with ritonavir-boosted nirmatrelvir may result in lower ethinyl estradiol concentrations. The FDA EUA for ritonavir-boosted nirmatrelvir suggests that people using this type of contraceptive product should consider using an additional non-hormonal method of contraception. However, the lower concentrations of ethinylestradiol are not expected to be clinically significant during the 5 days of treatment. The progestin concentration of a combined hormonal contraceptive is expected to remain similar or increase with co-administration, which would maintain the efficacy of the oral contraceptive. CRitonavir-boosted nirmatrelvir interacts with certain monoclonal antibody conjugates, including ado-trastuzumab emtansine, brentuximab vedotin, enfortumab vedotin, polatuzumab vedotin, and tisotumab vedotin. Before co-administering ritonavir-boosted nirmatrelvir and any of these monoclonal antibody conjugates, consult the drug's FDA prescribing information and consult with the patient's specialist providers as needed. Key:EUA = Emergency Use Authorization; FDA = Food and Drug Administration | ||
Drugs that have clinically relevant drug interactions with ritonavir-boosted nirmatrelvir
Clinicians should be aware that, in some cases, drug interactions with ritonavir-boosted nimatrelvir may result in serious or life-threatening drug toxicities. The recommended treatment course of ritonavir-boosted nirmatrelvir for COVID-19 is 5 days. CYP3A4 inhibition occurs rapidly, with maximal inhibition occurring within 48 hours of ritonavir initiation.1After treatment is completed and ritonavir is discontinued, 70% to 90% of CYP3A4 inhibition resolves in 2 to 3 days.2The resolution time of the inhibition varies according to factors such as the age of the patient; therefore, resolution may take longer in some people, such as older adults.
Nirmatrelvir and ritonavir are substrates of CYP3A4. Ritonavir-boosted nirmatrelvir should not be administered within 2 weeks of administration of a strong CYP3A4 inducer (eg, St. John's wort, rifampicin). Ritonavir-boosted nirmatrelvir iscontraindicatedin this context because late compensation of enzyme induction can reduce concentrations of nirmatrelvir and ritonavir, rendering the treatment ineffective against SARS-CoV-2. Alternative treatment for COVID-19 should be prescribed.
Ritonavir is an inducer of certain drug metabolizing enzymes and drug transporters. However, when ritonavir is used for 5 days, its induction properties are less likely to be clinically relevant than when the drug is used chronically (eg, in people taking HIV protease inhibitors).3Guidance in this document is based on the drug-drug interaction potential of the FDA-cleared 5-day course of ritonavir-boosted nirmatrelvir. Longer treatment courses of ritonavir-boosted nirmatrelvir are not authorized under the current FDA Emergency Use Authorization (EUA), and there are insufficient data on the efficacy of administering a second course of treatment in cases where suspect a viral rebound of SARS-CoV-2.
Identification of drug-drug interactions
Please refer to the following resources for information on how to identify and manage drug interactions.
- Quick Reference Lists:
- Table 1 above lists selected outpatient medications that are not expected to have clinically relevant interactions with ritonavir-boosted nirmatrelvir.
- Box 2 below lists selected outpatient medications that have clinically relevant drug-drug interactions with ritonavir-boosted nirmatrelvir.
- Web-based drug interaction checker:
- Tables with guidance on the management of specific drug interactions:
- HeUniversity of Waterloo/University of Toronto Guide to Drug Interactions
- FDA EE. UU.fact sheetyCheck listfor nirmatrelvir boosted with ritonavir
Drug-drug interaction management strategies
Consider the magnitude and significance of potential drug-drug interaction when choosing management strategies for patients receiving ritonavir-boosted nimatrelvir. Potential strategies include:
- Increase vigilance for possible adverse effects of concomitant medication.
- Adjustment of the dose of concomitant medication.
- Temporarily suspend concomitant medication.
- Use an alternative to concomitant medication.
- Use of alternative therapies for COVID-19 (seeTherapeutic Management of Non-Hospitalized Adults with COVID-19).
Use the chosen strategy during the 5 days of treatment with ritonavir-boosted nirmatrelvir and for at least 2 to 3 days after stopping treatment. The strategy may need to be continued longer if ritonavir-boosted nimatrelvir is initiated in an older adult or if the interacting drug has a long half-life.
Consider consulting with an expert (eg, a pharmacist or the patient's specialist providers) when treating patients receiving highly specialized therapies or medications that are prone to concentration-dependent toxicities, such as certain anticonvulsants, anticoagulants, antiarrhythmics, chemotherapeutics , neuropsychiatric and immunosuppressive drugs.
The decision to prescribe ritonavir-boosted nimatrelvir to patients receiving calcineurin and mammalian rapamycin inhibitors should always be made in consultation with the patient's specialist providers. Ritonavir-boosted nirmatrelvir can be safely prescribed for selected patients if expertise in interaction management is available and close therapeutic drug monitoring is logistically feasible. If not, an alternative therapy for COVID-19 should be considered. Watch theStatement from the American Transplant Societyfor more information.
Interactions between ritonavir-boosted nirmatrelvir and chemotherapeutic agents should also be managed in consultation with the patient's medical specialists. For guidance on managing these interactions, see theFDA US Fact Sheetand the prescribing information of the chemotherapeutic agent. HeUniversity Health Network/Kingston Health Sciences Centerprovides an additional resource for evaluating drug interactions between ritonavir-boosted nirmatrelvir and chemotherapeutic agents.
Patients should be counseled about the drug interaction potential of ritonavir-boosted nirmatrelvir and the signs and symptoms of possible adverse effects. If ritonavir-boosted nirmatrelvir is prescribed to patients taking certain recreational drugs, those patients will require counseling and careful monitoring for adverse effects.
Box 2. Selecting Outpatient Medications That Have Clinically Relevant Drug-Drug Interactions With Ritonavir-Boosted Nirmatrelvir (Paxlovid)
Not all drugs that may interact with ritonavir-boosted nirmatrelvir are included in Table 2. Deviation from recommended strategies may be appropriate in certain clinical scenarios.
| Prescribe alternative therapy of COVID-19 | ||
|---|---|---|
| For these drugs, management strategies are not possible or feasible, or the risks outweigh the potential benefits. | ||
anticonvulsants
| Cardiovascular
| Pulmonary hypertensionC
|
| Temporarily discontinue concomitant medication, if clinically appropriate | ||
| Discontinue these medications during treatment with ritonavir-boosted nirmatrelvir and for at least 2 to 3 days after completing treatment. They may need to be stopped longer if the patient is an older adult or if the drug has a long half-life. If retention is not clinically appropriate, use an alternative concomitant medication or therapy for COVID-19. | ||
anticoagulants
| immunosuppressantsF
| Neuropsychiatric
|
| Adjust the dose of concomitant medication and monitor for adverse effects | ||
| Reduce the dose and/or extend the dosing interval of the concomitant medication. consult theLiverpool COVID-19 Drug Interactions Websiteor theUniversity of Waterloo/University of Toronto Guide to Drug Interactionsfor specific dosing recommendations.jIf the dose of the concomitant medication cannot be adjusted, discontinue the medication (if clinically appropriate) or use an alternative concomitant medication or therapy for COVID-19. | ||
anticoagulants
| immunosuppressants
| Pain
|
| Continue concomitant medication and monitor for adverse effects | ||
| A preventive dose adjustment is not required, but may be considered based on an individualized assessment of the patient's risk of adverse reactions. Educate patients about possible adverse effects. consult theLiverpool COVID-19 Drug Interactions Websiteor theUniversity of Waterloo/University of Toronto Guide to Drug Interactionsfor monitoring guidance and dose adjustment information as needed.j | ||
anticoagulants
| Cardiovascular
| Pain
|
aThe efficacy of clopidogrel is likely to be reduced. It may be acceptable to continue clopidogrel if the benefits of using ritonavir-boosted nirmatrelvir outweigh the risk of reduced efficacy of clopidogrel. bFor patients at very high risk of thrombosis (eg, those who received a coronary stent in the last 6 weeks), consider prescribing an alternative antiplatelet drug (eg, prasugrel, if clinically appropriate) or therapy alternative for COVID-19. CSome PDE5 inhibitors are used to treat both PAH and erectile dysfunction; however, the doses used to treat PAH are higher than those used for erectile dysfunction. Because of this, and because PDE5 inhibitors are used chronically in PAH patients, co-administration with ritonavir-boosted nirmatrelvir is contraindicated in these patients. PDE5 inhibitors can be co-administered with ritonavir-boosted nimatrelvir in patients with erectile dysfunction, although the PDE5 inhibitor dose should be adjusted. dRitonavir-boosted nirmatrelvir may increase the concentrations of some chemotherapeutic agents, increasing the potential for drug toxicity. Some chemotherapeutic agents may decrease the efficacy of ritonavir-boosted nirmatrelvir. please refer toFDA US Fact Sheetfor ritonavir-boosted nirmatrelvir and the prescribing information of the chemotherapeutic agent and consult the patient's specialist physician. HeUniversity Health Network/Kingston Health Sciences Centeris an additional resource for evaluating drug interactions of chemotherapeutic agents. miFor patients at high risk of arterial or venous thrombosis (eg, those who have had a stroke in the last 3 months with a CHA2SD2-VASc score of 7–9 or pulmonary embolism in the last month), consult your GP or specialist and consider using an alternative anticoagulant (eg, LMWH) or alternative therapy for COVID-19. For patients with a lower risk of arterial or venous thrombosis, physicians may consider administration of low-dose aspirin while rivaroxaban is discontinued. FThe use of another COVID-19 therapy may need to be considered. These immunosuppressants have significant drug-drug interaction potential with ritonavir, andshould not be usedif close follow-up, including therapeutic drug follow-up, is not feasible. Consult a patient's specialist providers before co-administering these immunosuppressants with ritonavir-boosted nirmatrelvir. Watch theStatement from the American Transplant Societyfor more information. gramWithhold lovastatin and simvastatin for at least 12 hours before starting ritonavir-boosted nirmatrelvir, during treatment, and for 5 days after stopping treatment. Discontinue atorvastatin and rosuvastatin at the start of ritonavir-boosted nirmatrelvir treatment and resume after completing the 5-day course. If discontinuation of a statin is not clinically appropriate (eg, because the patient recently had a myocardial infarction), clinicians may reduce the doses of atorvastatin and rosuvastatin and continue treatment. However, lovastatin and simvastatin should be switched to an alternative statin. hGuidance on the management of drug-drug interactions between certain benzodiazepines and ritonavir-boosted nirmatrelvir can vary significantly among product information resources. Be aware that abrupt discontinuation or rapid dose reduction of benzodiazepines may precipitate an acute withdrawal reaction.4The risk is higher for patients who have been using high doses of benzodiazepines for a long time. iDo not co-administer this medication with ritonavir-boosted nirmatrelvir in patients with hepatic or renal impairment. jFor drugs not listed on the Liverpool COVID-19 Drug Interactions website or the University of Waterloo/University of Toronto drug interaction guidance, please refer to the FDA labels for information on co-administration of these drugs. medicines with ritonavir or other strong CYP3A4 and/or P -gp inhibitors (eg ketoconazole). kDexamethasone exposure is expected to increase 2.60-fold when dexamethasone is co-administered with ritonavir-boosted nirmatrelvir.5Clinicians must weigh the risks and benefits of continuing the patient's normal dose of dexamethasone (while monitoring for AA) versus decreasing the dose. Patients receiving higher doses of dexamethasone will be at increased risk of AA. yoPatients should take ritonavir-boosted nirmatrelvir at least 3 hours after receiving brincidofovir. metroRitonavir-boosted nirmatrelvir interacts with certain monoclonal antibody conjugates, including ado-trastuzumab emtansine, brentuximab vedotin, enfortumab vedotin, polatuzumab vedotin, and tisotumab vedotin. Before co-administering ritonavir-boosted nirmatrelvir and any of these monoclonal antibody conjugates, consult the drug's FDA prescribing information and consult with the patient's specialist providers as needed. Key:AE = adverse effect; BPH = benign prostatic hyperplasia; CHA2SD2-VASc = congestive heart failure, hypertension, age, diabetes, stroke, vascular disease; CYP = cytochrome P450; EUA = Emergency Use Authorization; FDA = Food and Drug Administration; LMWH = low molecular weight heparin; PAH = pulmonary arterial hypertension; PDE5 = phosphodiesterase 5; P-gp = P-glycoprotein | ||
References
- Katzenmaier S, Markert C, Riedel KD, et al. Determination of the time course of CYP3A inhibition by potent reversible and irreversible CYP3A inhibitors using a limited sampling strategy.Clin Pharmacol Ther. 2011;90(5):666-673. Available in:https://www.ncbi.nlm.nih.gov/pubmed/21937987.
- Stader F, Khoo S, Stoeckle M, et al. Withhold lopinavir/ritonavir in patients with COVID-19: duration of drug interaction effect.Antimicrobial chemotherapy J. 2020;75(10):3084-3086. Available in:https://www.ncbi.nlm.nih.gov/pubmed/32556272.
- University of Liverpool. Assessment of the interaction risk of COVID-19 therapies. 2022. Available in:https://covid19-druginteractions.org/prescribing_resources. Accessed February 13, 2022.
- Food and Drug Administration. The FDA requires that the boxed warning be updated to improve the safe use of the benzodiazepine class of drugs. 2020. Available in:https://www.fda.gov/media/142368/download.
- Li M, Zhu L, Chen L, Li N, Qi F. Evaluation of drug interactions between voriconazole and glucocorticoids.J chemotherapy. 2018;30(5):296-303. Available in:https://www.ncbi.nlm.nih.gov/pubmed/30843777.
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FAQs
What medications Cannot be taken with Paxlovid? ›
- Amiodarone (Pacerone)
- Disopyramide (Norpace, Norpace CR)
- Dofetilide (Tikosyn)
- Dronedarone (Multaq)
- Eplerenone (Inspra)
- Flecainide.
- Ivabradine (Corlanor)
- Propafenone.
The COVID-19 Treatment Guidelines Panel (the Panel) recommends using nirmatrelvir 300 mg with ritonavir 100 mg (Paxlovid) orally (PO) twice daily for 5 days in nonhospitalized adults ( AIIa ) and pediatric patients aged ≥12 years and weighing ≥40 kg ( BIII ) with mild to moderate COVID-19 who are at high risk of ...
What drugs should not be taken with ritonavir? ›Ritonavir interacts with many medications. Some products that may interact with this drug include: cobicistat, disulfiram, orlistat. Ritonavir can slow down or speed up the removal of other medications from your body, which may affect how they work.
What are the dosing guidelines for Paxlovid? ›The dosage for PAXLOVID is 300 mg nirmatrelvir (two 150-mg tablets) with 100 mg ritonavir (one 100-mg tablet) with all 3 tablets taken together orally twice daily for 5 days. Prescriptions should specify the numeric dose of each active ingredient within PAXLOVID.
What vitamins should not be taken with Paxlovid? ›Mixing Paxlovid with herbal remedies and supplements
Do not take St John's wort, the herbal remedy for depression, while you are being treated with Paxlovid. This is because it may make your course of treatment less effective.
No interactions were found between Paxlovid and Tylenol.
Who is considered high risk for Paxlovid? ›Who Qualifies as High Risk? Examples of high-risk patient characteristics include older adults (age 50 yr+), asthma, smoking (current or former), overweight, diabetes, pregnant, immune compromised, mental health disorders, substance use disorders, and cardiovascular disease.
Can I quit Paxlovid early? ›Do not stop taking PAXLOVID without talking to your healthcare provider, even if you feel better. If you miss a dose of PAXLOVID within 8 hours of the time it is usually taken, take it as soon as you remember.
When is the best time to take Paxlovid? ›How should this medication be used? morning and at bedtime, for 5 days. Take all 3 tablets at the same time • You must always take the nirmatrelvir tablets at the same time as the ritonavir tablet.
Can I take mucinex with Paxlovid? ›Interactions between your drugs
Ritonavir may increase the blood levels and effects of dextromethorphan. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications.
How quickly does Paxlovid work? ›
Paxlovid, an oral antiviral medication, will start to work against COVID as soon as you take it, but you may not start to feel better right away. It is important you start treatment as soon as possible, within 5 days of symptom onset and testing positive for COVID.
Is it OK to take Paxlovid with prednisone? ›No warnings were found for your selected drugs.
Is it OK to start Paxlovid at night? ›You can take them with or without food. Take one dose of 3 tablets in the morning and one dose of 3 tablets in the evening for 5 days. Leave around 12 hours between your morning dose and evening dose.
Is Paxlovid safe for kidneys? ›PAXLOVID is not recommended in patients with severe renal impairment (eGFR <30 mL/min) until more data are available; the appropriate dosage for patients with severe renal impairment has not been determined [see Use in Specific Populations (8.6) and Clinical Pharmacology (12.3)].
Should you take Paxlovid? ›Paxlovid is the first-choice treatment for mild to moderate COVID in people with a higher risk of severe illness. In initial clinical studies, it was about 90% effective at preventing COVID-related hospitalization and death.
Does vitamin C affect Paxlovid? ›No interactions were found between Paxlovid and Vitamin C.
Does vitamin B interact with Paxlovid? ›No interactions were found between Paxlovid and Vitamin B12. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.
Can you take decongestant with Paxlovid? ›No interactions were found between dexbrompheniramine / pseudoephedrine and Paxlovid.
What is the best decongestant for COVID? ›Take OTC antihistamines
Nasal decongestant sprays, such as oxymetazoline (Afrin, Vick's Sinex) and phenylephrine (Neo-Synephrine), can also be helpful.
One dose of Paxlovid doesn't last very long in your body. About a day after your last dose, the medication should be fully out of your system.
What are contraindications for taking Paxlovid? ›
PAXLOVID is contraindicated with drugs that are highly dependent on CYP3A for clearance and for which elevated concentrations are associated with serious and/or life-threatening reactions. Potential for serious reactions, such as hypotension (see Table 4). Potential for serious and/or life-threatening reactions.
How long does Paxlovid rebound last? ›Like COVID symptoms, the signs of rebound after taking Paxlovid may vary between people. But typically, your initial COVID symptoms will get better (or even go away) while taking Paxlovid. Then between 2 and 8 days after finishing the medication, your symptoms will get worse again.
What medicine is good for COVID cough? ›Use medications containing guaifenesin, such as Robitussin, Mucinex, and Vicks 44E. keeping you from getting rest. Coughing is useful because it brings up mucus from the lungs and helps prevent bacterial infections.
Can I drink wine with Paxlovid? ›Can I drink alcohol while taking Paxlovid? It's not known if alcohol affects Paxlovid. Is there any food or drink I need to avoid? You can eat and drink normally while you're taking Paxlovid.
What happens if I don't finish Paxlovid? ›Stopping this medication too early can put you at risk for serious COVID-19 illness. Make sure to take steps to protect yourself and others while you're taking this medication in order to get well soon and to prevent others from getting sick with COVID-19.
When are you no longer contagious with COVID? ›People with moderate or severe COVID-19 should isolate through at least day 10. Those with severe COVID-19 may remain infectious beyond 10 days and may need to extend isolation for up to 20 days.
What happens if you stop Paxlovid abruptly? ›Stopping the medication too early may allow the virus to continue to grow, which may result in a return of the infection or failure to protect you from the virus. Tell your doctor if your condition lasts or gets worse.
Is Paxlovid effective after 5 days? ›Paxlovid is 80% effective when taken within 5 days of severe COVID.
Should you eat before or after taking Paxlovid? ›Try to take Paxlovid at the same times of day for all five days of treatment, with or without food. Taking with food may help prevent any stomach upset from occurring. Both medications in Paxlovid should be taken together as prescribed.
Does Paxlovid make you less contagious? ›Currently, studies are exploring if additional days of Paxlovid can reduce the rebound rate. In the meantime, the current FDA EUA only allows for five consecutive days of treatment. If you experience rebound symptoms, you are likely contagious again. You should isolate yourself to prevent passing the disease to others.
Does Paxlovid help with COVID sore throat? ›
If you're at risk for developing serious COVID-19 illness, antiviral treatment like Paxlovid can help keep you healthy and relieve your sore throat.
Can Zyrtec be taken with Paxlovid? ›Interactions between your drugs
Using cetirizine together with ritonavir may increase the effects of cetirizine. Cetirizine effects may be increased during administration with ritonavir, particularly in the elderly and or if you have kidney impairment.
People who get what's being called “Paxlovid mouth” often notice a bitter or metallic taste in their mouth shortly after taking their first set of pills.
What is the success rate for Paxlovid? ›Results. The 7-day and 30-day COVID-19 rebound rates after Paxlovid treatment were 3.53% and 5.40% for COVID-19 infection, 2.31% and 5.87% for COVID-19 symptoms, and 0.44% and 0.77% for hospitalizations.
What to eat when you have COVID and everything tastes bad? ›- learn about your condition from trustworthy sources.
- eat cool or room temperature foods.
- take small mouthfuls – don't give up too quickly as you may get used to the taste.
- try bland foods like rice, boiled potatoes and pasta.
- try flavours that appeal to you.
- keep trying things – what you like can change from week to week.
Antiviral Treatment Reduces Likelihood of Severe Illness From Omicron. Researchers have found that Paxlovid (nirmatrelvir and ritonavir) is effective at preventing severe COVID-19 resulting from infection by the Omicron variant of SARS-CoV-2.
Can I use Flonase with Paxlovid? ›Combining these medications may increase the absorption of fluticasone into the blood stream.
Can you take albuterol with Paxlovid? ›No interactions were found between albuterol and Paxlovid.
Can I take Nyquil with Paxlovid? ›Interactions between your drugs
Using dextromethorphan together with doxylamine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination.
Paxlovid works to stop the virus that causes COVID-19 from multiplying, and reduces the amount of virus in the body. The medication's benefits last up to six months after infection, the study showed.
How common is Paxlovid rebound? ›
The risk of a Paxlovid rebound may be higher than previously reported, according to a study published Feb. 22 in Clinical Infectious Diseases, an Oxford University Press journal.
Does Paxlovid damage liver? ›Paxlovid may cause liver damage, but this has not been reported as a common side effect.
What are the side effects of serious Paxlovid? ›- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin.
- you're wheezing.
- you get tightness in the chest or throat.
- you have trouble breathing or talking.
- your mouth, face, lips, tongue or throat start swelling.
- changes in taste,
- diarrhea,
- high blood pressure (hypertension), and.
- muscle aches.
Resource Links. Treating COVID-19 with Paxlovid, a combination of nirmatrelvir with ritonavir, within 5 days of symptom onset was associated with lower risk for developing Post-COVID-19 Conditions (PCC), or Long COVID, in a large Veterans Affairs (VA) cohort study.
Can you take Tylenol while taking Paxlovid? ›No interactions were found between Paxlovid and Tylenol.
What is contraindicated with Paxlovid? ›PAXLOVID is contraindicated in patients with a history of clinically significant hypersensitivity reactions [eg, toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome] to its active ingredients (nirmatrelvir or ritonavir) or any other components of the product.
When is Paxlovid not recommended? ›Paxlovid is not recommended for patients with severe renal or hepatic impairment.
What medications should be avoided during COVID? ›If you have COVID-19 but do not have symptoms, do not take cold medications, acetaminophen (Tylenol), or over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil®) and naproxen (Aleve®). These medications may hide the symptoms of COVID-19.
Is it safe to take ibuprofen with Paxlovid? ›No warnings were found for your selected drugs.
How quickly does Paxlovid start working? ›
Paxlovid, an oral antiviral medication, will start to work against COVID as soon as you take it, but you may not start to feel better right away. It is important you start treatment as soon as possible, within 5 days of symptom onset and testing positive for COVID.
Can COVID get worse while taking Paxlovid? ›But typically, your initial COVID symptoms will get better (or even go away) while taking Paxlovid. Then between 2 and 8 days after finishing the medication, your symptoms will get worse again.
Is it worth it to take Paxlovid? ›Paxlovid is the first-choice treatment for mild to moderate COVID in people with a higher risk of severe illness. In initial clinical studies, it was about 90% effective at preventing COVID-related hospitalization and death.
What happens if you stop Paxlovid early? ›Stopping the medication too early may allow the virus to continue to grow, which may result in a return of the infection or failure to protect you from the virus. Tell your doctor if your condition lasts or gets worse.
Does mucinex help with COVID? ›Over-the-counter medications used for upper respiratory infections may help alleviate symptoms. Those medications include guaifenesin (Mucinex), pseudoephedrine (Sudafed), and dextromethorphan (Robitussin, Delsym).
Should I take a decongestant if I have COVID-19? ›You may take an expectorant/cough suppressant combination as needed for cough and congestion. Take an antihistamine/decongestant combination for your allergy symptoms and congestion. If you have uncontrolled blood pressure, then you should avoid the decongestant component.
Does Paxlovid interact with mucinex? ›Interactions between your drugs
Ritonavir may increase the blood levels and effects of dextromethorphan. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications.
High blood pressure
It's not unusual for a medication to raise blood pressure. And this can be a concern if you already have high blood pressure or other heart conditions. Small numbers of people who took Paxlovid have reported this side effect. Your blood pressure should return to normal after finishing Paxlovid.