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Nirmatrelvir-ritonavir for COVID-19
Emily G McDonald and Todd C Lee
CMAJ February 14, 2022 194 (6) E218; DOI: https://doi.org/10.1503/cmaj.220081
Emily G McDonald
Clinical Practice Assessment Unit (McDonald, Lee), and Divisions of Internal Medicine (McDonald) and Infectious Diseases (Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.
MD MScTodd C Lee
Clinical Practice Assessment Unit (McDonald, Lee), and Divisions of Internal Medicine (McDonald) and Infectious Diseases (Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.
MD MPH![Loading Loading](https://www.cmaj.ca/sites/all/modules/contrib/panels_ajax_tab/images/loading.gif)
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- McDonald, E. G., & Lee, T. C. (2022). Association nirmatrelvir/ritonavir contre la COVID-19. CMAJ, 194(9), E365-E366. Accessed July 13, 2024. https://doi.org/10.1503/cmaj.220081-f.
- Hiremath, S. (2022). Renalism. CMAJ, 194(29), E1040. Accessed July 13, 2024. https://doi.org/10.1503/cmaj.146430-l.
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Nirmatrelvir-ritonavir for COVID-19
Emily G McDonald, Todd C Lee
CMAJ Feb 2022, 194 (6) E218; DOI: 10.1503/cmaj.220081
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- Ritonavir-boosted nirmatrelvir (marketed as Paxlovid) is a Health Canada–approved oral antiviral medication with activity against SARS-CoV-2
- Studies recruited primarily unvaccinated participants, predated the omicron variant and have not yet undergone peer review
- The treatment is copackaged as nirmatrelvir (300 mg — two 150 mg tablets) with ritonavir (one 100 mg tablet); the 3 tablets are taken together twice daily for 5 days
- The ritonavir component boosts nirmatrelvir levels and is a cytochrome P450 3A4 (CYP3A4) inhibitor when taken short term, leading to important drug–drug interactions5
- Mitigation strategies for drug–drug interactions include dose reductions, switching or temporarily holding a drug, and therapeutic drug monitoring
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