Paxlovid may interact with common heart drugs, including some statins, study warns
Oct. 12 (UPI) -- People taking common medications for heart disease, including some statins, may be risking dangerous interactions if they use Paxlovid to treat viral symptoms arising from a COVID-19 infection.
So warns a review paper published Wednesday in Journal of the American College of Cardiology.
In December 2021, the Food and Drug Administration granted emergency use authorization for Paxlovid, a five-day oral antiviral medication, composed of nirmatrelvir and ritonavir, to treat symptomatic, non-hospitalized adults with mild to moderate COVID-19 infection who are at high risk of ending up with severe disease.
Dr. Sarju Ganatra, the paper's senior author, told UPI that the overarching aim of the paper is to heighten awareness, not to deter clinicians from prescribing "a very useful drug" for high-risk patients.
Specifically, the researchers highlighted five of the most important cardiovascular drug interactions with Paxlovid of which to be aware: antiarrhythmic agents; antiplatelet agents and anticoagulants; certain statins; ranolazine, used to treat chronic stable angina, and immunosuppressive agents prescribed for heart transplant patients.
With respect to statins, the scientists warned in a news release that simvastatin and lovastatin should be halted before taking Paxlovid, since the combination can lead to increased plasma levels and subsequent muscle weakness, called myopathy, and rhabdomyolysis, a condition in which the breakdown of muscle tissue releases a damaging protein into the bloodstream.
They said it would be reasonable to reduce the dose of atorvastatin and rosuvastatin when they are administered with Paxlovid -- and that the other statins are considered safe when given alongside the antiviral drug.
They also advised temporarily discontinuing ranolazine if Paxlovid is prescribed, and considering alternative COVID-19 therapies for heart transplant recipients because temporarily reducing dosing of immunosuppressive drugs would require intensive monitoring.
"There are a few medications where either it is not possible to hold them or not practically feasible given that some drugs may remain in the system for a long time even after stopping [them], and there we advise to avoid treatment with Paxlovid and suggest alternative therapy," Ganatra said in an email.
Ganatra, director of the cardio-oncology program at Lahey Hospital and Medical Center in Burlington, Mass., stressed that COVID-19 "continues to remain a public health threat, especially for those with high risk of having serious adverse outcomes, such as those with heart disease."
He cited his research team's previous study, published Aug. 20 in the journal Clinical Infectious Diseases, that demonstrated Paxlovid's benefits for high-risk patients, even if they were vaccinated.
"This makes it more likely that such patients with heart disease will be prescribed Paxlovid," Ganatra said. "However, Paxlovid potentially interacts with many commonly used cardiovascular medications such as certain blood pressure and cholesterol medications, antiplatelet medications, blood thinners, rhythm control medications, immunosuppressive medications and pulmonary hypertension medication."
He added: "This can lead to potentially serious side effects. It is crucial for clinicians and prescribers to be aware of such interactions and try to avoid them."
According to Ganatra, this calls for healthcare systems and hospitals to leverage their electronic health record systems "to integrate such [drug-to-drug] interactions to alert physicians/prescribers in real-time."
The paper notes that patients with heart disease and other risk factors, including diabetes, high blood pressure, chronic kidney disease and smoking comprise a large portion of the high-risk population who would benefit from Paxlovid.
