Head up: Paxlovid COVID-19 therapeutic and benzodiazepines

Quoting from Pfizer antiviral pills may be risky with other medications (see link below) ...

 

The Paxlovid cocktail consists of two tablets of the antiviral nirmatrelvir and one tablet of ritonavir, a drug that has long been used as what is known as a boosting agent in HIV regimens. Ritonavir suppresses a key liver enzyme called CYP3A, which metabolizes many medications, including nirmatrelvir. In the case of Paxlovid treatment, ritonavir slows the body’s breakdown of the active antiviral and helps it remain at a therapeutic level for longer. When Paxlovid is paired with other medications that are also metabolized by the CYP3A enzyme, the chief worry is that the ritonavir component may boost the co-administered drugs to toxic levels.

 

The medications include, but are not limited to: blood thinners; anti-seizure medications; drugs for irregular heart rhythms, high blood pressure and high cholesterol; antidepressants and anti-anxiety medications; immunosuppressants; steroids (including inhalers); HIV treatments; and erectile dysfunction medications.

 

Dr. William Werbel, an assistant professor of medicine at Johns Hopkins University who specializes in transplant infectious diseases, advised people at high risk of Covid-19 complications to talk to their health care providers, as well as a savvy pharmacist, about changes they could make to their drug regimens should they need Paxlovid — even before they become infected with the virus.

 

The Emergency Use Authorization Fact Sheet for Paxlovid (see link below) identifies the benzodiazepines triazolam (Halcion) and midazolam (Versed) as having significant interactions with ritonavir. However, the drug interaction checkers at rxlist.com and drugs.com indicate ritonavir interacts with other benzodiazepines including a moderate-to-significant interaction for alprazolam/Xanax and moderate interactions for diazepam/Valium, clonazepam/Klonopin, and chlordiazepoxide/Librium (but no interaction for lorazepam/Ativan).

 

The herbal product St. John’s Wort as well as the following drugs also interact with ritonavir:

 

antidepressants: bupropion, trazodone

antipsychotics: lurasidone, pimozide, clozapine, quetiapine

anticonvulsants: carbamazepine, phenobarbital, phenytoin

 

Sources:

Pfizer antiviral pills may be risky with other medications

https://news.yahoo.com/pfizer-covid-pills-may-risky-093036174.html

 

Fact Sheet for Healthcare Providers: Emergency Use Authorization for Paxlovid

Table 1: Established and Other Potentially Significant Drug Interactions (pages 9-15)

https://www.fda.gov/media/155050/download

Very interesting, Libertas. Thanks for the information! 

 

Katz

 

 

Yes, thank you for sharing this information!

Thank you Libertas, I'll pass this information along to my father who is on a couple of these medications, hopefully this will inspire him to be even more careful about exposing himself to Covid.

Thanks so much for this info!

Good information, I read about this a couple of days ago.  Thanks Lib.