Di Lenarda Andrea, Ferri Nicola, Lanzafame Massimiliano, Montuori Eva Agostina, Pacelli Luciano
Cardiovascular Center, Territory Specialist Department, Azienda Sanitaria Universitaria Giuliano Isontina - ASUGI Trieste, Italy.
Department of Medicine, University of Padova Padua, Italy.
Eur Cardiol. 2024 Aug 9;19:e15. doi: 10.15420/ecr.2024.04. eCollection 2024.
Cardiovascular disease is associated with progression to severe COVID-19 and patients with the condition are among those in whom early antiviral therapy should be warranted. The combination of nirmatrelvir/ritonavir (Paxlovid®) has been approved for clinical use by the Food and Drug Administration and European Medicines Agency. Because patients with cardiovascular disease are often on polypharmacy, physicians need to be aware of potential drug-drug interactions (DDIs) when treating COVID-19 with nirmatrelvir/ritonavir. Guidance is given for avoiding DDIs, emphasising that preventing and managing potential DDIs with nirmatrelvir/ritonavir requires thorough assessment and knowledge. The present review summarises the clinical pharmacology of nirmatrelvir/ritonavir and provides details on potential DDIs with a focus on daily practice in patients with cardiovascular disease. Particular attention is needed for drugs that are predominantly metabolised by cytochrome P450 3A4, are substrates of P-glycoprotein and have a narrow therapeutic index. Proper management of potential DDIs must balance the benefit of nirmatrelvir/ ritonavir to prevent severe disease with the risk of serious adverse events.
心血管疾病与进展为重症新型冠状病毒肺炎相关，患有该疾病的患者属于应给予早期抗病毒治疗的人群。奈玛特韦/利托那韦组合药物（帕罗韦德®）已获美国食品药品监督管理局和欧洲药品管理局批准用于临床。由于心血管疾病患者常同时服用多种药物，医生在使用奈玛特韦/利托那韦治疗新型冠状病毒肺炎时需要注意潜在的药物相互作用（DDIs）。本文给出了避免药物相互作用的指导意见，强调预防和管理与奈玛特韦/利托那韦潜在的药物相互作用需要全面评估和专业知识。本综述总结了奈玛特韦/利托那韦的临床药理学，并详细介绍了潜在的药物相互作用，重点关注心血管疾病患者的日常用药情况。对于主要经细胞色素P450 3A4代谢、是P-糖蛋白底物且治疗指数较窄的药物，需要特别关注。潜在药物相互作用的妥善管理必须在奈玛特韦/利托那韦预防重症疾病的益处与严重不良事件风险之间取得平衡。
