Assessment of Potential Drug-Drug Interactions between Nirmatrelvir/Ritonavir and Concomitant Drugs among Coronavirus Disease Patients in a Tertiary Care Hospital.
DOI:
https://doi.org/10.70672/0r53dt64Keywords:
Comorbidities, COVID-19, Drug interactions, nirmatrelvir and ritonavir drug combination, polypharmacy.Abstract
Background: Nirmatrelvir/ritonavir is indicated for the treatment of COVID-19infection. However, potential drug-drug interactions (pDDI) between nirmatrelvir/ritonavir and concomitant drugs require further investigation.
Objective: To assess the prevalence, management, and risk factors of pDDI between nirmatrelvir/ritonavir and concomitant drugs in patients with COVID-19 .
Methods: This cross-sectional study was approved by the Medical Research Ethics Committee of Malaysia. Inclusion criteria were COVID-19 patients aged ≥18 years, treated with nirmatrelvir/ritonavir between July and September 2022 in a tertiary care hospital in Selangor. Classification and management of pDDI were categorised according to the University of Liverpool COVID-19 Drug Interactions classification. The pDDI management in clinical practice was compared to the recommended classifications and categorised as 'compliant' or 'non-compliant. Patient characteristics were analysed descriptively. Binary logistic regression was used to identify pDDI risk factors.
Results: The study included 189 patients with a mean age ±SD of 56.76±18.68 years. Comorbidities and polypharmacy were observed in 147 (77.78%) and 73 (38.62%) patients, respectively. A total of 114 patients (60.32%) were reported to have at least one pDDI with nirmatrelvir/ritonavir. Most concomitant drugs had potential interactions with nirmatrelvir/ritonavir (n=152, 77.16%). Compliance with the recommended pDDI management was observed in 174 (88.32%) drug entries. Age (OR 1.04; 1.02-1.06; p=0.001), comorbidities (OR 8.87; 3.17-24.78; p<0.001), and polypharmacy (OR 6.76; 2.74-16.65; p<0.001) were significant risk factors of pDDI with nirmatrelvir/ritonavir.
Conclusion: Prevalence of pDDI among COVID-19 patients treated with nirmatrelvir/ritonavir was high and mainly compliant with the recommended pDDI management. Age, comorbidities, and polypharmacy were pDDI risk factors, warranting a case-by-case multidisciplinary approach to optimise treatment with nirmatrelvir/ritonavir.
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