A healthcare worker opens a box of Paxlovid antiviral tablets against COVID-19Share on Pinterest
New research has found that Paxlovid can interact with a number of medications. picture alliance/Getty Images
  • COVID-19 can be especially dangerous for people with cardiovascular concerns. As a result, such patients are more likely to be prescribed Pfizer’s antiviral treatment Paxlovid.
  • Paxlovid can, however, negatively interact with a number of medications prescribed for heart disease.
  • A new study reviews what is known about such interactions and treatment options that can help people avoid unwanted consequences.

Among the people most at risk for hospitalization and death from COVID-19 are people with pre-existing cardiovascular issues. To avoid potentially serious consequences from SARS-CoV-2 infections, doctors may choose to prescribe patients Pfizer’s Paxlovid.

It has become clear, however, that Paxlovid may adversely interact with a range of common heart medications patients may already be taking.

A new study reviews known interactions between Paxlovid and some heart disease medications and offers ways to avoid unwanted outcomes.

The study is published in the Journal of the American College of Cardiology.

Dr. Scott Roberts, assistant professor and associate medical director of infection prevention at Yale Medicine in New Haven, Connecticut, who was not involved in the study, weighed in on the findings.

“I imagine patients with cardiovascular conditions will have a harder time taking Paxlovid safely than those with other types of medical problems. The challenge with Paxlovid use in those with cardiovascular disease is the abundance of drug-drug interactions between many medications taken for cardiovascular conditions (such as blood thinners, anti-arrhythmics) and Paxlovid, which can lead to dangerous increases in some of these drugs’ levels,” he told Medical News Today:

Senior author of the study, Dr. Sarju Ganatra, a cardiologist at Beth Israel Lahey Health in Burlington, Massachusets, told MNT that even considering the care that must be taken to avoid conflicts, “We believe it [Paxlovid] is a good drug and can be very helpful.”

“We should not be deterred from considering Paxlovid as a potential treatment for COVID-19. However, co-administration of Paxlovid with medications commonly used to manage cardiovascular conditions can potentially cause significant drug-drug interactions and may lead to severe adverse effects.”
— Dr. Sarju Ganatra

“It is crucial to be aware of such interactions and make appropriate adjustments in the medication regimen to avoid any harm,” said Dr. Ganatra.

Paxlovid was authorized for emergency use against COVID-19 by the Federal Food and Drug Administration at the end of last year and was reauthorized in September 2022.

The issue of drug interactions is unrelated to “Paxlovid rebound.”

Dr. Ganatra listed the types of drugs with which negative interactions may occur when taken alongside Paxlovid:

  • “Antiplatelets, anticoagulants — blood thinners, [and] certain statins commonly used to treat high cholesterol
  • Antiarrhythmics — medications to manage heart rhythm issues
  • Antianginals — some of the medications which help relieve angina
  • Immunosuppressive medications — often prescribed to those with a heart transplant and for some other indications.”

The study includes a detailed listing of specific interactions, as well as alternative treatments to avoid conflicts with Paxlovid.

The researchers have also proposed a multi-level decision algorithm that can help clinicians determine whether Paxlovid is indicated for individual patients based on the cardiovascular medications they are already taking.

Other possible drug interactions

Paxlovid may also conflict with some medications prescribed for other conditions.

“Many medications can interact with Paxlovid,” said Dr. Ganatra, “[The] FDA has issued a list very recently, although without much details.”

Dr. Roberts mentioned an additional interaction issue with Paxlovid:

“Another major one is anti-rejection medications for those with organ transplants.”

“The levels can go dangerously high when given with Paxlovid unless the dosages are adjusted. I always advise discussing with a pharmacist how to modify the doses of medications a patient is taking when starting Paxlovid,” he explained.

The “Nirmatrelvir-ritonavir combination known as Paxlovid is used to treat symptomatic, non-hospitalized patients with coronavirus disease-2019 (COVID-19) who are at high risk of progression to severe disease,” explained Dr. Ganatra.

“Patients with cardiovascular risk factors and cardiovascular disease,” he noted, “are at a high risk of developing adverse events from COVID-19 and as a result have a higher likelihood of receiving Paxlovid. So, Paxlovid and heart-medication interactions are very important to understand and avoid.”

Even so, said Dr. Ganatra, Paxlovid “should be considered when indicated, keeping these interactions in mind and making adjustments in the drug regimen to avoid them.

Dr. Ganatra noted his research indicates Paxlovid may be even more valuable than first believed:

“Paxlovid was originally shown to be beneficial for unvaccinated patients. However, we did a follow-up real-world study and demonstrated that it is beneficial for high-risk vaccinated patients as well, such as those with heart disease.”

Dr. Ganatra said that he hopes his review study “will be helpful for clinicians to understand such interactions and also to make point-of-care decisions.”

“We believe, it’s important for providers and hospitals to create system-level interventions such as building in these interactions in the EMR [electronic medical records] system to alert the clinicians/prescribers to ensure patients get the right treatment, and we can avoid potentially harmful drug-drug interactions.”
— Dr. Sarju Ganatra