(CNN) — Covid-19 patients with a history of cardiovascular disease are at increased risk of developing serious illness and could benefit most from the Covid-19 treatment Paxlovid — but there’s a catch.
Paxlovid can have dangerous interactions with some of the most common cardiovascular drugs, including certain statins and heart failure therapies, a new paper warns.
The review paper, published Wednesday in the Journal of the American College of Cardiology, lists dozens of cardiovascular drugs and whether they’re safe to co-administer with Paxlovid or if they might have interactions.
Some medications, such as aspirin, can be safely taken with Paxlovid, according to the paper, but other medications could interact and therefore their dosage should be adjusted or temporarily stopped while a patient is taking Paxlovid.
When President Joe Biden tested positive for Covid-19 and started Paxlovid in July, his doctor, Dr. Kevin O’Connor took it off temporarily Crestor and Eliquis, two heart medications the President is taking for his pre-existing conditions. Doctors say there is no short-term risk of stopping these drugs.
The review paper states that interactions between Paxlovid and certain blood thinners can cause an increased risk of bleeding. Interactions between Paxlovid and some cholesterol medications, such as statins, can be toxic to the liver, and interactions between Paxlovid and certain blood pressure medications can cause low blood pressure, flushing, and swelling.
“There are some medications that you just can’t get off, and a doctor has to make a decision. It’s a risk-benefit analysis,” said Dr. Jayne Morgan, cardiologist and clinical director of the Covid Task Force at Piedmont Hospital/Healthcare in Atlanta, who was not involved in the new paper.
Regarding cardiovascular medications patients might wean off to take Paxlovid, Morgan noted the Covid-19 treatment is a five-day regimen.
“You have to diagnose and then get off your medication and do all of that in a timely manner to still meet that five-day window,” Morgan said, adding that people need to talk to their doctors about what’s best for them .
“Awareness…is the key”
The new paper’s authors — from Lahey Hospital and Medical Center, Harvard Medical School and other US institutions — wrote that Paxlovid should be avoided if potentially interacting cardiovascular drugs cannot be “safely interrupted.”
Paxlovid, an oral antiviral drug, was approved in December for the treatment of mild to moderate Covid-19 in people aged 12 and older who are at high risk of serious illness, hospitalization or death.
“Awareness of the existence of drug-drug interactions of Paxlovid with common cardiovascular drugs is critical. System-level interventions by integrating drug-drug interactions into electronic medical records could help prevent associated adverse events,” said the paper’s senior author, Dr. Sarju Ganatra, director of the cardio-oncology program at Lahey Hospital and Medical Center in Massachusetts issued a press release.
“Prescribing Paxlovid could be included in a prescription set that would allow physicians, whether general practitioners or cardiologists, to deliberately rule out contraindications to the concomitant administration of Paxlovid. Consultation with other healthcare team members, particularly pharmacists, can prove extremely valuable,” Ganatra said. “However, a healthcare provider’s basic understanding of drug-cardiovascular drug interactions is critical.”
“It’s not just a free ticket”
Interactions between Paxlovid and common heart medications are known, said Dr. Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston, who was not involved in the new paper.
“Drug interactions have been reported, but I think Paxlovid has been so widely prescribed that some doctors and patients may not be as tuned in as they should be,” Barouch said.
Paxlovid consists of two antivirals, nirmatrelvir and ritonavir.
“The second drug, ritonavir, is a non-specific drug that inhibits metabolism and increases the dose of the other drug. But the ritonavir in Paxlovid can also inhibit the metabolism of other drugs. So you have to be very careful when prescribing Paxlovid to people who take certain blood thinners, heart medications, statins and other medications,” Barouch said. “So it’s not just a free pass.”
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