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Tacrolimus Drug–Drug Interaction with Nirmatrelvir/Ritonavir (Paxlovid™) Managed with Phenytoin
INTRODUCTION: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) pandemic has had a significant impact on communities and health systems. The Federal Drug Administration (FDA) authorized Pfizer’s nirmatrelvir/ritonavir (Paxlovid™) through an EUA for the treatment of m...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9762866/ https://www.ncbi.nlm.nih.gov/pubmed/36536192 http://dx.doi.org/10.1007/s13181-022-00922-2 |
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author | Sindelar, Morganne McCabe, Daniel Carroll, Elisabeth |
author_facet | Sindelar, Morganne McCabe, Daniel Carroll, Elisabeth |
author_sort | Sindelar, Morganne |
collection | PubMed |
description | INTRODUCTION: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) pandemic has had a significant impact on communities and health systems. The Federal Drug Administration (FDA) authorized Pfizer’s nirmatrelvir/ritonavir (Paxlovid™) through an EUA for the treatment of mild to moderate cases of COVID-19 at high risk for progression to severe disease. Patients with a history of transplant who test positive for COVID-19 are considered high risk because of their immunosuppression and are therefore candidates for nirmatrelvir/ritonavir. CASE REPORT: This is a case of a 67-year-old female with a past medical history of orthotopic heart transplant who received tacrolimus as part of her immunosuppressive regimen. She originally presented with complaints of dyspnea and cough for several days in the setting of COVID-19. The patient was started on nirmatrelvir/ritonavir due to her high risk for progression to severe disease. Four days after starting nirmatrelvir/ritonavir, she presented to the ED for slowed speech, fatigue, weakness, and loss of appetite. Upon admission she was found to have a supratherapeutic tacrolimus level of 176.4 ng/mL and an acute kidney injury. In this case, phenytoin was used as a CYP3A4 inducer to quickly decrease the tacrolimus level to within therapeutic range. CONCLUSION: This case highlights the strong and important drug–drug interaction between tacrolimus and nirmatrelvir/ritonavir leading to toxic levels of tacrolimus. It also demonstrates the utility and effectiveness of phenytoin as a “rescue” medication for tacrolimus toxicity. |
format | Online Article Text |
id | pubmed-9762866 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-97628662022-12-20 Tacrolimus Drug–Drug Interaction with Nirmatrelvir/Ritonavir (Paxlovid™) Managed with Phenytoin Sindelar, Morganne McCabe, Daniel Carroll, Elisabeth J Med Toxicol Case Report INTRODUCTION: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) pandemic has had a significant impact on communities and health systems. The Federal Drug Administration (FDA) authorized Pfizer’s nirmatrelvir/ritonavir (Paxlovid™) through an EUA for the treatment of mild to moderate cases of COVID-19 at high risk for progression to severe disease. Patients with a history of transplant who test positive for COVID-19 are considered high risk because of their immunosuppression and are therefore candidates for nirmatrelvir/ritonavir. CASE REPORT: This is a case of a 67-year-old female with a past medical history of orthotopic heart transplant who received tacrolimus as part of her immunosuppressive regimen. She originally presented with complaints of dyspnea and cough for several days in the setting of COVID-19. The patient was started on nirmatrelvir/ritonavir due to her high risk for progression to severe disease. Four days after starting nirmatrelvir/ritonavir, she presented to the ED for slowed speech, fatigue, weakness, and loss of appetite. Upon admission she was found to have a supratherapeutic tacrolimus level of 176.4 ng/mL and an acute kidney injury. In this case, phenytoin was used as a CYP3A4 inducer to quickly decrease the tacrolimus level to within therapeutic range. CONCLUSION: This case highlights the strong and important drug–drug interaction between tacrolimus and nirmatrelvir/ritonavir leading to toxic levels of tacrolimus. It also demonstrates the utility and effectiveness of phenytoin as a “rescue” medication for tacrolimus toxicity. Springer US 2022-12-19 2023-01 /pmc/articles/PMC9762866/ /pubmed/36536192 http://dx.doi.org/10.1007/s13181-022-00922-2 Text en © American College of Medical Toxicology 2022, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. |
spellingShingle | Case Report Sindelar, Morganne McCabe, Daniel Carroll, Elisabeth Tacrolimus Drug–Drug Interaction with Nirmatrelvir/Ritonavir (Paxlovid™) Managed with Phenytoin |
title | Tacrolimus Drug–Drug Interaction with Nirmatrelvir/Ritonavir (Paxlovid™) Managed with Phenytoin |
title_full | Tacrolimus Drug–Drug Interaction with Nirmatrelvir/Ritonavir (Paxlovid™) Managed with Phenytoin |
title_fullStr | Tacrolimus Drug–Drug Interaction with Nirmatrelvir/Ritonavir (Paxlovid™) Managed with Phenytoin |
title_full_unstemmed | Tacrolimus Drug–Drug Interaction with Nirmatrelvir/Ritonavir (Paxlovid™) Managed with Phenytoin |
title_short | Tacrolimus Drug–Drug Interaction with Nirmatrelvir/Ritonavir (Paxlovid™) Managed with Phenytoin |
title_sort | tacrolimus drug–drug interaction with nirmatrelvir/ritonavir (paxlovid™) managed with phenytoin |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9762866/ https://www.ncbi.nlm.nih.gov/pubmed/36536192 http://dx.doi.org/10.1007/s13181-022-00922-2 |
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