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Pharmacokinetic interaction between verapamil and ritonavir-boosted nirmatrelvir: implications for the management of COVID-19 in patients with hypertension

A woman in her 80s was brought to the emergency department for acute onset of generalised weakness, lethargy and altered mental state. The emergency medical service found her to have symptomatic bradycardia, and transcutaneous pacing was done. Medical history was notable for hypertension, hyperlipid...

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Autores principales: Haque, Obaid Imtiyazul, Mahar, Samantha, Hussain, Shahzad, Sloane, Peter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9843211/
https://www.ncbi.nlm.nih.gov/pubmed/36639196
http://dx.doi.org/10.1136/bcr-2022-252677
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author Haque, Obaid Imtiyazul
Mahar, Samantha
Hussain, Shahzad
Sloane, Peter
author_facet Haque, Obaid Imtiyazul
Mahar, Samantha
Hussain, Shahzad
Sloane, Peter
author_sort Haque, Obaid Imtiyazul
collection PubMed
description A woman in her 80s was brought to the emergency department for acute onset of generalised weakness, lethargy and altered mental state. The emergency medical service found her to have symptomatic bradycardia, and transcutaneous pacing was done. Medical history was notable for hypertension, hyperlipidaemia, type 2 diabetes, and a recently diagnosed SARS-CoV-2 (COVID-19) infection for which she was prescribed ritonavir-boosted nirmatrelvir (Paxlovid) two days before the presentation. On arrival at the hospital, she was found to have marked bradycardia with widened QRS, hyperglycaemia and metabolic acidosis. Transvenous pacing along with pressor support and insulin were initiated, and she was admitted to the intensive care unit. Drug interaction between ritonavir-boosted nirmatrelvir and verapamil leading to verapamil toxicity was suspected of causing her symptoms, and both drugs were withheld. She reverted to sinus rhythm on the fourth day, and the pacemaker was discontinued.
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spelling pubmed-98432112023-01-18 Pharmacokinetic interaction between verapamil and ritonavir-boosted nirmatrelvir: implications for the management of COVID-19 in patients with hypertension Haque, Obaid Imtiyazul Mahar, Samantha Hussain, Shahzad Sloane, Peter BMJ Case Rep Case Reports: Adverse drug reactions and complications A woman in her 80s was brought to the emergency department for acute onset of generalised weakness, lethargy and altered mental state. The emergency medical service found her to have symptomatic bradycardia, and transcutaneous pacing was done. Medical history was notable for hypertension, hyperlipidaemia, type 2 diabetes, and a recently diagnosed SARS-CoV-2 (COVID-19) infection for which she was prescribed ritonavir-boosted nirmatrelvir (Paxlovid) two days before the presentation. On arrival at the hospital, she was found to have marked bradycardia with widened QRS, hyperglycaemia and metabolic acidosis. Transvenous pacing along with pressor support and insulin were initiated, and she was admitted to the intensive care unit. Drug interaction between ritonavir-boosted nirmatrelvir and verapamil leading to verapamil toxicity was suspected of causing her symptoms, and both drugs were withheld. She reverted to sinus rhythm on the fourth day, and the pacemaker was discontinued. BMJ Publishing Group 2023-01-13 /pmc/articles/PMC9843211/ /pubmed/36639196 http://dx.doi.org/10.1136/bcr-2022-252677 Text en © BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.
spellingShingle Case Reports: Adverse drug reactions and complications
Haque, Obaid Imtiyazul
Mahar, Samantha
Hussain, Shahzad
Sloane, Peter
Pharmacokinetic interaction between verapamil and ritonavir-boosted nirmatrelvir: implications for the management of COVID-19 in patients with hypertension
title Pharmacokinetic interaction between verapamil and ritonavir-boosted nirmatrelvir: implications for the management of COVID-19 in patients with hypertension
title_full Pharmacokinetic interaction between verapamil and ritonavir-boosted nirmatrelvir: implications for the management of COVID-19 in patients with hypertension
title_fullStr Pharmacokinetic interaction between verapamil and ritonavir-boosted nirmatrelvir: implications for the management of COVID-19 in patients with hypertension
title_full_unstemmed Pharmacokinetic interaction between verapamil and ritonavir-boosted nirmatrelvir: implications for the management of COVID-19 in patients with hypertension
title_short Pharmacokinetic interaction between verapamil and ritonavir-boosted nirmatrelvir: implications for the management of COVID-19 in patients with hypertension
title_sort pharmacokinetic interaction between verapamil and ritonavir-boosted nirmatrelvir: implications for the management of covid-19 in patients with hypertension
topic Case Reports: Adverse drug reactions and complications
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9843211/
https://www.ncbi.nlm.nih.gov/pubmed/36639196
http://dx.doi.org/10.1136/bcr-2022-252677
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