What are the precautions for Nirmatrelvir/Ritonavir combination?

In the clinical study of Nematrelvir/Ritonavir tablet combination Paxlovid (Nirmatrelvir/Ritonavir) in the treatment of new coronavirus infection , warnings and precautions such as allergic reactions, hepatotoxicity, and the risk of development of HIV-1 drug resistance appeared. There was also the risk of serious adverse reactions caused by drug interactions.

1. Allergic reactions: It has been reported that allergic reactions, severe skin reactions (including toxic epidermal necrolysis and Stevens-Johnson syndrome) and other allergic reactions may occur when using the nematvir/ritonavir tablet combination. If signs and symptoms of clinically significant hypersensitivity or anaphylaxis occur, immediately discontinue nematvir/ritonavir combination and initiate appropriate medical therapy and/or supportive care.

2. Hepatotoxicity: Patients treated with ritonavir experienced elevated liver transaminases, clinical hepatitis, and jaundice. Therefore, caution should be used when using the nematvir /ritonavir tablet combination in patients with pre-existing liver disease, liver enzyme abnormalities, or hepatitis.

3. Risk of HIV-1 drug resistance development: Due to the combination of nematvir and ritonavir, there may be a risk of HIV-1 becoming resistant to HIV protease inhibitors in individuals whose HIV-1 infection is not controlled or undiagnosed.

4. Drug interactions leading to serious adverse reactions: In patients receiving CYP3A metabolizing drugs, start using nematvir/ritonavir containing ritonavir (a strong CYP3A inhibitor) Tablet combination, or initiation of CYP3A metabolizing drugs in patients already receiving Nematrevir/ritonavir tablet combination may increase plasma concentrations of CYP3A metabolizing drugs. Drugs that induce CYP3A may decreaseitsconcentrations. The most commonly reported concomitant medications causing serious adverse reactions are calcineurin inhibitors (eg, tacrolimus, cyclosporine), followed by calcium channel blockers.

5. Embryonic-Fetotoxicity: A transient decrease in body weight was observed in the lactating offspring of rats taking nematvir, and there are also data showing that ritonavir is present in breast milk. Breastfeeding mothers with novel coronavirus infection should follow clinical guidance to avoid exposing their infants to novel coronavirus infection. The use of ritonavir may decrease the efficacy of combined hormonal contraceptives and patients taking combined hormonal contraceptives should be advised to use an effective alternative or additional barrier method of contraception.

NematrevirThe combination of nematvir/ritonavir tablets has been launched in China. Due to its short time on the market, it has not been included in the medical insurance. The domestic price has not yet been determined. The original drug of nematvir/ritonavir tablet combination marketed overseas, the specification is nematvir 150mg + ritonavir 100mg)*30 tablets per box, the price may be around 2,000 yuan (the price may fluctuate due to the exchange rate), India The price of each box of the generic Nematvir/Ritonavir tablet combination produced by the pharmaceutical factory may be around RMB 1,000 (the price may fluctuate due to the exchange rate). The ingredients of the two drugs are basically the same. For more drug information and specific prices, please consult Yaode Medical Consultant.