Contraindicated Medications with Paxlovid

Strong CYP3A4 Inducers

• The American Association for the Study of Liver Diseases and the European Association for the Study of the Liver recommend avoiding antimycobacterials such as rifampicin and rifabutin due to strong CYP3A4 induction 1, 2
• The European Medicines Agency advises against the use of herbal products like St. John's wort as it significantly reduces nirmatrelvir plasma concentrations 3, 4, 5

Medications with Dangerous Elevation Risk

Cardiovascular Agents

• The American College of Cardiology recommends avoiding antiarrhythmics such as amiodarone due to the risk of life-threatening cardiac arrhythmias 1, 2, 6
• The American Heart Association advises against the use of ergot derivatives due to the risk of acute ergot toxicity 1, 2

Anticoagulants

• The International Society on Thrombosis and Haemostasis recommends exercising extreme caution when using direct oral anticoagulants such as rivaroxaban, which can increase the risk of severe bleeding 7
• The American College of Chest Physicians suggests either switching to low molecular weight heparin or reducing the dose of apixaban by 25% with close bleeding monitoring 8

Lipid-Lowering Agents

• The American College of Cardiology recommends avoiding statins metabolized by CYP3A4, such as lovastatin and simvastatin, due to the risk of serious adverse events 1, 2, 6

Psychotropic Medications

• The National Institute of Mental Health advises against the use of sedatives and antipsychotics with narrow therapeutic windows, such as oral midazolam and triazolam, due to the risk of excessive sedation and respiratory depression 1, 2
• The American Psychiatric Association recommends avoiding antipsychotics such as quetiapine due to markedly increased plasma concentrations 1, 2

Pulmonary and GI Agents

• The American Thoracic Society recommends avoiding bronchodilators such as salmeterol due to the risk of serious cardiovascular adverse events 1, 2
• The European Respiratory Society advises against the use of sildenafil for pulmonary arterial hypertension due to the risk of excessive vasodilation 1, 2

Anti-Infectives

• The Infectious Diseases Society of America recommends avoiding azole antifungals such as itraconazole and ketoconazole due to the risk of increased paritaprevir exposure 1, 2

Additional High-Risk Interactions

• The American Academy of Allergy, Asthma, and Immunology recommends avoiding antihistamines such as astemizole and terfenadine due to the risk of cardiac arrhythmia 1, 2
• The American Society of Clinical Oncology advises against the use of certain oncology agents, including imatinib, irinotecan, and lapatinib, due to BCRP substrate effects 3, 4