Safely Prescribing Nirmatrelvir and Ritonavir—Avoiding Drug-Drug Interactions

A 72-year-old man called his primary care physician (PCP) after 2 days of throat pain, myalgia, mild shortness of breath, and fever. A home COVID-19 antigen test result was positive. He had received 3 doses of the BNT162b2 vaccine (Pfizer-BioNTech COVID-19 vaccine); the most recent dose was 6 months prior. Considering a history of recent coronary artery bypass graft, hypertension, diabetes, and he patient's age, his PCP prescribed nirmatrelvir and ritonavir (Paxlovid) for 5 days. The patient called his PCP after 2 days with active complaints of worsening myalgia. On medication review, the patient's active medications included atorvastatin, 80 mg daily; metformin, 1000 mg twice a day; aspirin, 81 mg daily; and dapagliflozin, 10 mg daily.