October 12, 2022
The COVID-19 drug Paxlovid has been proven to reduce the likelihood of severe illness among people at high risk. But it also can cause a dangerous reaction when taken alongside common heart disease medications, including certain statins and heart failure drugs, doctors say.
These adverse effects can include an increased risk of bleeding when Paxlovid is taken with certain blood thinners and liver toxicity when it is used with cholesterol drugs like statins. It also can cause low blood pressure and swelling when taken with certain blood pressure medications.
To increase awareness of these risks, researchers ran through a list of cardiovascular drugs, noting whether each was safe to take with Paxlovid. Their findings were published Wednesday by the Journal of the American College of Cardiology.
When a dangerous reaction is possible, the heart disease medication should be temporarily discontinued, or the dosage adjusted, while the person is taking the five-day regimen of Paxlovid, the researchers said.
When President Joe Biden tested positive for COVID-19 and started Paxlovid in July, his physician temporarily took him off of Crestor and Eliquis, a pair of medicines he takes for pre-existing conditions. But not all doctors are aware that heart disease patients may need to stop taking their regular medications while on Paxlovid, the researchers said.
In the paper, they wrote that Paxlovid should be avoided if these medications cannot be "safely interrupted."
Paxlovid, manufactured by Pfizer, can be prescribed to people ages 12 and older who have a mild-to-moderate COVID-19 infection and are at high risk of it progressing into a severe cases that causes hospitalization or death. To be effective, it must be taken within the first five days of symptoms.
Dr. Jayne Morgan, a cardiologist at Piedmont Hospital/Healthcare in Atlanta, who was not involved in the research, told CNN that it can be a challenge to make the COVID-19 diagnosis and stop the heart medications within the five-day window that Paxlovid is effective. A patient's doctor will need to weigh all the potential risks and benefits of taking the COVID-19 drug.
"Awareness of the presence of drug-drug interactions of Paxlovid with common cardiovascular drugs is key," said researcher Dr. Sarju Ganatra, director of the cardio-oncology program at Lahey hospital and Medical Center in Massachusetts. "System-level interventions by integrating drug-drug interactions into electronic medical records could help avoid related adverse events."
Paxlovid is a combination of two oral drugs, nirmatrelvir and ritonavir, that are packaged together. Nirmatrelvir helps prevent the coronavirus from duplicating itself inside the body. Ritonavir slows the body's process of breaking down nirmatrelvir so that the drug works longer. Ritonavir originally was approved by the U.S. Food and Drug Administration for treating HIV.
Other potential side effects of Paxlovid include metallic mouth, nausea, vomiting, diarrhea and liver toxicity. People with kidney or liver dysfunction should not take Paxlovid.
