A 55-year-old man with diabetes and hypertension tests positive for SARS-CoV-2. He is symptomatic but not hypoxic, within 5 days of symptom onset, and has risk factors for progression. Nirmatrelvir-ritonavir is being considered. He takes simvastatin 40 mg daily. What is the appropriate action?

• A Give nirmatrelvir-ritonavir without any change to simvastatin
• B Avoid nirmatrelvir-ritonavir because statins are absolutely contraindicated with all antivirals
• C Double the simvastatin dose during therapy
• D Withhold simvastatin during therapy and give nirmatrelvir-ritonavir ✓

Explanation

Ritonavir is a strong CYP3A4 inhibitor and dramatically raises simvastatin levels, creating a serious risk of rhabdomyolysis, so simvastatin must be withheld during the 5-day course and restarted afterwards. Atorvastatin can often be temporarily paused similarly. The combination itself remains usable in suitable patients, and doubling the statin would worsen toxicity rather than solve the interaction.

Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.