A 64-year-old man with type 2 diabetes on simvastatin develops mild COVID-19 on day 3 of symptoms with oxygen saturation 96% on room air. He qualifies for nirmatrelvir-ritonavir. Before starting the course, what adjustment is needed for his statin?

• A Double the simvastatin dose for the duration of therapy
• B No adjustment is required as there is no interaction
• C Switch to lovastatin for the duration of therapy
• D Temporarily stop simvastatin during the 5-day course ✓

Explanation

Ritonavir is a potent CYP3A4 inhibitor and markedly raises levels of simvastatin and lovastatin, creating a serious risk of rhabdomyolysis. Both statins should be held during the 5-day course and restarted afterwards. Doubling the dose would amplify toxicity, and switching to lovastatin substitutes one interacting drug for another. This interaction profile is why the prescriber must review every concomitant medication before starting Paxlovid.

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

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Written and medically reviewed by the StethoPrep medical team.