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Review
. 2022 Jul:10.2217/fvl-2022-0060.
doi: 10.2217/fvl-2022-0060. Epub 2022 Aug 2.

Cholesterol-lowering drugs for high-risk hypercholesterolemia patients with COVID-19 while on Paxlovid™ therapy

Alpo Vuorio  1   2 , Petri T Kovanen  3 , Frederick Raal  4
Affiliations
Review

Cholesterol-lowering drugs for high-risk hypercholesterolemia patients with COVID-19 while on Paxlovid™ therapy

Alpo Vuorio et al. Future Virol. 2022 Jul.

Abstract

Paxlovid™ is a promising antiviral oral medication for patients at a high risk of a severe form of COVID-19. Regarding COVID-19 patients who have hypercholesterolemia and are at high or very high risk for an acute atherothrombotic cardiovascular event, we are highlighting patients with heterozygous familial hypercholesterolemia as an example of severe hypercholesterolemia. Unfortunately, the concomitant use of Paxlovid and a statin, which is highly dependent on cytochrome P4507A (CYP3A) for clearance, may result in significant drug interactions. Since an abrupt withdrawal of statin use may cause serious negative rebound effects on the cardiovascular system, it is essential to continue statin treatment also during the 5-day Paxlovid treatment period. During Paxlovid treatment, simvastatin and lovastatin need to be substituted with another statin, such as pravastatin or fluvastatin, while a reduction of the dose of atorvastatin and rosuvastatin is recommended.

Keywords: COVID-19; PCSK9 inhibitors; Paxlovid; ezetimibe; familial hypercholesterolemia; interaction; statins.

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Conflict of interest statement

Financial & competing interests disclosure PT Kovanen has received consultancy fees, lecture honoraria and/or travel fees from Amgen, Novartis, Raisio Group and Sanofi. F Raal has received research grants, honoraria or consulting fees for professional input and/or lectures from Sanofi, Regeneron, Amgen and Novartis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.

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