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Case Reports
. 2024 May;52(5):3000605241247705.
doi: 10.1177/03000605241247705.

Nirmatrelvir/ritonavir treatment of patients with COVID-19 taking tacrolimus: case series describing the results of drug-drug interactions

Dan Shen  1 , Yinhua Gong  2 , Yulan Qian  2 , Jianguo Zhu  2 , Jie Gao  2
Affiliations
Case Reports

Nirmatrelvir/ritonavir treatment of patients with COVID-19 taking tacrolimus: case series describing the results of drug-drug interactions

Dan Shen et al. J Int Med Res. 2024 May.

Abstract

Nirmatrelvir/ritonavir is a novel drug combination that is authorized by the Food and Drug Administration for the treatment of coronavirus disease 2019 (COVID-19). Ritonavir is a cytochrome P450 3A inhibitor and a P-glycoprotein inhibitor that increases the plasma concentration of tacrolimus and other medications. We describe the cases of two patients treated with nirmatrelvir/ritonavir: a patient who had undergone kidney transplantation and another with a history of hematopoietic stem cell transplantation. Toxic concentrations of tacrolimus were induced in both. This case series highlights the risk associated with the concomitant administration of tacrolimus and nirmatrelvir/ritonavir.

Keywords: COVID-19; Nirmatrelvir/ritonavir; drug–drug interaction; hematopoietic stem cell transplantation; kidney transplantation; tacrolimus.

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Conflict of interest statement

Declaration of conflicting interestThe authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Serum creatinine and blood tacrolimus concentrations of patient 1 during his hospital stay.
Figure 2.
Figure 2.
Serum creatinine and blood tacrolimus concentrations of patient 2 during his hospital stay.
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