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Case Reports
. 2025 Jan;53(1):3000605241307845.
doi: 10.1177/03000605241307845.

The interaction between nirmatrelvir/ritonavir and sirolimus: a case report of a kidney recipient with renal insufficiency and COVID-19

Yinhua Gong  1 , Dan Shen  2 , Jinfang Shi  1 , Ye Jiang  1   3 , Jie Gao  1
Affiliations
Case Reports

The interaction between nirmatrelvir/ritonavir and sirolimus: a case report of a kidney recipient with renal insufficiency and COVID-19

Yinhua Gong et al. J Int Med Res. 2025 Jan.

Abstract

Nirmatrelvir/ritonavir is a novel drug combination authorized by the US Food and Drug Administration for the treatment of coronavirus disease 2019 (COVID-19). This report describes the case of a patient with a prior history of kidney transplantation who received nirmatrelvir/ritonavir. In this case, sirolimus use was successfully stopped before nirmatrelvir/ritonavir treatment, and the nirmatrelvir/ritonavir trough concentration was determined. During nirmatrelvir/ritonavir treatment, the sirolimus trough concentration remained stable. This case highlights the risk associated with the concomitant administration of sirolimus and nirmatrelvir/ritonavir. Providers should therefore be cautious when prescribing nirmatrelvir/ritonavir to kidney transplant recipients currently receiving sirolimus, with caution exercised based on creatinine clearance.

Keywords: COVID-19; Nirmatrelvir/ritonavir; drug–drug interaction; immunosuppression; kidney transplantation; sirolimus.

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Figures

Figure 1.
Figure 1.
Sirolimus, nirmatrelvir/ritonavir, serum creatinine during hospital stay of kidney transplantation recipient.
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