- Researchers say the COVID-19 drug Paxlovid may interact with some common heart medications.
- Experts, however, say some people can still take both drugs at the same time while others can stop their heart medication while they take Paxlovid.
- For those who can’t take Paxlovid, experts say there are other options, including the use of monoclonal antibodies.
The COVID-19 treatment Paxlovid can interact with common heart medications, but experts say for some people the situation can be managed.
Paxlovid is an antiviral medication used to treat mild to moderate cases of COVID-19 in people at risk of progression to severe disease and hospitalization.
Those with heart disease are among the groups who are at higher risk for serious illness, but a new review published in the Journal of the American College of Cardiology details that while Paxlovid is highly effective in people with heart disease, it also has numerous interactions with common heart medications.
“Awareness of the presence of drug-drug interactions of Paxlovid with common cardiovascular drugs is key. System-level interventions by integrating drug-drug interactions into electronic medical records could help avoid related adverse events,” Dr. Sarju Ganatra, the director of the cardio-oncology program at Lahey Hospital and Medical Center in Burlington, Massachusetts, and the senior author of the review, said in a press release.
“The prescription of Paxlovid could be incorporated into an order set, which allows physicians, whether it be primary care physicians or cardiology providers, to consciously rule out any contraindications to the co-administration of Paxlovid,” he added. “Consultation with other members of the health care team, particularly pharmacists, can prove to be extremely valuable. However, a healthcare provider’s fundamental understanding of the drug-drug interactions with cardiovascular medications is key.”
How, when to use Paxlovid
Some statins, antiarrhythmic agents, antiplatelet agents and anticoagulants, immunosuppressive agents, and Ranolazine were all identified in the study as common heart medications that could interact with Paxlovid.
Some of these medications can be stopped or altered for the duration of Paxlovid treatment, but for others, Paxlovid therapy is not advised.
“For some of these medications, you just can’t keep them together. For others, they’re OK. For some, it might raise the level or decrease the level of one of the medications. So it just requires adjustment or monitoring,” Dr. Dean Blumberg, the chief of Pediatric Infectious Diseases at the University of California Davis, told Healthline.
“For others, you can temporarily stop them and give the Paxlovid safely,” he added. “One of the most common medications that are used in the U.S. are statins to lower lipids. And it’s very easy to deal with that drug interaction because that’s a long-term issue… and so you can just stop that temporarily and then give the Paxlovid, and then a couple of days after the Paxlovid is finished, you can restart the statin and then really that’s not going to have any long term effects and makes sure you can take the Paxlovid safely.”
Paxlovid is usually taken orally at home for five days, with the goal of preventing progression to severe disease that would require hospitalization.
“You take the Paxlovid as quickly as possible. It interferes with the multiplication of the virus so that reduces the chance that the virus can disseminate, can spread, throughout the body into any number of other organ systems and cause damage there,” Dr. William Schaffner, an infectious disease expert at Vanderbilt University in Tennessee, told Healthline.
For people on heart medications that cannot be stopped or cannot be taken at the same time as Paxlovid, experts say there are alternative therapies that can be given.
“There are monoclonal antibodies that can be utilized that can help mitigate the COVID infection. So that’s something that the majority of patients should be able to qualify for,” said Dr. Eugene DePasquale, a cardiologist and medical director of the Heart Failure, Heart Transplantation and Mechanical Circulatory Support Program with Keck Medicine of USC.
“Earlier on during the pandemic, when these therapies first came out, the amounts of those therapies were more limited,” he told Healthline. “But I think that’s changed greatly. So this should be something that should be more easily available.”
While both monoclonal antibodies and Paxlovid can provide benefits, the logistics of monoclonal antibodies can be more challenging.
Paxlovid is a tablet collected at a pharmacy and taken at home. Monoclonal antibodies are given via an IV that requires attendance at a clinic.
Blumberg says people on heart medications who test positive for COVID-19 shouldn’t assume Paxlovid isn’t a treatment available to them.
“They should call their healthcare provider and see what the options are. Some of these interactions can be managed easily. Some can be managed with a little more effort. And sometimes you just need an alternative,” he said.
“But since they are at increased risk for more severe outcomes, it’s good to know what the options are to stay healthy” Blumberg added. “Remember that Paxlovid does decrease mortality by more than four times for those over 50 years of age, and it’s likely even higher for people who are older. So it really is a significant advance, and we know that it’s underused. So, it just needs to be used carefully and checking for any of these drug interactions.”
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