Real World Safety Data Indicate Drug-Drug Interactions with Paxlovid are Overstated

Minor Clinical Consequences with Concurrent Use

By Peter A. McCullough, MD, MPH

Paxlovid (nirmatrelvir tablets; ritonavir tablets), is the only oral agent officially endorsed by HHS, NIH, CDC, FDA for the ambulatory treatment of COVID-19. It has been undermined by concerns regarding drug-drug interactions (DDI) as well as “rebound” or an extension of the illness with abbreviated use. My clinical impression is that the drug is reasonably safe but only modestly effective. It appears to be slow-onset and only partially helpful as the an antiviral in the McCullough Protocol. As a clinician who has used all of the drugs in the protocol, my preferred antiviral is ivermectin 0.6 mg/kg per day for 5-30 days.

Bihan and coworkers analyzed the the BNPV pharmacovigilance database (N=12,179) which is administered by the Agence nationale desécurité du médicament et des produits de santé (ANSM), sponsored by the French Health Agency. There were 30 cases of DDI. Most of the interactions occurred in presumably transplant patients on tacrolimus or similar drugs. For the non-immunosuppressant cases the vignettes and outcomes were predictable and manageable.

Bihan et al, Nirmatrelvir/ritonavir (Paxlovid®): French pharmacovigilance survey 2022

In summary, despite theoretical concerns of DDI with paxlovid, the clinical reality for the brief course of treatment is reassuring. Despite its shortcomings, this drug can be used most appropriately in the context of a multidrug protocol in the treatment of acute ambulatory COVID-19. It should not be considered for monotherapy.

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Bihan et al, Nirmatrelvir/ritonavir (Paxlovid®): French pharmacovigilance survey 2022