Collaboration and Decision-Support Tools to Mitigate Nirmatrelvir/Ritonavir Drug Interactions.

PURPOSE/

OBJECTIVES

Nirmatrelvir/ritonavir (Paxlovid) is used to treat mild to moderate COVID-19 for patients at high risk for disease progression. However, its use presents challenges due to drug-to-drug interactions that affect its effectiveness and the safety of coadministered medications. In response, a nurse-initiated protocol and interprofessional prescribing guidance were developed at a large nonprofit academic medical center to expedite proactive treatment for at-risk, ambulatory patients with COVID-19. The guidance was based on a standardized risk score.

DESCRIPTION OF THE PROJECT: Decision-support tools were developed collaboratively with the pharmacy team and built into the electronic health record to provide just-in-time directives for prescribers. Patients who would otherwise have been excluded were prescribed nirmatrelvir/ritonavir using evidence-based, drug-to-drug interaction management strategies coupled with patient education and supported by the team infrastructure.

OUTCOME: Between November 1, 2020, and February 1, 2023, 3802 patients at high risk for disease progression who had a documented drug-to-drug interaction with nirmatrelvir/ritonavir were evaluated for treatment. Of these patients, 2351 (61.8%) were treated.

CONCLUSION

Our management strategies efficiently and safely provided treatment to more than 60% of patients at high risk of disease progression who would otherwise have been excluded from receiving this medication option due to drug-to-drug interactions with nirmatrelvir/ritonavir.