COVID-19 Medications
Loren Bonner
For clinicians who work in acute care settings, some practical guidance pertaining to drug–drug interactions (DDIs) for the treatment of patients with COVID-19 is finally available.
In an article published October 1, 2023, in the American Journal of Health-System Pharmacy (AJHP), researchers addressed DDIs for patients being treated for COVID-19, as some of these medications used for COVID-19 treatment are started prior to hospitalization and may have continuing effects in terms of drug interactions after hospital admission.
“The most striking part of this article pertains to ritonavir-boosted nirmatrevir,” said lead author Asad Patanwala, PharmD, MPH, chair of clinical pharmacy at the University of Sydney School of Pharmacy in Australia. “There are a lot of drug interactions with this agent, and [it] has important clinical implications for patients who may be admitted to the hospital after being prescribed this drug in the community.”
Patanwala said a key issue is that even if the drug is stopped when the patient is admitted to the hospital, the drug interaction effect can be pertinent for several days. “This is something that clinicians may not commonly consider,” he noted.
Handy guide
After reviewing the published literature on the topic and summarizing what is known to date, researchers put together the guide for clinicians to refer to and read as practical advice.
Not only do the authors provide key pharmacological concepts underlying DDIs, including a discussion of the gastric environment, the CYP450 isozyme system, transporters, and pharmacodynamics in relation to DDIs, but they also provide a decision-making framework for clinicians.
They also include important DDIs pertaining to contemporary acute care clinical practice related to COVID-19.
“We think that table will be particularly useful as clinicians can visualize all the pertinent issues that may apply to each drug,” said Patanwala. “It is possible that as new drugs are approved for COVID-19, there will be additional interactions to consider, which we have not discussed.”
Tables as well as the decision-making framework can be found in the article (see sidebar for link).
COVID-19 therapies to consider for DDIs
Below are current COVID-19 therapies recommended by NIH and most likely seen in clinical practice.
Specific mechanisms for DDIs for each COVID-19 drug can be found in the table in the AJHP article at apha.us/COVIDandDDIs
| Monoclonal antibodies |
| Bebtelovimab |
| Tixagevimab/cilgavimab |
| Corticosteroids |
| Dexamethasone |
| IL-6 inhibitors |
| Tocilizumab |
| Sarilumab |
| JAK inhibitors |
| Baricitinib |
| Tofacitinib |
| Antivirals |
| Ritonavir-boosted nirmatrelvir |
| Molnupiravir |
| Remdesivir |
Continuous evaluation
Because the information is applicable to every patient with COVID-19 who presents to the hospital, Patanwala said it could affect many patients as the country experiences waves of COVID-19 each year. “It also applies to the entire spectrum of patients with mild acute illness and to those who are critically ill,” he said.
“We hope that clinicians will use the framework and the summary table we have created to guide their decisions,” Patanwala said. “As more patients are admitted to hospitals with COVID-19, these drug interactions should be evaluated and when appropriate, alternative therapies should be used for concurrent medical problems.” ■