In this section : Covid-19
Molnupiravir
Sotrovimab
Conscious Proning
Covid-19 Basics
Remdesivir
Thromboprophylaxis
Identifying Patients in the Highest Risk Groups
Steroids for Patients with Covid-19 Infection
IL-6 Inhibitors – Tocilizumab or Sarilumab
Baricitinib
Paxlovid (Nirmatrelvir/Ritonavir)
Covid-19 Sick Day Rules for Patients with Primary Adrenal Insufficiency
Paxlovid (Nirmatrelvir/Ritonavir)
Last updated 18th July 2024
Please ensure you have read the information on the Covid-19 Basics page before proceeding.
Introduction
- Currently the first-line treatment for use in hospitalised patients with COVID-19 not requiring oxygen, who meet one of the following criteria:
- In a high risk group
- Have diabetes
- Have heart failure
- Are aged over 70 years
- Have BMI >35 kg/m2
- Have been identified as at risk of destabilisation of their current condition due to their COVID-19 infection
- Discuss during the working day with relevant consultant and ward pharmacist if the following criteria are met:
- Within 5 days of symptom onset
- No history of advanced decompensated liver cirrhosis
- The patient is NOT pregnant
Drug Interactions
- Paxlovid has multiple drug interactions which may result in other medication being amended or monitored for the duration of the course. Please do NOT prescribe until a pharmacist has confirmed that there are no relevant drug interactions.
Dose
- Both medications are taken together, twice daily for 5 days.
- Prescribe on the “protocol” tab on HEPMA – there is one option for normal renal function, and one for reduced renal function.
Nirmatrelvir Ritonavir Normal Renal Function (eGFR >60mL/min) 300mg 100mg Moderate renal impairment (eGFR 30-60 mL/min) 150mg 100mg Severe renal impairment (eGFR <30mL/min) Not licensed but may still be able to use - please discuss with Pharmacist. Dosing guidelines in renal impairment are now available - There have been several administration errors with this medication due to its packaging.
- Please attach a note to appear when charting:
- “Nirmatrelvir and ritonavir are prescribed separately on HEPMA but are both packaged together in the SAME BOX. The name and strength of each tablet is printed on the reverse of the foil packaging.
- Please administer … x 150mg nirmatrelvir and 1 x 100mg ritonavir together. Take them from the same side of the foil – preferably gold for morning and blue for evening. This will make it easier for the patient to manage when they are discharged.”
Administration
- The medication arrives at the ward in a single box containing ritonavir tablets and nirmatrelvir tablets.
- Each tablet strip contains a morning and an evening section for easy administration by the patient – please stick to this when administering in hospital so that the patient can self-administer once home.
- Ask a member of pharmacy staff for clarification if necessary before administering.
Links
- NICE COVID-19 rapid guideline: Managing COVID-19
- SEHD Covid Therapeutic Alert 2023 1 – Publication of NICE Multiple Technology Appraisal (MTA) – Treatment Recommendations for Covid 19
- Casirivimab plus imdevimab, nirmatrelvir plus ritonavir, sotrovimab and tocilizumab for treating COVID-19
Content by Alison Moore