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 27th June 2023
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 are either in a high risk group or who 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 or stage 4-5 chronic kidney disease
- 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) |
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.
- The nirmatrelvir tablets are identified on the back of the foil by number (PF-07321332).
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