ABSTRACT
Background and ImportanceNirmatrelvir/ritonavir (Paxlovid®) has been recently authorised for treating coronavirus disease 2019 (COVID-19) in adults who do not require supplemental oxygen and who are at increased risk for progressing to severe disease. Due to multiple drugs metabolised by CYP3A may have significant interactions with ritonavir, physicians and pharmacists should work together for the safe and effective use of paxlovid.Aim and ObjectivesTo describe the pharmacist interventions (PIs) in the emergency department (ED) regarding optimisation of paxlovid prescriptions in non-hospitalised COVID-19 patients.Material and MethodsAn observational prospective study was conducted from 1 April 2022 to 31 August 2022 in a 1000-bed university hospital. Clinical variables were obtained using electronic medical records. We registered demographic data (sex, age), vaccination status and comorbidities, hospitalisation and prescription with other therapies (such as remdesivir and baricitinib) after paxlovid treatment, posology, potential drug interactions and contraindications. PIs were classified into the following types: (1) dose adjustment, (2) contraindication, (3) potential interaction, (4) non-compliance with the indication. We also identified primary non-adherence to paxlovid.ResultsWe included 77 patients, 56% female, median age of 67 years (IQR 52-81). Most patients (87%) were fully vaccinated (including booster dose), 12% required subsequent hospitalisation for COVID-19, none of them died and only one patient required remdesivir as other therapies. In relation to comorbidities, 86% of patients had respiratory diseases, 33% hypertension, 30% cancer treated with chemotherapy, 21% autoimmune diseases, 17% renal disease, 16% diabetes mellitus, 9% liver disease. The percentage of patients with PIs was 70%. The total of PIs carried out was 87:(1) 31%, (2) 13%, (3) 33%, (4) 23%. Forty-six potential interactions were detected being the most frequent: statins (33%), antihypertensives (11%), anticoagulants (6%), immunosuppressants (6%), among other drugs, as well as, 14 contraindications, in which statins again stood out. Primary non-adherence was detected in 10% of patients. 100% of PI were accepted.Conclusion and RelevanceHospital pharmacists are key in the optimisation of paxlovid prescriptions in the ED. This includes assessing for potential drug interactions, as well as contraindications, among other PIs. Due to the recent conditional marketing authorisation of paxlovid, it is important to encourage multidisciplinary work to reduce potential dosing errors and adverse reactions, increasing patient safety.References and/or AcknowledgementsConflict of InterestNo conflict of interest