Paxlovid ®, the only orally available COVID drug, consists of two main components: Nirmatrelvir and Ritonavir. Ritonavir is known for the potent inhibition of CYP (cytochrome P450) enzymes in the liver mainly of CYP3A4, resulting in a large number of clinically significant drug-drug interactions (DDIs). This results in an increased number of adverse events, raising concerns for patient safety. Since numerous instances of inappropriate prescribing, particularly with co-medications, were noted at the pharmacy despite prescriber consideration at the point of prescribing, a pharmaceutical service was introduced to perform medication reviews. The aim was to describe the frequency, type, and severity of detected DDIs in Paxlovid® recipients identified during pharmacy screening. A retrospective monocentric quantitative data analysis was performed in an Austrian clinic in Vienna. Ethics approval was obtained. All patients prescribed Paxlovid® were included and data collected from the patients' electronic records. A data collection tool was developed and piloted to ensure inter-rater reliability. Drug drug interactions including prescribing recommendations were determined using the COVID 19 Drug Interactions checker developed by the University of Liverpool. 122 of 140 (87.1%) patients whose records were reviewed required dose reduction, alternative COVID medication and/or interventions to prevent interactions or overdosing. In 33 (23.5%) cases the necessary action was performed by the doctors at the point of prescribing. However, in 89 (63.6%) cases the required action was not identified at the point of prescribing but identified during the pharmaceutical medication review after Paxlovid® was ordered in the pharmacy. Since interventions were made prior to the patient receiving the supply, all patients in this group benefitted from the pharmaceutical service leading to enhancement of patient safety. This study demonstrated that many drug related problems were identified through the pharmaceutical intervention This shows that pharmacist involvement in prescribing highly interacting drugs such as Paxlovid® is beneficial to enhance patient safety and mitigate risks.
Citation
STOIBER, A., GRAY, G., SAILER, G., HUF, W. and TONNA, A. 2024. A description of pharmacists' interventions to optimise the treatment of adults with orally available Covid-drug, Paxlovid. Poster presented at the 28th European Association of Hospital Pharmacists (EAHP) annual congress 2024 (EAHP 2024): sustainable healthcare; opportunities and strategies, 20-22 March 2024, Bordeaux, France.
Presentation Conference Type
Poster
Conference Name
28th European Association of Hospital Pharmacists (EAHP) annual congress 2024 (EAHP 2024): sustainable healthcare; opportunities and strategies
