Paxlovid and Drug Interactions

Drugs that are considered 'strong inhibitors' of an enzyme inhibit 80% of the drugs breakdown. This means that the drug can reach five times the blood level it normally reaches, even if you take your regular dose. Please talk to your doctor before taking Paxlovid with any drugs, but especially the drugs listed below:

some immunosuppressants:

• ciclosporin (cyclosporin)
• tacrolimus
• sirolimus
• upadacitinib

many chemotherapeutics:

• docetaxel
• tamoxifen
• paclitaxel
• cyclophosphamide
• doxorubicin
• erlotinib
• etoposide
• ifosfamide
• teniposide
• vinblastine
• vincristine
• vindesine
• imatinib
• irinotecan
• sorafenib
• sunitinib
• vemurafenib
• temsirolimus
• anastrozole,
• gefitinib;

azole antifungals:

• ketoconazole
• itraconazole

macrolides (except azithromycin)

• clarithromycin
• erythromycin
• telithromycin

dapsone (in leprosy),

tricyclic antidepressants:

• amitriptyline
• clomipramine
• imipramine
• cyclobenzaprine

SSRI antidepressants :

• citalopram
• norfluoxetine
• sertraline

some other antidepressants:

• mirtazapine (NaSSA),
• nefazodone (atypical),
• reboxetine (NRI),
• venlafaxine (SNRI),
• trazodone (SARI),
• vilazodone (serotonin modulator),

buspirone (anxiolytic),

antipsychotics:

• haloperidol
• aripiprazole
• risperidone
• ziprasidone
• pimozide
• quetiapine
• lurasidone

opioids (mainly analgesics):

• alfentanil
• buprenorphine (analgesic, addiction maintenance treatment),
• codeine (analgesic, antitussive, antidiarrheal),
• fentanyl
• hydrocodone (partial involvement, not the bioactivation factor),
• methadone (analgesic, addiction maintenance treatment),
• levacetylmethadol
• tramadol (to inactive metabolites, do not confuse with metabolism via CYP2D6);

benzodiazepines:

• alprazolam
• midazolam
• triazolam
• diazepam (bioactivation to desmethyldiazepam)
• clonazepam

some hypnotics:

• zopiclone
• zaleplon
• zolpidem

donepezil (acetylcholinesterase inhibitor),

statins (except pravastatin and rosuvastatin):

• atorvastatin
• lovastatin
• simvastatin
• cerivastatin

calcium channel blockers:

• diltiazem (sensitive substrate),
• felodipine (sensitive substrate),
• nifedipine (sensitive substrate),
• verapamil (sensitive substrate),
• amlodipine (sensitive substrate),
• lercanidipine
• nitrendipine
• nisoldipine

amiodarone (class III antiarrhythmic),

dronedarone (class III antiarrhythmic),

quinidine (class I antiarrhythmic),

PDE5 inhibitors:

• sildenafil
• tadalafil

kinins (vasodilators, smooth muscle contractors),

steroids:

• finasteride (antiandrogen),
• estradiol (estrogen),
• progesterone
• ethinylestradiol (hormonal contraceptive),
• testosterone (androgen),
• toremifene (SERM),
• bicalutamide

glucocorticoids:

• budesonide
• hydrocortisone (cortisol)
• dexamethasone
• fluticasone

some H1-receptor antagonists (H1 antihistamines):

• ketotifen
• terfenadine
• astemizole
• chlorphenamine

protease inhibitors:

• indinavir
• ritonavir
• saquinavir
• nelfinavir

non-nucleoside reverse-transcriptase inhibitors (antiretroviral drugs):

• nevirapine
• delavirdine
• efavirenz
• etravirine
• rilpivirine

albendazole (antihelminthic)

cisapride (5-HT4 receptor agonist)

aprepitant (antiemetic)

caffeine (stimulant)

cocaine (stimulant)

cilostazol (phosphodiesterase inhibitor)

dextromethorphan (antitussive)

domperidone (antidopaminergic)

eplerenone (aldosterone antagonist)

lidocaine (local anesthetic, antiarrhythmic)

ondansetron (5-HT3 antagonist)

propranolol (beta blocker)

salmeterol (beta agonist)

warfarin (anticoagulant)

clopidogrel becoming bioactivated (antiplatelet),

2-oxo-clopidogrel

omeprazole (proton pump inhibitor)

nateglinide (antidiabetic)

methoxetamine

montelukast (leukotriene receptor antagonist),

vilaprisan (selective progesterone receptor modulator),

certain angiotensin II receptor blockers:

• losartan, (sensitive substrates)
• irbesartan