Nirmatrelvir/ritonavir (Paxlovid) is an Emergency Use Authorized oral antiviral for the treatment of mild-moderate SARS-CoV-2 in patients at high-risk for progression to severe disease.
Nirmatrelvir is a SARS-CoV-2 protease inhibitor. Ritonavir is an HIV-1 protease inhibitor and a strong CYP3A inhibitor. Ritonavir increases systemic exposure of nirmatrelvir to therapeutic levels.
Renal:
Nirmatrelvir is primarily elimninated via the kidneys. Moderate renal impairment (CrCl 30-60 ml/min) resulted in 40-90% higher systemic exposures.
Ritonavir does not require dose adjustment for renal impairment.
Hepatic:
No dose adjustments for hepatic function are required
Adapted from the Northern Light Eastern Maine Medical Center Antimicrobial Stewardship Program