The Medical Letter on Drugs and Therapeutics
COVID-19 Update: Prescription of Paxlovid by Pharmacists (online only)
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Med Lett Drugs Ther. 2022 Aug 8;64(1656):e124
Principal Faculty
  • Mark Abramowicz, M.D., President: no disclosure or potential conflict of interest to report
  • Jean-Marie Pflomm, Pharm.D., Editor in Chief: no disclosure or potential conflict of interest to report
  • Brinda M. Shah, Pharm.D., Consulting Editor: no disclosure or potential conflict of interest to report
Additional Contributor(s)
  • Michael Viscusi, Pharm.D., Associate Editor: no disclosure or potential conflict of interest to report
Upon completion of this activity, the participant will be able to:
  1. Discuss the requirements for pharmacist prescribing of Paxlovid for treatment of COVID-19.
 Select a term to see related articles     COVID-19   nirmatrelvir   Paxlovid   Ritonavir 

The FDA has amended its Emergency Use Authorization (EUA) for Paxlovid (Pfizer), the investigational oral antiviral drug nirmatrelvir copackaged with oral ritonavir, to allow for it to be prescribed by licensed pharmacists in certain situations.1 Paxlovid is authorized for oral treatment of mild to moderate COVID-19 in high-risk outpatients ≥12 years old who weigh at least 40 kg.2,3 NIH guidelines list it as the treatment of choice for COVID-19 in high-risk adult outpatients.4

The amendment to the EUA allows pharmacists to provide Paxlovid to eligible patients for whom they can review measurements of renal and hepatic function (obtained within the last 12 months) and a list of prescription and nonprescription medications currently being taken.

Paxlovid is not recommended for use in patients with severe renal impairment (eGFR <30 mL/min) or severe hepatic impairment (Child-Pugh C); dosage adjustments are recommended in patients with moderate renal impairment (eGFR ≥30 to <60 mL/min).3 The drug is contraindicated for use with strong CYP3A4 inducers,5 or with drugs that are highly dependent on CYP3A for clearance and are associated with serious or life-threatening events at elevated serum concentrations (e.g., amiodarone, midazolam). According to the revised EUA, if other medications in the patient’s regimen must be modified because of a potential interaction, the patient should be referred to their healthcare provider.

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