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  • Management of drug-related problems including drug–drug interactions caused by nirmatrelvir/ritonavir in paediatric patients with SARS-CoV-2

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Management of drug-related problems including drug–drug interactions caused by nirmatrelvir/ritonavir in paediatric patients with SARS-CoV-2
  1. Nadir Yalcin1,2,
  2. Kutay Demirkan1
  1. 1 Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
  2. 2 Department of Clinical Pharmacy, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to Dr Nadir Yalcin, Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara 06100, Turkey; nadir.yalcin{at}hotmail.com

https://doi.org/10.1136/archdischild-2022-324168

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    Children are 18.9% of the reported weekly COVID-19 cases in the USA. Consequently, novel treatment modalities—like nilmatrelvir/ritonavir—are also relevant to paediatrics. However, novelties can come with specific issues like adherence or drug–drug interactions (DDIs)1 because participants who received nilmatrelvir/ritonavir within 3 days of COVID-19 symptoms’ onset had a 89% lower risk of COVID-19-related hospital admission compared with placebo.2 Nirmatrelvir/ritonavir was approved with emergency use authorisation, also in paediatric patients (12–18 years) with mild and moderate COVID-19 by the US Food and Drug Administration (FDA, 22 December 2021) and by the European Medicines Agency (EMA, 27 January 2022).

    Nirmatrelvir/ritonavir (300/100 mg) is administered orally two times per day(every 12 hours) for 5 days as soon as possible following COVID-19 (including Omicron variant) diagnosis in paediatric patients weighing over 40 kg. Half of this dose (150/50 mg) is recommended if the estimated glomerular filtration rate is between 30mL/min and 60 mL/min and should not to be used if the eGFR is below 30 mL/min.3 4 Its use is neither recommended in patients with severe hepatic impairment (Child-Pugh class C).3 As of 27 January 2022, adverse effects …

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    Footnotes

    • Contributors Conceptualisation and writing: NY; review and editing and supervision: KD.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.