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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. 1Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
  2. 2Department 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}

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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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  • 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.