Analysis of Interaction Between Nirmatrelvir/ritonavir or Ritonavir and Tacrolimus
10.3870/j.issn.1004-0781.2025.06.017
- VernacularTitle:奈玛特韦/利托那韦或利托那韦与他克莫司相互作用分析
- Author:
Yinhua GONG
1
;
Cheng XIE
1
;
Jie GAO
1
Author Information
1. 苏州大学附属第一医院药学部,苏州 215000
- Publication Type:Journal Article
- Keywords:
Nirmatrelvir;
Ritonavir;
Tacrolimus;
Interaction of drug
- From:
Herald of Medicine
2025;44(6):942-948
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the characteristics of the interaction between nirmatrelvir/ritonavir or ritonavir and tacrolimus,and to provide a reference for the safe clinical use of these medication.Methods Case reports related to the combination of nirmatrelvir/ritonavir,ritonavir,and tacrolimus were retrieved from PubMed,Embase,CNKI,Wanfang,and VIP databases up to June 2023.Statistical analysis was conducted on baseline blood concentration,baseline creatinine,tacrolimus dosage,nirmatrelvir/ritonavir usage,and tacrolimus blood concentration under the combination of medication.Results A total of 10 patients,who used nirmatrelvir/ritonavir and tacrolimus were identified from 9 articles,including 5 males and 5 females,the minimum age of 14 years old and the maximum age of 76 years old,average age(47.5±20.1)years.Among these patients,6 cases had kidney transplantation,3 cases had heart transplantation,and 1 case had lung transplantation.Six literature articles on the combination of ritonavir and tacrolimus were included,with a total of 6 cases,including 4 males and 2 females,aged 52 to 58 years,with an average age of(54.5±2.5)years.There were 3 cases of kidney transplantation with HIV,1 case of kidney transplantation with HCV,1 case of liver transplantation with HIV,1 case of orthotopic heart transplantation with HIV.Nirmatrelvir/ritonavir significantly increased tacrolimus concentration,and the extent of increase vary depending on the medication situation.The highest increase was 35.8 fold,while the remaining increases ranged from 2.7 to 14.0 fold,the average was 10.7 fold.All 10 patients experienced varying degrees of creatinine elevation,including two cases of toxic metabolic encephalopathy and one case of liver damage due to rifampicin rescue.Four patients were rescued by phenytoin sodium,and two were rescued by rifampicin.All patients recovered well after clinical treatment.The combination of ritonavir and tacrolimus can also lead to varying degrees of increase in tacrolimus concentration.Conclusions Ritonavir significantly increases the blood concentration of tacrolimus.After discontinuation of nirmatrelvir/ritonavir,tacrolimus concentration should be monitored to guide the dose adjustments for safe reactivation.
