COVID-19 and antiepileptic drugs: an approach to guide practices when nirmatrelvir/ritonavir is co-prescribed

• Published in: European journal of clinical pharmacology Vol. 78; no. 10; pp. 1697 - 1701
• Main Authors: Yalcin, Nadir, Allegaert, Karel
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2022; Springer Nature B.V
• Subjects: Antiepileptic agents; Antiretroviral drugs; Antiviral drugs; Biomedical and Life Sciences; Biomedicine; Carbamazepine; Contraindications; Coronaviruses; COVID-19; Drug dosages; Drug interaction; Drug interactions; Epilepsy; Oxcarbazepine; Patients; Pentobarbital; Perspective; Pharmacokinetics; Pharmacology/Toxicology; Pharmacy; Phenobarbital; Phenytoin; Ritonavir; Severe acute respiratory syndrome coronavirus 2; Valproic acid; Dosing; SARS-CoV-2; Anticonvulsants; Ritonavir; Seizure; Drug interaction; Nirmatrelvir
• ISSN: 0031-6970; 1432-1041; 1432-1041
• DOI: 10.1007/s00228-022-03370-7

Management and dose adjustment are a major concern for clinicians in the absence of specific clinical outcome data for patients on antiepileptic drugs (AEDs), in the event of short-term (5 days) nirmatrelvir/ritonavir co-exposure. Therefore, in this report, we identified drugs that require dose adjustment because of drug-drug interactions (DDIs) between nirmatrelvir/ritonavir and AEDs. We hereby used four databases ( Micromedex Drug Interaction, Liverpool Drug Interaction Group for COVID-19 Therapies, Medscape Drug Interaction Checker, and Lexicomp Drug Interactions) and DDI-Predictor . In the light of applying the DDI-Predictor , for carbamazepine, clobazam, oxcarbazepine, eslicarbazepine, phenytoin, phenobarbital, pentobarbital, rufinamide, and valproate as CYP3A4 inducers, we recommend that a dose adjustment of short-term nirmatrelvir/ritonavir as a substrate (victim) drug would be more appropriate instead of these AEDs to avoid impending DDI-related threats in patients with epilepsy.