Management of medication-related issues, including drug interactions caused by nirmatrelvir/ritonavir in pediatric patients with SARS-CoV-2

Children account for 18.9% of weekly COVID-19 cases reported in the United States. Therefore, new treatment modalities, such as nilmatrelvir/ritonavir, are also relevant for pediatrics. However, novelties can be accompanied by specific problems such as compliance or drug interactions (DDI)1 because participants who received nilmatrelvir/ritonavir within 3 days of onset of COVID-19 symptoms had an 89% reduced risk of COVID-19-related hospitalization compared to placebo.2 Nirmatrelvir/ritonavir has been approved with emergency use authorization, also in pediatric patients (12 to 18 years old) with mild and moderate COVID-19 by the US Food and Drug Administration (FDA, December 22, 2021) and by the European Medicines Agency (EMA, 27 January 2022).

Nirmatrelvir/ritonavir (300/100 mg) is given orally twice daily (every 12 hours) for 5 days as soon as possible after diagnosis of COVID-19 (including Omicron variant) in pediatric patients weighing more than 40 kg. Half of this dose (150/50 mg) is recommended if the estimated glomerular filtration rate is between 30 ml/min and 60 ml/min and should not be used if the eGFR is less than 30 ml/min.3 4 Its use is also not recommended in patients with severe hepatic impairment (Child-Pugh class C).3 As of January 27, 2022, adverse effects…

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